News 3/9/16

Top News

A study finds that physician practices spend 785 hours per doctor on the “unnecessarily costly” reporting of quality measures, totaling $15.4 billion annually. 

Reader Comments

From Spiffy Shades: “Re: McKesson’s ambulatory EHR/PM products. They are selling all of them to E-MDs.” McKesson will apparently exit the physician practice business by selling Medisoft, Lytec, Practice Partner, and Practice Choice to E-MDs. Marlin Equity Partners bought E-MDs in March 2015 and AdvancedMD in August 2015 to add to its MDeverywhere holding. It seems to have some synergistic plan for the hodgepodge of EHR/PM products of McKesson, which I speculate is slowly but surely divesting its way out of healthcare IT except maybe for RelayHealth.

From Robert Lafsky, MD: “Re: article on EHR free-text notes. One colleague wryly laments that a lot of doctors just use the EMR as a word processor and this is a good example. The inability to deal with structured fields seems endemic. Are we just doomed to wander the desert for 40 years until a new generation has replaced us?” A study of 26,000 electronic prescriptions that were sent to community pharmacies by community-based prescribers finds that in two-thirds of them, the prescriber placed information in the free-text field that should have instead been entered as discrete data. Nearly one in five of the prescriptions had free-text instructions that didn’t match what the prescriber actually entered. Another 10 percent of prescriptions were actually cancellation requests, sent either because the EHR vendor doesn’t support the standard cancellation message or the prescriber didn’t know how to use that function. More than half of the inappropriate free-text messages involved  insurance benefits or dispensing quantities. The authors conclude that EHR and e-prescribing vendors need to improve product design and usability testing, apparently holding prescribers harmless for using their software incorrectly.

From Dingo: “Re: HIMSS conference app. You should create one so that readers can connect with each other, see a sponsor event schedule, and find social events.” HIMSS had its own app, but I didn’t try it. I assume it focused on the educational session schedule. If you used that app, what did you like and dislike about it? If not, what kind of app would you use?

From Bill Earry: “Re: consulting companies. I’m a physician informaticist interested in exploring whether consulting is right for me. What are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems?” I’ve never been a consultant, so I’ll ask those who are to weigh in, especially physician consultants.

From I.C. O’Jay: “Re: innovation. It’s pointless talking to a health system CIO about innovative products. They have no interest or insight.” IT executive management is very much like public health. You’re trying to do the most good with the biggest impact given a limited budget and headcount. Do I vaccinate 1,000 children or launch a nutrition education program? Do I keep a marginal but inexpensive department system and use the money to fund a revenue cycle technology project? How should I prioritize the need to apply endless system upgrades and infrastructure projects to keep the lights on against some startup’s cool but unproven app? The hardest part about running an IT organization is enlightening departments, end users, and vendors about the constant constraints under which the organization operates – enterprise IT isn’t like buying an Office Depot computer or installing an iPhone app and it never will be. Part of the job involves watching well-meaning but naive users storm off in a huff because their shallowly-researched bright idea is not feasible given the organization’s budget, tolerance for risk, competing projects, and strategic focus. You say “no” a lot, and rightfully so. In fact, I might speculate that CIO success is predicated more on what projects they don’t undertake rather than the ones they do.

From NextGen Customer: “Re: the former hospital systems business sold to QuadraMed. During a recent conference call, a comment was made that QuadraMed bought NextGen for the customers and will not be making any enhancements. One individual said we will have to move to the other product. I contacted another NextGen customer and they said they had already been approached.” Unverified.

From Court Watcher: “Re: Epic v. Tata. There’s a new order on a motion for summary judgment. The court said there’s compelling evidence of unauthorized access by Tata’s employees over an extended period of time. The court found Tata guilty of violating the computer fraud laws and the Wisconsin computer crimes act. They also apparently violated their contracts.” I’ve written about this case a few times. Epic says Tata’s India-based employees claimed to be working for Kaiser Permanente in trying to slip into Verona-based classes and to download everything in the consultant portion of Epic’s UserWeb system for enhancement ideas for its Med Mantra hospital information system. Most of the legalese is over my head, but the Tata people seem to be real scumbags. People claim Epic is paranoid about protecting its intellectual property, but more than one example exists of people in a foreign company trying to steal Epic’s information to create a competing product.

From HIT Banker: “Re: HIMSS conference. For the last two years, one of our female junior staffers has been solicited by various male executives to join the guy in his hotel room. I wonder how much debauchery is going down behind the scenes at HIMSS? I would like to see a poll on this, although I doubt you would get honest responses. I might simply ask, ‘Did you do anything at HIMSS that you would not tell your significant other?’” What HIMSS attendees do as consenting adults is their own business, but I will modify your curiosity into this poll: did you experience unwanted sexual overtures or comments during the conference that made you uncomfortable?

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor PatientMatters. The Orlando-based company helps health systems transform the hospital patient’s financial experience with tools, training, and expertise to increase cash and lower debt as self-pay balances increase. The company focuses on seven specific areas of cash leakage: pre-registration and scheduling, ED, POS collection, patient advocacy, early-out, payment plans, and bad debt in transforming patients into educated consumers who can engage effectively. Specific tools include address verification, identity verification, eligibility, patient payment estimation, pay select, patient loans, statements, and a patient portal. One customer increased ED POS collections by 71 percent in three months, increased patient cash payments by 20 percent in six months, and decreased bad debt by 54 percent. Thanks to PatientMatters for supporting HIStalk.

I found this PatientMatters intro video on YouTube.

We fulfilled the DonorsChoose grant request of Ms. Jones from Georgia in providing her first grade class with an iPad, case, and headphones. She reports, “My students are excited about learning when they are handed an iPad, as if it was a treat or reward. Their little eyes light up and they become engaged in their learning and complete more tasks with a higher rate of success … when they are allowed to use the iPad, their confidence and self-esteem increases and more work is completed in a timely manner. This is mainly due to the immediate feedback after completing each assignment. This gives them a great sense of accomplishment.”

Also checking in was Ms. K from Tennessee, whose second graders are “having fun while learning” in using the seven math games we provided.

Listening: The Struts, Brit rockers that sound to me like a stew of Queen, Slade, and Quiet Riot. Then it’s off to some harder stuff from the amazing Avenged Sevenfold, to which I’ll be desk-drumming for the next several hours (especially since that particular song was dedicated to drummer The Rev, who died of a drug overdose in 2009 at 28).

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

The CEO of genetic testing company Ambry Genetics makes the de-identified data of 10,000 breast and ovarian patients available to researchers, bucking the trend of biotech companies that believe they compete on data rather than testing. CEO Charlie Dunlop is blunt about his motivations: “I have stage 4 cancer myself. I don’t care what goes down. This is what we’re doing at Ambry Genetics. We’re here to try to save the world, period." The AmbryShare website defines itself as, “It’s a chance to help stop data hoarding and unlock the promise of the human genome project.”

Cerner announces a $300 million share buy-back program. Above is the one-year share price of CERN (blue, down 23 percent) vs. the Nasdaq (red, down 4 percent). Shares have dropped to July 2014 prices.

MedCity News confirms the rumors I ran here this weekend indicating that Aetna has laid off dozens of people working on its iTriage app. Aetna confirms the layoffs without providing numbers, adding that it plans to combine iTriage with its WellMatch price transparency app.

Scotland-based Craneware’s first-half profits rose 17 percent after strong sales and recurring revenue growth.

Sales

UC Irvine Health (CA) chooses Phynd to unify, manage, and share the data of its 25,000 providers across multiple IT systems.

People

Culbert Healthcare Solutions promotes Brad Boyd to president. Founder Rob Culbert relinquishes that role but remains CEO.

Nordic promotes Nicole Meidinger to VP of business development.

Announcements and Implementations

University of Texas M.D. Anderson Cancer Center (TX) goes live on Epic.

KPMG’s auditing practice will use IBM Watson to analyze customer resource allocation.

Experian Health adds its Patient Estimates solution to Athenahealth’s marketplace.

Government and Politics

ONC releases the Million Hearts EHR Optimization Guides, showing providers who use Allscripts, Cerner, or NextGen how to use their EHRs to manage aspirin therapy, blood pressure, cholesterol, and smoking cessation. ONC calls for other EHR vendors to develop guides for their products.

A Texas anesthesiologist and hospital owner is convicted of billing $10 million for supervising CRNAs when he wasn’t actually present. The government provided evidence that at the times he was supposedly working in the OR, he was actually (a) undergoing surgery himself; (b) flying on his private jet; and (c) traveling out of state. He also signed medical records attesting to the services he provided before the surgeries even started.

Wired profiles big data entrepreneur John Mininno, who has built a business around analyzing CMS-released claims data to find likely Medicare fraud, then finding an employee of the organization willing to file a whistleblower lawsuit in return for sharing any settlement. His programmers look for unusual patterns, such as providers who file a normal claim volume on a snowy day when they probably weren’t running at full capacity.

Privacy and Security

Philips launches the Netherlands-based Philips Blockchain Lab, which will explore the use of the cryptographic technology in healthcare.

An interesting article explains the motivation of shady people who post idiotic Facebook puzzles, pet photos, and emotional stories that beg users to “like them” or share them in some way. “Like-farming” attempts to rack up a ton of exposure, after which the original post is changed to either spam or malware links that pollute your own Facebook news feed as well as those of your friends in some cases. New South Wales police warned people last week of the phony contest above (posted under a fake Qantas Air account) in which Facebookers were urged to click “like” for a chance to win free travel.

A study of Android diabetes app privacy policies finds that 81 percent have no privacy policy at all and only 4 percent of them say they will ask users before sharing their data. Most apps shared insulin and blood glucose levels, and of those that offer a privacy policy, 40 percent don’t disclose that they share data.

A stolen, unencrypted laptop belonging to physician practice Premier Healthcare (IN) exposes the information of 200,000 people.

Other

Marketing firm Cramer brags about being hired by Athenahealth to create the HIMSS16 data sharing presentation of Jonathan Bush and John Halamka, developing the “relatable, human storyline,” creating a PowerPoint to “wow the audience,” and coaching the presenters through a “table read” and “two simulated on-stage rehearsals.”

A six-hospital study finds that monitoring discharged heart failure patients with telemonitoring, telephone calls, and health coaching had no effect on 180-day readmissions.

An ED doctor in England faces a disciplinary hearing after tweeting out tirades that include a proposed fine against “ambulatory neurotics with a few aches and pains” who call an “ambulance for a broken nail, an earache, period pain, not being able to sleep …” and who are “crippling the NHS.” He also tweeted, ““I’m sure ADHD is merely a polite term for a child who is just a little sh**”

Sponsor Updates

• Besler Consulting releases a new podcast, “The Relationship Between Physician Coding and Compliance.”
• Burwood Group becomes a Citrix Platinum Solution Advisor.
• Chilmark Research names Caradigm a top vendor among care management vendors.
• Premier is named to the “World’s Most Ethical Company” list for the ninth straight year.
• Spok will convert its Connect 16 annual healthcare communications conference to a series of one-day events held in six cities starting March 24.
• CitiusTech posts a new video profiling its partnership with IBM.
• CompuGroup Medical will exhibit at the National Association of Community Health Centers P&I Forum March 16-19 in Washington, DC.
• CoverMyMeds crosses the 500,000 provider account threshold, and is now integrated with over 500 EHRs.
• CTG recaps its time at HIMSS16. 
• HIMSS16 attendees help Divurgent raise $5,000 for Children’s Hospital of Nevada at UMC.
• EClinicalWorks will exhibit at AMGA 2016 Annual Conference March 10-12 in Orlando.
• The local paper looks at the ways in which API Healthcare is benefiting from its sale to GE Healthcare.
• Glytec CMO Andrew Rhinehart, MD reviews the American Diabetes Association 2016 standards of care in the latest Annals of Medicine.
• HCS will exhibit at the National Council for Behavioral Health Conference through March 9 in Las Vegas.
• SK&A publishes a report on EHR software usage in physician practices.

  Blog Posts

Blog Posts

• 3 Post ICD-10 Transition Solutions for Your Practice (AdvancedMD)
• Organizational Health Part 2 (Optimum Healthcare IT)
• How to Innovate Without Losing Control (AirStrip)
• What a HIMSS-sane week! (NextGen Healthcare)
• What does population health mean to you? The view from HIMSS16 (Forward Health Group)
• How do We Secure Mobility at the Speed of Innovation? (AirWatch)
• Optimization Governance (Impact Advisors)
• 8 Tips to Help You Transition From ICD-9 to ICD-10 (Aprima)
• Metabahn & HealthLoop chose Catalyze, but why? (Catalyze)
• Improving Your Financial Health Through Patient Engagement (Culbert Healthcare Solutions)
• Five Keys to Success Under the Oncology Care Model (ECG Management Consultants) 
• Marketing to Your Existing Clients to Drive Revenue (E-MDs) 
• Cisco and Extension Team Up to Tackle Modern Clinical Workflow Challenges (Extension Healthcare)
• Forms Beyond Your HER: Making it Possible for ALL Clinical Forms to be Paperless (FormFast)
• GenY4HIT – Reshaping Healthcare (Galen Healthcare Solutions)
• Insurance Carrier Setup Neglect: A Costly Oversight (Part 2 of 2) (Hayes Management Consulting)
• Epic Service Desk: Why Should an Organization Invest? (The HCI Group)
• How to Use a Volunteer Work Day (Healthgrades)
• Innovation at HIMSS is all About Interoperability (Healthwise)

Contacts

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

Morning Headlines 3/8/16

Walgreens looks to cut ties with Theranos

Financial Times reports that Walgreens is moving forward with plans to end its relationship with Theranos in an effort to close the wellness centers Theranos runs in 40 of its Arizona pharmacy locations.

‘The data is being collected—now it needs to move’

In a short interview, National Coordinator Karen DeSalvo, MD discusses MARCA and the unclear future of Meaningful Use Stage 3.

MD Anderson rolls out new electronic health records system

MD Anderson goes live with its Epic install. Epic was selected as vendor of choice in November 2013.

Walking Billboards for Patient-Centered Care

Patient advocate and artist Regina Holliday’s work is profiled by the Wall Street Journal.

Curbside Consult with Dr. Jayne 3/7/16

I’m still recovering from HIMSS, which really gave me a beat-down this year. What started as the usual sore throat and froggy voice from yelling over loud music and being exposed to smoke seems to be turning into something more. On top of that, my self-diagnosed broken toe is actually a pair of fractures.

Fortunately, I scheduled a fairly low-key week, so I am working from the sofa with my foot propped. I’m wading through quite a few press releases that were lost in the HIMSS shuffle. I know vendors like to save them up for the week, but then there is so much noise that they’re easily missed.

I’m also following up on some consulting leads. Although a couple of them are from actual healthcare delivery organizations, most of them are from vendors who like the idea of having a physician informaticist on call, but not necessarily having to keep them on the payroll.

I’ve enjoyed the flexibility of consulting as well as the variety. There are a lot of organizations that have problems they’re trying to solve or could benefit from some outside opinions. It’s actually a lot like being a family physician. Sometimes the problems are straightforward with obvious solutions like cold and flu symptoms. Other times the issues require a lot of analysis and diagnostic maneuvers as well as the possible intervention of other specialists. The “detective work” aspect of medicine is what attracted me to the field in the first place, so I’m glad to be able to put those skills to work in other arenas.

Having worked in the large health system space, I’ve also developed some pretty solid firefighting skills that I’m putting to use assisting a client with their 2015 Meaningful Use attestation. The deadline is Friday, and although they thought they were prepared, it turns out that their internal MU resource hadn’t really been doing much in regards to documentation. Unfortunately, this was only discovered after she left the practice. I’m helping one of their senior clinical leads understand what documentation they have, what they’re missing, and how to go about creating an attestation binder for each eligible provider. It’s not glamorous, but they’re very appreciative, so I’m enjoying the work.

ONC announced three challenges in conjunction with HIMSS. The first is for $175,000 and seeks consumer apps that use open APIs to help patients aggregate their information under their control. I saw the Humetrix iBlue Button app at last year’s HIMSS and gave it a test drive. It was straightforward and easy to use. I know there are other vendors as well, so I will be interested to see what this challenge yields.

The second challenge is for the same amount, but this time for improved user experience for providers. Eligible apps will use open APIs the improve clinical workflow.

I had worked with a vendor last year who had designed a slick-looking bolt-on documentation solution for providers. They were looking for vendor partners. I had to advise them that they’d be hard pressed to get vendors to play along with them since essentially the purpose of their product was to correct clunky and ugly workflows.

They were reluctant to admit that calling someone’s baby ugly isn’t the best way to build relationships. Instead, I advised them towards a more grassroots effort with either provider organizations or specialty societies. They’re still working on their approach. I hope to hear from them again soon, but maybe this challenge will spur even more innovation.

The third challenge is for $275,000 and supports the development of an “app discovery site” to help developers distribute their apps for providers to evaluate. The overall goal of the challenges is to leverage FHIR to build interest in open APIs while advocating user-focused innovation. I agree with them that improving in these areas is important, but don’t think we have enough money on the table yet to really move the needle.

My former health system employer decided to consolidate its clinical platforms primarily because it was tired of supporting 1,000+ applications. It feels a bit like we’re headed back in that direction — having to add on multiple third-party solutions to get the work given the increasing complexity of healthcare delivery. Not to mention that just having interoperable solutions isn’t going to motivate people to send data in a codified way that would make it truly useful.

We’re seeing issues with regulations that require customers to use LOINC for reporting laboratory measures, yet there is no requirement that lab vendors actually send LOINC codes with the results. This has put provider organizations in a bind. Although I’m grateful for the work that problem has provided my consultancy, we’d be better off if the codes were required as so many other things are.

Interoperability also isn’t going to change the culture of companies wanting to maintain competitive advantage. There’s too much at stake from a market share and financial perspective for most organizations to truly cooperate, whether they are on the vendor or provider side.

Like most patients, I’m still having to log into three or four different patient portals to track down my information. There is no incentive for the systems to share, and in some cases, the focus on accountable care organizations is making patient care less accessible as groups vie to maintain control over patients in an effort to control costs.

The Department of Health & Human Services recently released its annual Report to Congress, providing an update on the adoption of health information technology and the exchange of health information. Although it documents the progress that has been made, it also describes some key barriers, including:

• Lagging adoption by providers who were not eligible for incentives.
• Insufficient specificity of standards.
• Varying interpretation and implementation of government policies and legal requirements.
• Safety and usability issues.
• So-called “information blocking”

So far, the only real instances of information blocking I’ve seen are in the provider community, and range from lack of education in some smaller practices to activities that cry out for antitrust scrutiny. I haven’t seen much of a response to the Report, which was issued right before HIMSS. I’d be interested to hear what readers think about it.

Have you read the HHS Report to Congress? Email me.

Email Dr. Jayne.

Readers Write: Trend Watch: Innovation Forges On in the Provider Sector

Trend Watch: Innovation Forges On in the Provider Sector
By John Kelly

Provider organizations face tremendous innovation challenges. The success or failure of new systems and technology will depend on their ability to adapt and anticipate the impact of major industry changes. Looking ahead to a successful 2016, hospitals and provider organizations should still expect barriers to using EMR data, should be wary of the hype surrounding cognitive systems, and should prepare for a value-based care partnerships world where providers and payers share information in ways not imaginable until recently.

EMR data will not be fully liberated in 2016

Barriers that exist to move data in and out of EMRs will not abate in 2016, despite pressure. The business model of EMR vendors and real technological barriers will continue to thwart the goals of interoperability sought under the concept of Meaningful Use.

The good news is that providers and payers are establishing pockets of innovation using edge technologies to support better care and risk sharing based upon shared data, and the public outcry over data blocking from EHRs will eventually force vendors to adopt standard APIs. We can expect the personal health data train to gain momentum with hundreds of new market entrants, but not in 2016.

Don’t trust the hype around cognitive systems

Technology-based cognitive systems in healthcare are not in our immediate future. There is lack of clarity around the FTC’s rules regarding software that makes a medical decision — when do they have to be certified as a medical device? Without medical device certification, can the output of cognitive systems be loaded into an EMR? What about malpractice liability?

Analytics vendors and their customers have been tentative in applying the technology to direct patient care, and counter to what other prognosticators believe, this liability and the fear of the unknown will slow down the cognitive market in the US.

ACOs will invest in payer technology

Successful ACOs will require the technology to support all-payer data ingestion. They will need to see the patients as a single population, but within the context of separate payer contracts. These organizations are beginning to invest in the technology that payers have used for years to successfully acquire and integrate claims data with their population health registries.

If providers are to succeed assuming risk, it will be by employing a highly-focused health management approach that addresses the specific risks associated with specific populations of patients. Population and risk analytics infrastructure requires capital investment beyond the reach of many small and mid-size provider organizations. To encourage providers to assume greater risk for performance, payers will offer shared information exchange platforms that augment provider capabilities with analytic services.

Accountable care continues to evolve

Healthcare market transformation will gain momentum in 2016 and provider organizations should also consider the following:

• Most first-generation ACOs will fail because they don’t know what it means to truly manage risk. They do not have the ability or will to modify how they treat patients. CMS, commercial payers, and the provider community have to figure out how to hold providers harmless on what they can’t control while also rewarding them for doing the things they can do well, then help them bet on their ability to delivery consistently on their promises.
• 2016 will see an assault on post-acute care providers, who until this point have long been profitable even as many provide little relative value. This will affect nursing homes, outpatient rehabs, and even vendors who sell to post-acute care providers. The release of Medicare data for public research, particularly in the area of Medicare fraud, combined with the high-profile budget line for post-acute care will accelerate the move to overhaul the post-acute care industry.
• Finally, don’t expect a change in administration to affect CMS innovation. Regardless of the 2016 Presidential election outcome, payment reform will continue, primarily both macro-economic reasons, but importantly as well, the political reality that both parties favor fundamental reform.

John Kelly is principal business advisor at Edifecs of Bellevue, WA.

Readers Write: The Many Flavors of Interoperability

The Many Flavors of Interoperability
By Niko Skievaski

As the shift towards value-based care persists, the demand for data is as hot as ever. That means the term “interoperability” will be thrown around a lot this year. Let’s describe the various flavors in which it will inevitably be discussed. I’ve seen many conversations become confused as the context for the buzzword is mixed. Here’s an attempt at outlining the various i14y use cases. (Can we start abbreviating it like we do i18n?)

Interoperability for Care Continuity

This is the iconic use case that first comes to mind. Chronically ill patients with binders full of paper records and Ziplocs bulging with pill bottles. As patients bounce around town seeing specialists, they often need to repeat demographic data, med lists, allergies, problems, diagnoses, prior treatment, etc. The solution to this use case calls for ad hoc access to a patient’s data at the point of care. A provider’s chart doesn’t necessarily need to be synced to all other providers in the disjointed care team. Rather, the data needs to be available upon request from the relevant provider.

New payment models have fueled demand for this solution. In a fee-for-service world, redundant tests actually brought more income to the health system,  whereas in value-based models, excessive costs are eaten by the organization. This aligns the provider and patient by incentivizing only the tests and treatments that have the highest likelihood of impacting the patient’s health. Understanding the value of any given treatment also requires looking across a wide set of patients. This brings us to the second use case.

Interoperability to Measure Value

In order to understand how to pay for healthcare based on value, we must make an attempt to measure the impacts to health: a patient’s health is a function of the healthcare they receive as well as a slew of other variables. Estimating this relationship requires a magnitude more data than we’ve traditionally measured. Beyond knowing the diagnosis and treatment, we’d need to control for behavior, family history, comorbidities, prior treatments, etc. Basically everything we can know about a patient’s health. And that’s for a single patient. To build a model, we’d need this information from a large sample of patients to determine the impact of each of these variables. But as treatments are provided to patients and we receive more results, we’ll need to be updating our models to refine their accuracy over time.

Much of this data is stored in an electronic health record over the time period a patient was cared for by that health system. But it’s likely missing data from care outside of that health system. And beyond that patient, how could we combine this record with a sizable population to make a predictive (or even representative) model? Even at very large health systems, limiting their records down to the few who have a rare diagnosis for a given sex and age, the sample set can become insignificantly small.

This i14y use case requires large sets of longitudinal data, rather than single patient records in an ad hoc query. Current attempts at producing such data sets have been extremely resource intensive and normally centered around research efforts focused on a single diagnosis in a de-identified manner. We’ve also seen rampant consolidation in the industry, partially driven by the notion that taking care of larger and larger populations of patients will enable more accurate estimations of value.

Interoperability to Streamline Workflows

This i14y use case has been around since before the term garnered widespread adoption in healthcare. HL7 was created back in 1987 to develop a standard by which health data could be exchanged between the various systems deployed at a health system: electronic health records, lab information systems, radiology information systems, various devices, and pretty much everything else deployed in data center. These systems are most often tied to a centralized interface engine that acts as a translation and filtering tool bouncing transactional messages between each.

So problem solved, right? Not quite. Over the past few decades, health systems have customized their HL7 deployments just as isolated communities evolve a language into a dialect. This proves problematic as each new software application adopted by the health system requires extensive interface configuration and the precious FTE that entails. Interface teams are increasingly the most backlogged tranche of the IT department. As health systems search for more efficient ways to deliver care, they’re more often turning to cloud-based software applications because of the dramatically reduced infrastructure costs and mobility.

This use case likely requires upgraded infrastructure that allows a health system to efficiently connect with and communicate with cloud applications. The customized HL7 dialects will need to be replaced or translated into something consistent and usable for cloud applications. HL7, the organization, is currently developing FHIR as a much needed facelift to a graying standard. In the coming years we look forward to seeing more FHIR adoption in the industry, and hope to avoid the level of customization we have seen with HL7v2 — although initial feedback and documentation from EHR vendors is not promising.

Interoperability to Engage Patients

This is likely the most interesting need for i14y because of its potential. Patients don’t currently walk into doctor’s office and demand that their health data be electronically sent to applications of their choosing. But then again, where are these applications? The inability for patients to authorize API access to their health data has undoubtedly stifled the development of innovative applications. Instead, new application creation has focused on the B2B space in search of enterprise revenue.

If a patient could download an app on their phone and authorize it to pull their medical history, an army of coders would mobilize in creating apps to engage patients as consumers. Application adoption would be holistically democratized and new apps would get to market instantaneously, as opposed to the usual 18-month B2B sales cycles. Applications would be developed to help patients decipher the complexities of care, track care plans and medication adherence, and benchmark against others with similar comorbidities. They could effortlessly download and store their records and be the source of truth. They could contribute their records to research banks that would be willing to pay for their use. Widespread adoption of patient authorized access to health data would almost make the other i14y use cases moot.

Luckily, we’re getting closer. There’s mention of its mandate in MU3. One of the challenges is solving for the chicken-or-egg problem. We need enough widespread adoption of a single authentication framework and data standard to simultaneously sway the development community and health systems to adopt. MU3 seeks to force the right hand side of that equation, however failing to mandate a prescriptive framework or standard in its current draft while wavering in its timeline. As written, it’s possible that health systems can comply with differing technology making the problem only slightly better.

I’m optimistic as accelerating demand has spurred i14y innovation across the sector. HL7 is rapidly organizing support around FHIR and SMART. Incumbent integration engines are stepping up their game and outside integrators are rapidly moving into healthcare. Startups are sprouting to tackle pieces. Some health systems are proactively standing up their own i14y strategies. EHR vendors are vowing to adopt standards and roll out tools to encourage application development. I don’t doubt that we’re beginning to see the fruits of the solutions that will be adopted in the years to come. But it’s on us — as providers, technologists, developers, and patients — to continue the rally cry by demanding i14y now.

Niko Skievaski is  co-founder of Redox.

Morning Headlines 3/7/16

VA may abandon VistA as its long-term electronic health record solution

The VA publically questions its commitment to modernizing Vista, its homegrown EHR platform, after requesting $40 million less for Vista modernization projects in 2017 than last year.

Main Line Health employees snared in security breach

10,000 employees at Main Line Health System have had their personal information compromised after an employee responds to a phishing email. The health system reports that no patient information was compromised.

Madison Memorial to move forward with $16 million purchase of records software

Madison Memorial Hospital (ID) contracts with Cerner to replace its existing Meditech EHR. The initial price of the contract was $6 million, and the ten year total cost of ownership is budgeted to reach $16 million.

2016 Student Technology Prize for Primary Healthcare

Mass General launches its “Ambulatory Practice of the Future” development challenge, calling on college students to design innovative solutions for primary care. The contest will award a $150,000 first place prize.

Monday Morning Update 3/7/16

Top News

The VA is reassessing whether VistA has a long-term place as its EHR and has halted some of its VistA modernization steps following a business case analysis ordered by new VA leadership. The VA says it requested $40 million less in 2017 VistA modernization money because it will focus instead on making its existing systems interoperable.

According to Assistant Secretary for Information and Technology LaVerne Council (photo above), “We want to take a step back and look at what we really need an EHR and a healthcare system to do. There are multiple needs that are different than in 2014 around the area of women’s health, the Internet of Things, and how we manage private sector care.”

House Appropriations Chair Hal Rogers (R-KY) wasn’t happy with the VA’s testimony to the committee, saying, “We’ve been at this for 10 years and we’ve given you billions of dollars. I’m hearing muckety-muck here. I don’t know what you’re saying. Apparently, you’ve not made your mind up yet about whether you’re going to replace VistA with something off the shelf. Is that right or wrong? Yes or no?”

Council replied that the VA hasn’t decided yet, blaming her VA predecessors for not developing a sound plan but extolling the virtues of the VA-DoD Joint Legacy Viewer. She joined the VA in July 2015 after retiring as corporate VP/CIO of Johnson & Johnson.

Council also says that a visual overlay to the VA’s 30-year-old patient scheduling system may eliminate the need for its planned $690 million replacement depending on how the VA-wide rollout in April is received.

Reader Comments

From Vegas Blues: “Re: healthy health conventions. Is it a foregone conclusion that we can’t eat healthy at a Las Vegas conference venue?” Plenty of sugary snacks, fatty sandwiches, and coffee were available, but I didn’t see much fruit or unprocessed food. It’s a fine line between providing what attendees want vs. what’s good for them, however. The H in HIMSS stands for healthcare, not health. It’s like McDonald’s, which offers a lot of healthy food that nobody orders, earning it scorn for the choices its customers make.

From Jardin: “Re: delegating computer tasks to non-physicians. The Senate unanimously passed this because, according to the committee chair, ‘hospitals and providers dread EHRs’ and “MD documentation is burdensome.’ After a year-long review that included HIMSS and physician lobbyists, Congress proposes a solution that adds costs, introduces errors, and eliminates many EHR benefits. After spending billions on health IT, we’re regressing back to the e-secretary model, pushing the burdens of the same EHRs to scribes or RNs. Nurses continue to be invisible in the law. Why isn’t there an industry outcry to actually fix the problem instead of just passing it off?”

From Flaming Introvert: “Re: HIMSS conclusions. As a near-entry level vendor employee, this is my second HIMSS and I’m not sure if I love it or hate it. It’s upbeat and our customers provided positive feedback about our changes and their needs. It’s refreshing to connect with patient advocates, even if most conversations end with the defeatist consensus of, ‘It really sucks, but what can we do about it?” Low point was getting to HIStalkapalooza too late for the shoe judging – I don’t normally parade around in six-inch heels without potential ROI. Maybe that same sentiment applies to HIMSS overall – it continues to yield enough return to induce me to participate, but I’m always glad to get home.”

From Bonus Room: “Re: iTriage. Just laid off 33 employees and CTO Patrick Leonard is leaving.” Unverified. I haven’t seen any official announcements from the medical question and doctor finding app vendor that’s owned by Aetna. However, the report came from a non-anonymous iTriage employee.

From Love American Style: “Re: Epic’s 2015 release. I’m a project director for an Epic customer. We are still in the testing phases and the severity and number of patches at this point in the release cycle has been unprecedented. Patient safety problems, patches that break workflows, performance problems all abound. Things I would have expected Epic in prior years to have nipped in the bud long before now.” Unverified.

From Delled: “Re: Michael Dell at HIMSS. He’s my hero, but I was stuck in the overflow room for his keynote. The moderator was so bad that people left in droves like the session was over. At one point Dell had to remind the moderator that he was supposed to ask a specific question. Finally I worked my way to the front against the crowd streaming for the exits, and at the end when he was leaving the stage, I asked to shake his hand (photo attached). He ignored me.” Michael Dell would have been an awful choice to keynote even if he wasn’t trying to sell out Dell’s pitiful healthcare offerings so he can finance his $67 billion passion for computer storage in acquiring EMC. EMC owns VMware, which has watched its shares drop 40 percent and has laid off 800 people since Dell came sniffing. Other than funding Dell Medical School, his healthcare accomplishments are zero or less, hoping desperately to sell Perot Systems for the same price he paid in 2009, backpedaling on the the idea that the future is in services rather than hardware.

Here’s my formula for becoming a highly-paid, well-received HIMSS keynote speaker, not inspired by Michael Dell since I didn’t attend any HIMSS keynotes:

1. Be famous for any reason. Healthcare relevance is unnecessary and even detrimental – the goal is to raise the spirits of attendees by making them think they are as cool, rich, good-looking, or smart as the celebrity podium-gripper.
2. Negotiate a speaking fee of several hundred thousand dollars, making sure to insert contractual clauses requiring approval of the introduction and the freedom to sell whatever product or service the speaker offers on the side.
3. Arrange travel to minimize the time hanging out with the insufferably fawning organization people who hired you and who therefore think they’re entitled to face time or the privilege of escorting you through the exhibit hall that makes you glaze over.
4. Announce to the worshipful masses how utterly delighted you are to be in their midst, carefully omitting the fact that you could have attended any time you wanted in previous years if your delight didn’t carry a price tag.
5. Begrudgingly allow a high-ranking executive of the group running the conference to (a) hug you before or after your speech; (b) ask carefully scripted softball questions after the stage is reset into a fireside chat type configuration; and (c) annoy the audience by prattling on instead of letting you talk as you’re being paid to do. At least moderator verbosity prevents audience members from asking their own pointed questions that might result in an unfortunate, life-ruining off-the-cuff answer. After the friendly chat, allow the executive to magnanimously present your foundation with a big check above and beyond your personal speaking fee.
6. Have your hired copywriter modify the harmless, standard speech you’ve given dozens of times to conventions ranging from car dealers too the Bowling Proprietors’ Association of America, penciling in four seemingly insightful anecdotes as provided by the people writing the check that are sure to make the audience feel that you understand them even though you have no idea what they actually do. You don’t  have to review the scripted comments in advance – they will be right there in front of you on the Teleprompter per your contractual requirement.
7. Include a handful of humorous, self-deprecating, name-dropping insider anecdotes to allow geeky non-profit IT people to live your celebrity life vicariously and to brag afterward that they briefly shared your aura.
8. Be vaguely motivating in a boilerplate-type way that won’t require actually thinking up something new, extolling the generic virtues of teamwork, leadership, doing what you love, and being true to oneself.
9. Close with over-the-top accolades that defer glorification to whatever the audience members do for a living, telling them that they are the real heroes even though (a) they’re paying to see you and not vice versa, and (b) you just made more money in 60 minutes than they make in a year.
10. Go straight offstage to a limo with the engine running to minimize unpaid downtime before the next cookie-cutter speaking gig.

HIStalk Announcements and Requests

A little more than half of poll respondents doubt that Athenahealth and eClinicalWorks will become major inpatient systems vendors. Skeptical says that if eCW’s entry into inpatient is like its interoperability solutions, “we should expect major-league hype and minor-league results.” Vote Early and Often says eCW employees stuffed the ballot box and the company can’t service enterprise customers that expect project discipline and management maturity. Frank Poggio says it’s too late – the market has been sewn up by Cerner and Epic with Meditech, the only small-hospital vendor, losing ground. It’s All Good says there’s a long history of companies aspiring to be what they aren’t (Allscripts) and that eCW should stick to ambulatory.

New poll to your right or here: HIMSS attendees, will the hard-dollar benefit of your attendance cover your employer’s cost to send you within one year? Click the Comments link after voting to explain.

Here’s an extra, reader-requested poll for HIMSS15 exhibitors: in the year that has elapsed since, did you make a sale that you wouldn’t have made had you not exhibited?

Ms. Livingston says her New Mexico elementary school students “have the idea that they don’t deserve what the schools that have more money enjoy having” and therefore are having great fun with math story books we provided in funding her DonorsChoose grant request.

Also checking in was Mrs. Jochum from Nebraska, who sent photos of her students using the Osmo learning systems we provided.

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 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

Sixty-nine bed Madison Memorial Hospital (ID) will implement Cerner at a cost of $6 million upfront and $86,000 per month in maintenance fees. They chose Cerner over Epic and their incumbent vendor Meditech.

Virtua Health System (NJ) chooses Epic, which apparently beat Cerner in offering a replacement for Siemens Soarian.

Steward Health System chooses Imprivata Cortext for provider communication across its nine hospitals.

Aurora Health Care (WI) chooses Strata’s StrataJazz as its full financial analytics and performance platform.

People

Healthgrades hires C.J. Singh (Backcountry.com) as CIO.

Ross Martin, MD assembled video good wishes for Deloitte’s Chris Brancato, who is recovering from unfortunately eventful spine surgery that has left him hospitalized and therefore unable to attend the HIMSS conference. Some of the greetings were recorded at HIStalkapalooza.

Announcements and Implementations

CPSI announces a program by which its revenue cycle customers can apply their additional revenue toward buying its Evident Thrive EHR with no upfront costs. CPSI shares have rallied a bit in the last few months, beating the Nasdaq slightly by increasing 3 percent in the past year.

Health Catalyst arranges its product roadmap around nine subject areas.

Intelligent Medical Objects will work with Northwestern University’s medical school to support pharmacogenomics clinical decision support through creation of terminology to support concepts such as “ultra-rapid metabolizer of clopidogrel.” IMO will make the results available to members of the federally funded eMERGE consortium at no cost.

Vital Images launches an ACO imaging analytics solution and announces a personalized HIE/EMR viewing platform.

Privacy and Security

The personal information of all employees of Main Line Health System (PA) is exposed when one of them replies to a spear phishing email.

Innovation and Research

Mass General’s “Ambulatory Practice of the Future” calls for undergraduate and graduate engineering students to compete for $400,000 in prizes for creating innovations in primary care (technology, instrumentation devices, etc.) Pre-proposals are due April 18, 2016. Ten finalist teams will be awarded $10,000 and the top three winners will receive $150,000, $100,000, and $50,000. Last year’s winner was Hemechip, a point-of-care diagnosis device for sickle cell disease.

Other

The HIMSS16 final attendance count was 41,885, down 3 percent from last year’s 43,129. This is the first time I can recall attendance going down year over year unless maybe it was in 2000 due to the Y2K scare. Possible reasons I came up with:

• Industry hangover from MU and ICD-10.
• Fatigue with the novelty of having the federal government drive so much of the conference agenda.
• Lame keynote choices.
• Election year uncertainty.
• A move to immediately valuable vendor user group meetings instead of a massively broad conference that is more useful to providers who are shopping products.
• A cutback in travel funds from vendors anticipating a market slowdown.
• Questionable return on investment for both providers and vendors.
• An increasingly less-useful education track that favors just pushing attendees into the exhibit hall nonstop.

A reader sent a link to the Sands Expo’s brochure describing its “green “ practices conference planning tool that should relieve HIMSS attendees worried about the lack of obvious recycling efforts. Interesting facts from it:

• The Sands Expo facility earned LEED Gold certification for existing buildings.
• Meeting rooms are equipped with sensors that control energy-efficient lighting.
• Onsite solar panels address some of the energy requirements.
• The convention center recycling rate is 80 percent, with waste sorted at both on-site and off-site recycling stations.
• Leftover food is made available in the employee dining room with the unused amount composted and sent to a local pig farm.
• Carry-out and concession serviceware is compostable.
• The entire property is smoke free except for the casino and 6 percent of guest rooms.
• The facility offers volunteer opportunities to conferences exhibiting that include helping with soap and shampoo recycling, creating Clean the World hygiene kits from recycled materials for locals in need, helping sort donated products for the local food bank, packaging nutrition bags for senior citizens in poverty, packing food in backpacks for local children, boxing meals for after-school programs, and volunteering with Opportunity Village to support those with severe intellectual disabilities.

HIMSS barely missed what would have been a huge PR scoop as the Denver Broncos announce that Peyton Manning will retire, just two days after his HIMSS conference keynote.

An 86-year-old woman accidentally strangles herself to death when her medical alert bracelet, which did not have a breakaway clasp, gets tangled in her walker.

Weird News Andy advises people to “Don’t Worry, Don’t Be Happy.” A study finds that joy – along with anger, grief, and fear – can cause emotional stress that contributes to takotsubo (aka broken heart) syndrome. 

Sponsor Updates

• Huron Consulting Group and Strata Decision Technology announce a partnership to create a value-based care transition solution.
• NextGen Healthcare integrates CareSync CCM into NextGen Ambulatory EHR and will offer the product to its customers who want to perform and bill chronic care management services.
• Aventura chooses HealthCast as its single sign-on partner.
• Catalyze will add support for Microsoft Azure to its HIPAA compliance platform as a service.
• The Advisory Board Company offers case studies from four health systems that saved $4 million using its Crimson performance analytics program.
• Nordic will offer its customers visual analytics from Qlik Sense.
• NextGen Health integrates inMediata’s inBanking payment reconciliation solution with its practice management system, allowing payments to be electronically reconciled against banking deposits.
• VMware integrates Imprivata’s user credentialing and messaging products into its Workspace One provider digital workspace.

Blog Posts

• #HIMSS16 – Where are we on the journey to value-based care? (Nordic)

Contacts

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

Dr. Jayne’s HIMSS16–Thursday

I was able to sleep a bit later this morning – no breakfast meetings or client calls. Trying to determine which sessions I want to catch has been an exercise in frustration. It feels like most of the ones I’m interested in all occur at the same time.

While I was looking at the short list of possibilities for today and eyeballing what I missed, it struck me that some submitters were much better at creating eye-catching titles than others. Some of my favorites:

• Patient Engagement: No Diamond Ring Required
• Five States, 700 Physicians, and Four Best Practices for HIEs
• Just Press Print: Challenges in Producing EHRs in Litigation
• Patient Identification: Biometric or Botched
• How to Avoid Getting Sued by Your Cyber Risk Insurer
• Rise of the Medical Scribe Industry – Risk to EHR Advancement
• Hard Truth about a Soft Go Live

A couple of the sessions I was particularly interested in happen to occur on Friday, so I’m looking forward to finding them online. I’m also looking forward to reviewing “What Do You Do When Your Improvement Project Fails” because it’s near and dear to my heart. When I went for my Lean Six Sigma certification, my first project was a complete and total bust. It ended up being a good thing, however, since it led to the creation of an upgrade methodology that I still use today, but it was definitely painful at the time, not to mention embarrassing.

I had mentioned yesterday about the lack of recycling (or discussion of single stream management) and a reader commented that there were signs near the waste receptacles. I made a more concerted effort to notice today and still didn’t find any more than I had already seen. The conference center did have divided bins (waste vs. cans/bottles) that I saw previously and failed to acknowledge, but most of the bins I saw in the exhibit area were unmarked.

My hotel had no mention of recycling whatsoever. They did mention on the express check-out card that they don’t issue paper bills for environmental reasons. Still, I needed a paper copy for reasons of my own and the desk clerk actually scolded me, saying I’d receive it via email by the end of day. It’s midnight in my world and I still haven’t seen it, but I guess in Vegas time they have a couple more hours.

I noticed some bachelorette-appearing ladies coming out of Treasure Island in what appeared to be last night’s clothes. They were sporting some adult-themed balloon hats and I’m just sorry I wasn’t fast enough to get a picture. It’s a good thing that what happens in Vegas stays in Vegas because they were looking pretty rough. Perhaps they were headed up the street to White Castle for some hangover therapy. I didn’t remember seeing it on the strip last time I was here, but the strip can be overwhelming and things are easily missed.

I did a last-minute swing through the exhibit hall and heard quite a few comments about people getting ready to head out. I do wish I had more time to see more products and attend more sessions, but staying through Friday wasn’t an option. I’m not thrilled about the schedule shift that occurs when HIMSS is in Las Vegas and it seems like others aren’t so thrilled either. Next year we’re back in Orlando, which is challenging for its own reasons. I wish HIMSS would reconsider other options for the meeting.

The show floor was still fairly busy although nothing like opening day. I had equal numbers of reps who were smiling and trying to engage people walking by as compared to those who were looking pretty bored. I popped down to Hall G to see a couple of specific vendors and ended up running into someone I hadn’t seen in ages and chatting took up most of my remaining time.

It takes a lot of discipline to try to see everything and do everything at HIMSS. I’d like to blame my broken toe for slowing me down, but I think the whole event is almost too much. Thanks again to Edifecs and their #WhatIrun for literally making it possible for me to limp my way through the week in comfort.

I was fortunate again this year to have a vendor executive offer to share his car to the airport, allowing me to bypass the taxi queue craziness and providing a nice chat on the way. I enjoyed getting his thoughts on the industry and the move to value-based care. The airport was surprisingly low key and I made it through security in record time, for which I was grateful.

During my flight, I was able to catch up on the unbelievable amount of email that had come in during the week. One was from a PR firm correcting me for not using their client’s full name in my mention. Although I appreciate their position and their diligence to the brand, I hope they understand that (a) HIStalk is not my full-time job; (b) sometimes we write quickly and on the fly; and (c) during HIMSS, I usually end up writing at 1-2 a.m. after hitting the show all day and at least three or four vendor events each night. An email from a different vendor used the analogy of “a tree falling in a vast, cold, poison-ivy infested forest” gets my compliments for best prose of the day.

Weird News Andy wins the award for best fashion advice in the “What Not to Wear” category, sharing a piece explaining the perils of wearing shoes with gun-shaped heels and bullet-shaped accents.

I also received a note from a vendor exec apologizing for missing HIStalkapalooza. Apparently there was an EHRA dinner and awards ceremony that overlapped and they couldn’t make it to Mandalay Bay before the doors were closed. Another physician reader who did attend asked if I had any photos of her team and John Halamka doing the limbo at HIStalkapalooza. I am very sad to say that I do not, but if anyone does, please share.

What has been the best part of HIMSS? Email me.

Email Dr. Jayne.

Jenn’s HIMSS 3/3/16

My last day at HIMSS … how I already miss seeing friendly faces around every corner, the fantastic free food in the press room, readers stopping by the HIStalk booth to tell me why they love (or hate) some of the things we do. I’m already looking forward to Orlando, and can’t say goodbye quickly enough to Pacific Time. But I’m getting ahead of myself.

My last morning got off to a nice start. I found that chivalry is indeed not dead, as several gentleman helped me cart my luggage between the HIMSS shuttle and conference entrance. I wasted no time in grabbing coffee from the press room before meeting with Lauren Douglass, brand manager for Medhost’s YouCareUniverse. She brought me up to speed on several nuggets of news, including the fact that the company’s YourCareEverywhere mobile app has recently been certified for Meaningful Use – the first of its kind to attain certification, to the best of her knowledge. The company, like many others at the conference, is joining the interoperability conversation in a big way via a project with an unnamed EHR vendor.

Encore Health CEO Dana Sellers joined me afterwards to chat about the show. (I love talking with smart folks that have been in the industry as long as she has; it’s a great way to absorb just a tiny bit of their wisdom.) We talked about everything from The 5 Love Languages to value-based care. She pointed out that, while a theme usually emerges by this point in the conference, she just couldn’t put her finger on one this time around. She equated it to post-Y2K, when the industry settled into a six month lull to catch its breath. “We’re in that same lull,” she explained, adding that her customers are taking a step back to recover from Meaningful Use and ICD-10. Sellers predicts that once they’ve taken a breather, providers will move full speed ahead with figuring out how to derive value from their healthcare IT.

Her comments regarding lack of a theme hit a nerve. HIMSS conference news cycles in years past have been driven by industry-wide EHR adoption, then ACOs, then Big Data (as its history of HISsies attests), and I was fully prepared for yet another buzzword to rear its ugly head. While population health management, analytics, cybersecurity, and value-based care have been tossed around, I haven’t gotten a sense that one is more important than the rest to providers walking the exhibit halls. Yes, everyone is talking about interoperability, but as BIDMC CIO John Halamka smartly said in his session with Jonathan Bush, “Interoperability is a bit like porn. I can’t define it, but I know it when I see it.” I haven’t even heard much mention made of precision medicine, aside from HHS reps talking it up in various sessions. Perhaps readers will offer a different perspective.

After coffee talk, I walked just a few yards to the HX360 Pavilion, which turned out to be a really nice, open space for its exhibitors, including Matter and Startup Health. I’m not sure how it compared to pavilions past, but it was nice to enter into an exhibit space not filled to the gills with humanity.

I caught the #HITsm panel featuring illustrious thought leaders like Drex DeFord, a longtime friend of HIStalk and participant in our HIMSS16 CIO luncheon. Host @HealthStandards kept the live and virtual discussion high level by focusing on innovation in HIT. A number of themes emerged, including the consumerization of healthcare and technologies poised to have the biggest impact. My vote goes to any type of tech – high or low – that can alleviate the costs associated with aging in place, long-term care, and palliative care. A big chunk of healthcare dollars goes towards caring for the elderly in these categories, and so it stands to reason that technology that addresses these areas might make some waves (if it’s not already doing so) in terms of cost and outcomes.

Standards were also mentioned, at which point everybody groaned.

I spent the rest of my time walking through the exhibit hall one last time. Traffic was light in some areas and heavy in others, as this picture of HL7 International’s booth can attest. Folks were lined up two to three deep to hear Massachusetts EHealth Collaborative President and CEO Micky Tripathi talk about the Argonaut project.

The #FHIRSelfie photo op just around the corner from where he spoke looked like a lot of fun.

Healthfinch co-founder and CEO Lyle Berkowitz, MD (and associate CMO of Innovation at Northwestern Memorial HealthCare (IL)) was gracious enough to stop and snap a selfie with me, even though I initially mistook him for Cedars-Sinai CIO Darren Dworkin.

My last official “drive by” of the day was to say one final thank you to the Xerox team for the lovely dinner the night before. Chief Innovation Officer of Commercial Healthcare Tamara StClaire and I chatted about the fabulous food and conversation (creamed corn = amazing / value-based care = struggle), and Xerox’s new population health management solution, which I’ll cover in HIStalk Practice’s Population Health Management Weekly Wrap Up on Sunday. I threw her a curveball in asking for her thoughts on HealthSpot’s stealthy departure/implosion. She equated Xerox’s partnership with HealthSpot as a learning lesson – one that has left the company now fully committed to remaining in the telemedicine space with an eye towards offering virtual queuing and payment processing. She wouldn’t name names, but did say that the company is in talks with several telemedicine vendors to prop up their IT infrastructure in the coming months.

I shuffled through tweets as I queued for a taxi to the airport (the line was not that bad), and had to share this one because it is apropos no matter which HIMSS conference.

As is this chart tweeted by @MandiBPro and @drNic1. The expo’s WiFi actually ended up being pretty reliable, which isn’t always the case at HIMSS.

My flight home has thus far been fun. The terminal was filled with familiar faces and longtime friends and I’m about to crack open one of the books I splurged on at the airport bookstore. I’m hoping humor – and healthcare IT – will get me through the long flight. Safe travels everyone!

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 3/4/16

VA leaders cite progress on health record interoperability

David Shulkin, the under secretary for health at the Department of Veterans’ Affairs, testifies before Congress that the VA and DoD are on track to be fully integrated by 2018, though during the same hearing VA CIO LaVerne Council reported that it was time to “take a step back” from planning the modernization of Vista while it considers off-the-shelf alternatives.

Cerner lands another big contract

Dignity Health will implement Cerner across all of its ambulatory clinics. Dignity already runs Cerner in its 39 acute care hospitals

This genetics company claims it just achieved a major milestone in biology — and it could transform personalized medicine

Veritas Genetics breaks the $1,000 genome sequencing threshold, offering full sequencing, interpretation, and genetic counseling for less than $1,000.

Life as a Healthcare CIO: Dispatch from HIMSS

John Halamka, MD recaps his impression of HIMSS16, expressing excitement over Surescripts National Record Locator Service, CommonWell, FHIR, and other initiatives that are gaining momentum.

From HIMSS 3/3/16

From Idiosyncratic Reaction: “Re: change. Thought you would like this.” It’s perfect.

From Civil Discourse: “Re: HIStalkapalooza. I realize that some people like loud music, but I would rather see a provider-only get-together that facilitates making contacts and having more in-depth conversations with peers.” The tug-of-war between “it’s a party” and “it’s a networking event” started in the event’s second year in 2009, but since then, HIStalkapalooza has evolved more into a party and attendees are self-selecting knowing that’s the case. Maybe there should be a two-hour, provider-only networking event before the regular HIStalkapalooza starts, or even a separate event entirely. The downside is that just putting on HIStalkapalooza consumes lots of time for weeks beforehand and I’ve assumed that the conference provides ample networking opportunities already. I’m open to ideas.

From Mutually Assured Destruction: “Re: HIMSS16 observations. See if these resonate.” Here’s what MAD submitted:

• Best new addition to HIMSS Annual Conference. HIMSS Living Room. We attend the annual conference for the networking and it’s such a pleasure to be able to connect in a comfortable space with food for sale and a nice mix of comfortable seating, mini conference tables, etc. I had more ad hoc face-to-face meetings in two days than in months of scheduled meetings, and the hallways weren’t lined with floor-sitters trying to rest their weary feet.  Well done, HIMSS!
• Most interesting tone change. I’ve noticed throughout my HIMSS lifetime that each year, a different villain was blamed for problems with health IT. One year it’s physicians who wouldn’t accept change. Next year it was health system administrators who wouldn’t budget more than 3 percent of spending on HIT. Then the government for issuing unworkable mandates. Then health IT vendors whose EHRs weren’t user friendly enough. It was very refreshing to hear Karen DeSalvo say, (paraphrasing) “Let’s stop the blame and shame and look for solutions.”
• Biggest irony. That a conference focused on developing solutions for improving the nation’s health is hosted in a location where daily exposure to second-hand smoke is unavoidable. Anyone with even the mildest asthma condition spent the week wheezing and coughing. I know there are only so many venues that can handle the HIMSS annual conference, but if we never return to the Vegas Strip it will be soon enough for me.
• Biggest stressor/biggest regret. Being a no-show at HIStalkapalooza because of a last-minute work command performance conflict, knowing I’ll be blacklisted next year.

From High Pitch: “Re: HIMSS session on cognitive computing. It was a pure Watson vendor pitch. Don’t they have a customer who is willing to speak on behalf of the success they’ve had?”

Four hospitals in Israel were infected with ransomware in the past month alone.

Dignity Health will expand its use of Cerner.

Some of the DrFirst roving reporter interview videos from HIMSS16:

• Politico’s David Pittman’s prediction of key themes at HIMSS16
• Mark Mixon discusses privacy and security in rural community hospitals
• Linda Stotsky: insights on the future of clinical decision support
• Healthcare lawyer Matt Fisher discusses security and privacy on social media
• What Parkview Medical Center does to protect privacy and security

Lots of folks were wheeling suitcases through the casino this morning and packing up their exhibits this afternoon, foretelling the usual poor attendance at Friday’s sessions. It will be cold where a lot of people are going, with these highs Friday: New York 39, Boston 36, DC 43, Atlanta 59, and Chicago 38. Las Vegas will be sunny and 80 degrees.

Overheard: “I’m a hospital business analyst. I stopped by the booth of Borda RFID to get product information. The rep didn’t want to let me in the booth. I tried to get some collateral and she told me I couldn’t have anything because it was for CIOs who were coming by later. She made me put it down. I pointed out my CIO across the aisle and said, ‘Notice that his bag is empty while mine is full. Guess who initiates product investigation at my hospital?”

I spent the morning wandering downstairs Hall G, walking slowly and offering eye contact at each booth to see which vendors were paying attention:

• I had great coffee and a brownie at BridgeHead.
• CaptureProof explained their secure patient-provider photo, video, and comments exchange.
• Doc IT Solutions is a first-time exhibitor. They offer document management and said they’ve done great this week.
• Oblong Mezzanine is a telepresence-like visual collaboration conference room setup that is realistic and allows impressive image manipulation via a wand, almost like in “Minority Report.” It’s being used by Mercy Virtual. Their full-scale mock conference room was nicely done. They say it’s being used by tumor boards and other groups that need a lifelike virtual meeting setup. This was the coolest thing I saw today.
• Stibo Systems is a master data management vendor that serves 34 of the top 50 retailers in the world. They said MDM is not yet widely known in healthcare, but interest is growing.
• IMAT Solutions offers tools to normalize and aggregate data in real time for reporting.
• DataMotion Health equips providers with the ability to let their patients download their data.

I ran across this booth in the Hall G maze. Pretty cool.

I checked out FormFast, which had an iPad-powered self demo. They offer electronic forms, barcoding, and data collection, including online consents.

The folks at Netskope were giving away this book, which is actually very good. Netskope’s tools allow companies to find situations where PHI or other sensitive information is being sent to unauthorized cloud services, which its studies have shown happens in 21 percent of healthcare organizations. The average healthcare organization uses 1,017 cloud apps. The company’s technology allows creating policies for each risky activity. They offer a free cloud risk assessment.

That’s all I have for the moment. I left mid-afternoon today because I’m super tired (probably like everyone else). I’ll wrap up anything I have left to say about HIMSS16 this weekend. Safe travels home, everybody.

Dr. Jayne’s HIMSS16–Wednesday

If I thought yesterday was an overwhelming 16 hours of HIMSS-related events, today was even more packed. I started the day with a couple of standing client calls. It’s important for those of us that are here to remember that for the rest of the health IT community, time marches on and no one really cares whether we’re at HIMSS or not.

Fortunately, both of my clients are doing well and the calls were brief, allowing me to use the time zone change to my advantage and still make it to the exhibit hall close to opening. Crowds seemed lighter today and I felt much less like I was trapped in a salmon run.

I had the opportunity to check out Aprima’s new patient portal, which was aesthetically pleasing with very little clutter. They have solid features and are planning to add more during upcoming releases. We had a good discussion about the difficulties of developing a patient portal, including the requirements for proxy users and the difficulty of handling data for pediatric patients. They definitely understand the challenges and I’m looking forward to seeing how their product evolves over the next year.

One of the other areas I focused on today was Chronic Care Management documentation for ambulatory EHRs. For those of you not in that space, Medicare came out with a new billing code last year that allows providers to bill an additional $42 per month for care management services for patients meeting certain criteria involving chronic diseases. Each vendor seems to have its own spin on how to handle the documentation (there are time thresholds that must be met) as well as how to identify patients for the service in the first place.

I didn’t see any vendor with as robust documentation as I would have liked to, but that reflects the slow uptake in the market for the new code. Patients have to consent to enrollment and usually end up paying around $8/month in coinsurance, so adoption has been slow in some markets.

I met up for lunch with a handful of my favorite women and one of them was packing these fetching flats for later in the day. Due to my broken toe from earlier in the week, I’ve had to resort to some less-fashionable shoe choices, but it was nice to live vicariously through her.

I was also busy today attending sessions. Most of them were sparsely attended and it didn’t seem like the rooms were particularly well matched to the number of attendees. I’ve been to several other conferences where attendees are asked to register their session preferences in advance to the planners can right-size the rooms for the expected audience. One presenter commented that this was the largest room he’s ever spoken in especially given the number of people present. I think there were about 20 people in a ballroom that would seat several hundred. He did a great job with his material, but included a couple of off-color jokes, which would have been better left unsaid.

I haven’t been able to hit nearly the number of sessions I had planned. Rumor has it that HIMSS will be posting the sessions to their website so we can complete the continuing education requirements after the fact. Hopefully they’ll be posted soon because I’d like to cross Maintenance of Certification off my list for the rest of the year. I had the chance to connect with a couple of fellow clinical informaticists and swap war stories, which is one of the main reasons I like to come to meetings like this.

I always love Epic’s artwork, including this bottle-cap wearing unicorn and a musical cow. I overheard a couple of attendees commenting about the adult coloring books at Aventura. Kudos to them for tapping into a current trend and having a give-away that was definitely out of the box.

I’ve been plagued by dry skin on this trip, requiring a trip to the store for better moisturizer. I forgot my lip balm at the hotel so spent a bit of the afternoon scouring the hall for another tube. NextGen didn’t disappoint with their high-end giveaway and the mesh bag will be perfect for corralling cords in my bag. I know Mr. H mentioned the apparent lack of recycling and I’m always happy to see something I can reuse. I know some hotels do recycle and do the sorting for you, but I haven’t seen anything about that practice on the signage at the expo center or at my hotel.

IMO had some technical tee shirts at their booth. I’ll be enjoying mine as I continue to hit the treadmill during the rest of the winter. They also hosted a reception tonight at Hyde, located right on Lake Bellagio. The views of the fountains were stunning and I was impressed by the understated elegance of the event.

Tonight seemed like the busiest night for vendor events, with offerings from Nordic, Athena, NextGen, Greenway, and a host of others. It seemed like the events were shorter this year than in the past, with many of them only scheduled for two hours. The tight timeline and spread-out nature of the venues made it difficult to get to all of them although I did give it a fighting try.

I’ve never been able to make it to a Greenway event because it usually conflicts with HIStalkapalooza, but due to the date shift this year I finally made it happen. I’m glad I did because it was the best party of the night. Held at the OMNIA nightclub at Caesar’s, it featured a good selection of food and some sassy bling-handled cake pops. The DJ had the party hopping and it continued well past the published end time, with wait staff continuing to circulate for drink orders and offering water to those of us that were starting to wind down. Their photo booth was busy all night, and since it was open and in the middle of the action, we got quite a few laughs.

I met up with a good friend for a nightcap, although I didn’t get to stay as long as I wanted. Luckily he understood my need to go back and finish writing as well as to try to catch up on the hundreds of emails I haven’t been fielding for the last few days. Jet lag has definitely set in but I hope to sleep in a little tomorrow.

Jenn’s HIMSS 3/2/16

My third day at HIMSS started bright and early thanks to the paper-thin walls of my hotel room and the 4:45 am wake-up call for the room next door. Given that I was still on East Coast time, I gave in and got up. I cabbed over to HIMSS, thinking it would be quicker than using the shuttle. My hotel is not that far from the Sands Expo, and yet it still took about 20 minutes for my cabbie to navigate the traffic. He’s not a fan of the very narrow taxi drop-off area. I think I’ll try the shuttle tomorrow morning and see if that’s any quicker. At least it will be free.

After grabbing a quick coffee in the press room, I hunkered down at the HIMSS Spot to watch the passers by and catch up on email and tweets. The WiFi was surprisingly bearable today, which meant I was able to get work done on the go rather than attempting to cram it all in before bed. After watching the masses zip past, I headed over to our booth to relieve Lorre, who left to play hostess for a few hours at HIStalk’s CIO luncheon. The highlight of my morning was sashing Ross Martin, program director at CRISP; a member of the HIStalkapalooza alumni; and president, founder, and fellow of the American College of Medical Informatimusicology. After singing a few notes, I too became a member of ACMIMIMI. It was a very productive morning.

I also had the chance to chat with Robert Donnell, MD interim CMIO at the Medical College of Wisconsin, and Shiv Rao, MD a cardiologist at University of Pittsburgh Medical Center. My favorite game to play at HIMSS thus far has been to ask folks how they define population health management. It’s amusing because no two answers have thus far been the same. Rao believes PHM is a state of mind, not necessarily a solution, with domain experts making the difference. Donnell told me that, while PHM is talked about everywhere he goes, there’s no standard definition. He thinks of it as community health, a kind of “warranty service” that ideally will one day be fueled by IoT. We didn’t get into the security or privacy implications of that notion.

The very dapper Steve Whitehurst, CEO of Health Fidelity (above, top), stopped by to say hello; as did Nuance Director of Corporate Communications Ann Joyal and Director of Cloud and Mobile Marketing Jonathan Dreyer cruised by to tell me a bit about the company’s new Dragon Medical One platform. I wish I could remember the fun statistic they shared equating a tower of Bibles to physician notes.

The ARC Devices team also stopped by to demo their wireless smart thermometer, coming soon to a peds hospital near you in versions with your favorite comic book characters. It may be low-tech, but this is the kind of product that’s already helping to improve nursing workflows.

The Drchrono team also stopped by to give me a live demo of the company’s new medical billing app, which was pretty slick in that the physician doesn’t have to actually type anything in. No clicks, just taps and drags. I took a picture of the demo, but instead opted to run the one above of company co-founder and COO Daniel Kivatinos petting President Obama’s dogs while in town for the Precision Medicine Summit. Drchrono is one of a handful of vendors that have agreed to support the initiative via a commitment to deploying the applications required for consumers to donate their health data directly to the PMI cohort. Kivatinos tells me he had aspirations of having his picture taken with the president, but the dogs had less security.

HC1 CEO Brad Bostic and Chief Marketing Advisor Ali Roach stopped by to follow up on an after-hours invite they sent last week, and we ended up chatting about healthcare CRM. HC1, which offers healthcare relationship management software, seems like it might face some competition from Salesforce. Bostic assured me that it’s nearly the opposite – a rising tide lifts all boats, and Salesforce’s entry into the market actually validates what his company has been offering for some time.

After Lorre returned, I finally had the opportunity to take a turn around the exhibit floor. The CenterX booth caught my eye because of its vibrant pink and oddly angular shape.

The Leafsprout booth had a very welcoming alien, which made me think they must have had a balloon artist lurking around somewhere.

DSS Inc. promoted its EHR solutions via a full-on screen-printing press. I suppose the ceilings are so high that ventilation wasn’t an issue.

The folks at Hyland did their best to entice me with a beer. Their booth’s permanent bar was definitely hopping.

Dimension Insight’s booth compelled me to stop zipping around and stare at its digital fish. It’s the most relaxing booth display I’ve seen thus far. I might have to return tomorrow for a few minutes of Zen-like stillness in between appointments.

I finally had the chance to meet PerfectServe CEO Terry Edwards in person. This is the company’s third HIMSS – his tenth – and the best so far in terms of attendee interest in PerfectServe’s secure messaging (and much more) solution.

I’m not a car aficionado, so I can’t even tell you what this type of care is. I do know, however, that it’s cool (so does the guy stepping up to have his picture taken with it.) Maybe a Formula One model?

Thanks to the folks at Aventura who sent me off with these cute plush owls and a coloring book. They ran out of owls last year, and have already started rationing them. I may spend today with my eyes peeled for crayons or colored pencils. Coloring during the flight home may be good stress relief.

I ended the day at Xerox’s dinner at Envy Steakhouse, where I got to enjoy good food (my only real meal of the day, in fact), great conversation, and even better company. Xerox Healthcare CIO of Commercial Healthcare Tamara StClaire did a great job of keeping us talking about value-based care and population health management. My favorite tangent had to do with healthcare IT’s love of buzzwords, often used as a way to either jump on some sort of product-buzz bandwagon. Given that I read dozens of press releases every day, I can attest to the fact that today’s marketing teams tend to use buzzwords and acronyms as a crutch, enabling their messaging to limp along without putting full weight on the underlying end-user problem their solution solves. I mentioned a rising tide earlier, and there’s nothing like sitting amidst a group of brilliant people to make you want to really bring you’re A-game expertise. Thanks to Xerox for having me.

My last night in Vegas ended at a decent hour. A good night’s sleep will set me right to visit a few more booths and attend one or two more sessions tomorrow before heading home. The #HIMSSanity is almost over!

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Dr. Jayne’s HIMSS16 Tuesday

Today provided a full 16 hours of HIMSS-related fun, starting with a questionably planned breakfast meeting that was way too early for a post-HIStalkapalooza morning. As usual the party was tons of fun, with lots of celebrity sightings and more than my fair share of time on the dance floor. Party on the Moon never disappoints, and I was glad to share the night with some good friends, connect with last year’s Secret Crush, and meet some new people.

Props to Dr. Eric Rose of IMO for his blue suede shoes.

These boots were also fetching. After catching a late night snack and some must-needed rest, I hit the exhibit hall along with apparently everyone else. The crush of people moving through the expo center was unreal, with long lines for breakfast and coffee.

I started my day with a Greenway demo. I’m focusing on population health during this visit and give full credit to the product specialist, who asked a lot of good questions about what I was looking for and immediately recognized that I was more knowledgeable than the average bear, jettisoning her standard presentation to tailor it to my needs.

After hitting a few more booths, I headed over to Medicomp to play the new improved version of Quipstar. This year they are featuring their Quippe Clinical Lens product, which was easy to use. The Green Team was victorious, making this my first win at Quipstar. The team was made of audience members as well as the core group of Evan Frankel (4ealth Consulting Group), Maria Luoni (NextGen Healthcare), Bonny Roberts (Aventura), and Debbi Gillotti (nVoq) as well as several audience members. I was pleased to see quite a few HIStalk readers in attendance as well.

I was able to get a quick behind-the-scenes tour of the operation behind the Quipstar show and learned the answer to one of the biggest mysteries of our time.

Sunquest had the first sponsor sign I spotted.

Orchard had some cute stress-ball giveaways. I plan to surf the hall tomorrow with one of my favorite people, who has gathered up some of last year’s giveaways and plans to return them to their vendors. We’ll see how that goes.

I spotted my secret crush in the exhibit hall sporting his sash with his bright orange Aventura shoes. I’m just glad he got the sash back at the end of the night, since there were multiple people wearing it at different points at HIStalkapalooza.

I spent lunch catching up with a start-up vendor, who is not exhibiting but who is conducting meetings at HIMSS. Given the cost of booth space and other amenities, I’m not surprised by this approach. The hall hosted several happy hours this afternoon – Webair with their “Doctors, DR, and Drinks” event as well as Orion and Greenway. I participated in a vendor focus group which was very interesting, then headed for a quick shoe change and purse swap before the second night of events.

In the afternoon I hit the Intelligent Health Pavilion, located in the subterranean exhibit hall. I was surprised by how much buzz was going on there, and ran into a friend that I hadn’t seen since 2009. It was good to catch up in person. I also spotted these snazzy wing tips.

Dell hosted a client event at Bellagio’s Bank nightclub, which was hopping. Practice Insight had a subdued but classy event at the Platinum Hotel. We also hit the Imprivata event at Beer Park at Paris. The band was great and they had not only a photo booth, but someone hand-rolling cigars. Next it was off to the Bourbon Room at the Venetian to connect with friends old and new. Renewing relationships is the best part of HIMSS and I hope to connect Wednesday with someone I haven’t seen in almost six years. It’s been too long.

From HIMSS 3/2/16

From Bonus Question: “Re: HIStalk. How big is your team? How many events people do you have? Where is your headquarters?” I always have to laugh when someone thinks I have an HIStalk team, like it’s a real business instead of just doing what I love doing. Jenn and I write, Lorre handles sponsor stuff and webinars. That’s the whole team. We don’t have events people – Lorre spends a lot of time arranging HIStalkapalooza. Our headquarters location is our computer screens.

From Cereal Killer: “Re: CMIO lunch. Why didn’t you have one this year?” I’ve only had one of those lunches, which was at least year’s conference since McCormick Place had a HIMSS Bistro setup near the show floor that’s not available in Las Vegas. I should have realized that the Venetian and Palazzo have lots of restaurants I could have booked, but I always forget that while HIMSS controls every hotel and conference room for miles during conference week, it doesn’t insist on managing restaurant space (yet).

From Sirius: “Re: HIMSS booth dress and food fest. One may be more appropriate versus appealing.” I’ve noticed that booth food is a lot less available than in years past, but Iron Mountain has put out some impressive spreads, including the chocolate-dipped fruit I saw today.

From Digital Probe: “Re: Hall G exhibitors. They could sponsor HIStalk for a year and get tons more exposure than a three-day booth setup that nobody sees.” I feel sorry for companies that paid dearly to exhibit in the downstairs Hall G without understanding how little traffic it gets and how crammed in the tiny booths of unknown companies are. As I overhead from one attendee, Hall G attracts companies whose business model avoids competing with Epic and Cerner (he claims there are 30 companies down there demonstrating instant messaging), but of which 40 percent will be defunct within a year.

From Cherry Pie: “Re: booth eye candy. Your news item had a photo of attractive dancers and you’re complaining about booth babe eye candy? Please!“ This comment made me angry. I had included a photo that Party on the Moon took from their stage that showed the male singer and four females that included singer Kelsey Chandler in costume, captured during one of their amazing numbers and posted by the band to their Facebook. Cherry Pie apparently is happy to insult Kelsey by suggesting that her primary contribution is her appearance, which is absurd if you had heard her singing Monday evening. CP’s smug opinion doesn’t help the cause of talented women who are free to look, dress, and behave however they like. I know CP probably fancies himself a progressive man, but he’s not doing women any favors by insinuating that attractive ones must have been chosen just for their looks – that’s just as maddeningly sexist as actually hiring subjectively attractive women over more qualified but subjectively less-attractive ones. You’re either gender blind or you aren’t and I doubt Kelsey needs your approval of her choice of dress, showmanship, or vocal talent.

Looks like from the preliminary HIMSS estimates that conference attendance down quite a bit from last year. I hope that’s true – I’d like to see HIMSS worry about it enough to eliminate some of the practices that might be turning people off. I’m happy to provide my own list.

Stop by our Booth # 5069 Thursday at 11, when we’ll have your HIStalkapalooza hosts Barry Wightman and Jennifer Lyle on hand to say hello. Barry is director of marketing at Forward Health Group, where he deals with software-assisted outcomes, but he’s also a published book author, voiceover talent, fiction editor, and rock musician. Jennifer is founder and CEO of Software Testing Solutions, which helps health IT software vendors accelerate end-user delivery (and therefore revenue recognition) via automated testing, whether it’s for interoperability interfaces, middleware, outreach software, or LIS applications, cutting testing time from weeks to days. They would be ecstatic to see some HIStalkapalooza attendees drop by.

I’d like to give a shout-out to the folks who are minding the store while the rest of us are screwing around at the HIMSS conference worrying about which party to attend. My conclusion is this: the folks here can’t be all that important if their organizations run seamlessly in their absence. People who don’t travel much think it’s glamorous and fun, so those here can score points by emailing back to work and thanking the people who stayed behind.

I really appreciate the vendors and CIOs who participated in my CIO lunch on Wednesday. Lorre reports that everyone seemed to enjoy themselves, the food and Maggiano’s were great (I paid for lunch, just in case someone thinks it came out of the money donated), and Dana Moore says he’ll write a description of what each sponsor talked about for me to run later. I funded a lot of projects from the proceeds, with every dollar donated going directly to helping a lot of classrooms, teachers, and students that needed some financial assistance. A vendor executive who is setting up a family charitable foundation told me he had DonorsChoose vetted and they passed with flying colors, which isn’t surprising given their near-perfect Charity Navigator scores. The CEO, a former teacher, takes a very low salary.

Speaking of DonorsChoose, Epic QA donated $50, to which I applied matching funds as well as some personal money to purchase a library of 25 biographies for Mrs. Hale’s third grade class in Indianapolis, IN. She responded almost immediately, “From the bottom of my big, third grade teacher heart, THANK YOU! Thank you so much for taking the time to help get my students biographies that are kid friendly and engaging. They will be so excited to read about people from the present and past. I can’t wait to see their faces when I tell them we have so many new biographies to choose from.”

Ross Martin, MD, MHA was too busy changing jobs and houses to perform at HIStalkapalooza like we originally planned. However, I had a sash made for him, which he picked up in our booth today. He made a great Elvis here at our 2012 event.

Nordic’s Aaron Mann dispels the notion that HIStalkapalooza is just a party, explaining that a chance encounter is actually pretty likely when you have a room full of the industry’s coolest people.

DrFirst filmed Jonathan Bush doing his Donald Trump imitation at HIStalkapalooza.

Here’s an HIStalkapalooza flashback video from the 2012 Las Vegas event, hosted by the amazing ESD. I watch this every few months since I really like the music and the atmosphere it captured. For trivia buffs, we held this one at the since-closed First Food & Bar restaurant in the Palazzo. Let’s hear your memories and comparisons if you were there.

DrFirst captured John Halamka accepting his HIStalk Lifetime Achievement Award on stage. He won several awards Monday evening. I’m a big fan.

I will never like this product name, formed by leaving out the “t” in “quantum.”

Chris Miller of the DoD led a discussion about their EHR project. He said military users demanded an integrated system and that DoD is happy making configuration decisions instead of leading technical design sessions for self-development.

A CEO suggested that I take a look at Novarad’s VNA. That’s not my strongest area of expertise, but it was simple to understand and their services agreement covers maintenance and disaster recovery. The zero-footprint viewer running on Google Chrome was cool. Users can upload any document from a network-attached drive and store it in designated patient folders in the VNA.

Is it just me or is it bizarre that in this day and age, Las Vegas apparently doesn’t recycle? I didn’t see any blue trash cans.

I watched a kiosk demonstration at the Fujitsu booth and pondered this question about biometric security since they offer palm vein scanning ID systems. People have rightfully observed that if biometric credentials are stolen, there’s little recourse since users can change passwords but not their fingerprints or palm vein patterns. Here’s my idea. In both cases, all that’s stored by the scanning system is a set of mathematical inferences from the image, not the image itself. Why not allow each vendor to develop their own ID matrix from the hundreds of available data points? Maybe Vendor A takes the mathematical representation of the palm vein scan and uses 25 data points of their choosing to construct a verifiable user ID, while perhaps Vendor B uses a different 52 data points to string together their own ID characteristics. That form of “encryption” allows each vendor to positively ID patients using characteristics that are meaningless outside their own environment, making it pointless to steal the entire biometric database because it doesn’t work on other systems. Even if Vendor A gets breached, they can simply choose a new algorithm and convert existing profiles, immediately locking their own systems back down while preserving the ability to keep using biometrics without noticeable patient impact. Interoperability of biometric ID is unnecessary – it’s perfectly fine for individual IT systems to positively ID patients from their individual, proprietary subset of the entire biometric scan.

A reader told me about this 2013 TEDMED video by ZDoggMD on testicular self-examination, set to the crotch-grabbing music of Michael Jackson. It’s brilliant. “I’m checking out my nads in the mirror.” He was on stage at HIStalkapalooza with Jonathan Bush.

HIMSS Media was doing a live radio show from the exhibit hall. I can’t imagine that anyone was actually listening.

CareTech had their “mission control” display out. Pretty cool.

Allscripts had quite a few people in their booth today.

The coolest product I saw was from EchoPixel, which is exhibiting “blended reality” in the HP booth. It’s a fuzzy monitor image above because it’s 3D, but putting on the 3D glasses makes it shockingly real for clinicians to look at diagnostic images spatially, practice their procedures, and interactively pick up and move objects like implantables to plan surgeries. Not only was it super cool, the friendly lady showing it was Janet, who has a biomedical engineering PhD from Cal Berkeley (she was shyly embarrassed a little when I noticed the credentials on her business card and starting gushing like a star-struck fan). It was an outstanding product demonstrated by a really cool engineer. You should see it before the exhibit hall closes Thursday.

Epic’s booth sign claims that moving from Cerner or Allscripts increases profitability.

Cerner strikes back in pointing out that Banner bought University of Arizona Health Network and promptly announced plans to replace Epic with Banner’s Cerner systems. UA had made a bit of a mess of it, with project budget overruns being one of several reasons it had to sell out to Banner.

Hall G is a lot of tiny booths of mostly unknown companies. I’m sure there’s some good stuff down there, but it was sort of depressing down there in the basement, especially knowing that companies paid dearly for a low-traffic location.

Legacy Data Access made their point with a dinosaur. Pretty cool.

I asked NTT Data about Bob the amazing magician they have in their booth. Apparently he’s about to retire, but they’re hoping to lure him back next year. I commented that I saw him doing absolutely unreal things in talking about the deceased relatives of some HIMSS attendees watching his performance – they said that in the demonstration shows he did for their employees, several left the room crying after his apparent contact with their family members who have passed on. I wouldn’t have believed it myself, but I strongly recommend that you see him Thursday and decide for yourself. I thought I was going to have to physically support my fellow HIMSS attendee whose deceased grandmother Bob described in amazingly precise detail despite knowing nothing more than her name.

Thanks, LifeImage, for the cool backup battery for electronics.

Our booth neighbors Stericycle Communications have been tolerant of our never-ending parade of visitors. Stop by and have your picture made with Elvis – it will make their day. They’re nice people.

I don’t understand how either of these neighboring companies are still in business.

I heard the hall-filling sound of singing and found Anthelio’s Sinatra imitator cranking up his backing music to very high levels. You could hear him 20 rows over. I’m sure neighbors complained given the strict HIMSS rules on sounds or activities that detract from other exhibitors, so I’m certain they had to turn it down. He was OK.

I saw quite a few vendor people eating lunch in their booths out in the public areas. Bad idea. Attendees are either going to feel they’re intruding or they’re going to get hungry. You’re on stage when you’re in your booth on the time clock, so act like it.

Every year I’m amazed at how customer-indifferent the people working the Microsoft booth are. I stopped by today as the only person in front of four Microsoft employees standing in in front of some notebooks and Surface Pro devices. Two immediately walked away chatting together as I stood there trying to make eye contact, while the remaining two talked among themselves in studiously avoiding eye contact until I finally left. They really are self-important geeks who shouldn’t be allowed within 100 yards of prospects or customers, yet every year I experience the exact same treatment in their booth.

Medecision’s mentalist was sporting a cool suit.

I was happy not to see the distractions of previous HIMSS conferences like people pretending to be statues, dozens of booths baking cookies, and golf simulators. Here’s the odd thing, though: nearly every vendor was giving away pens, but I couldn’t find a single one offering anything to write on. I really needed a notepad.

I found myself pondering why low-level vendor employees have to wear company shirts while on HIMSS booth duty, while their richly compensated bosses don suits instead. Shouldn’t the company’s highest-paid person be proudest to work there?

The HIMSS “Ask Me” people are really friendly and helpful. Kudos to them.

Overheard: “Todd Park left Athenahealth with $40 million in shares to go to work as HHS CTO. Federal service requires liquidating such holdings, but since the government then recognizes the proceeds as tax free, Todd avoided paying the many millions of taxes that would have otherwise been due on the $40 million stock sale. I’m not saying he took the job for just that reason, but the man knows how to work a spreadsheet to his advantage.”

Cerner’s booth had an open feel, complete with a journey through various healthcare settings.

The DoD EHR project got some podium and booth time.

Epic claims to not have a marketing department, but someone there is doing a pretty good job of stating the company’s case.

Morning Headlines 3/3/16

ONC proposes greater oversight for EHR vendors

ONC publishes a proposed rule granting it authority to regulate EHR certification testing bodies, as well as review certified health IT products for information blocking and potential risks to patient safety,

EHR adoption is a great success! Except that docs still hate them

During a panel discussion on EHRs and interoperability, National Coordinator Karen DeSalvo,  MD and CMS Acting Administrator Andy Slavitt, MD offer contrasting views on the future of healthcare. Slavitt explains his pessimism, “She works with the technology community, which is making tons of progress. I’ve been spending the last few months hearing from physicians trying to use technology, I think they affect my mood just a little bit.”

Garmin and Allscripts Enter Strategic Relationship to Improve Patient Care

Allscripts partners with Garmin to integrate real-time patient generated health data captured by Garmin’s fitness trackers into Allscripts’ population health manager solution. Berkshire Medical Center (MA) will pilot the technology.

Jenn’s HIMSS 3/1/16

Oh, how naïve I was to think that I could sleep past 4:30 am Vegas time … The early start was actually a good thing, giving me plenty of time to get my bearings, enjoy the eventually beautiful sunrise, and prepare for the day’s events.

My first stop was the HIMSS16 Media Breakfast, during which panelists from HIMSS, including HIMSS North America Executive Vice President Carla Smith, Divurgent Vice President of Clinical Information Dana Alexander, and Metro Health (OH) Vice President and CIO Don Reichert took members of the press through results of the association’s 27th annual leadership survey. The two big takeaways seem to be that more and more providers are including a clinical IT executive in their C-suites – a trend that is having a “notable impact on the organization’s orientation toward health IT.”

The other is the association’s long overdue focus on the gender-based wage gap, and the larger conversation that opens up about diversity. Survey findings indicate that women lag behind men by about $25,000 in compensation for C-suite roles. Kudos to Smith for taking the lead on bringing these statistics to light. She and her team are hopeful that the findings will lead to additional research that will in turn evolve into HIMSS resources and programs focused on engendering diversity in organizations that have historically been led by white males. Reichert held up Metro Health as an example of an organization that has made a conscientious effort to focus on diversity in its hiring practices via new programs. Perhaps that’s the kind of case-study session HIMSS needs to think about offering next year in Orlando. 

I headed over to the HIMSS Spot shortly after the breakfast, where I caught up with ONC CNO Rebecca Freeman, RN University Hospitals Health System Interim CIO Sue Schade, and Encore Health CEO Dana Sellers at the #healthITchicks meetup. All three had great advice to share on balancing work and life, especially when caring for young children and aging parents; working in a male-dominated field; and encouraging young women to learn more about STEM.

My favorite session of the day by far was the lunchtime “View from the Top” featuring Beth Israel Deaconess CIO John Halamka and Athenahealth CEO Jonathan Bush. The duo tag teamed a talk about how far we’ve come in health IT, how far we have to go, and the opportunities that are staring us right in the face. Their talk was a bit toned down compared to their on-stage antics at HIStalkapalooza the night before. I had no idea Halamka was such a great speaker, or that he is the nation’s leading expert on poisonous mushrooms and plants. Apparently he does a brisk business in telemedicine visits with parents of children who’ve eaten mushrooms (the garden-variety kind and the psychedelic kind) , and adult nature lovers who are convinced the wild variety they find in the woods will go great in homemade stroganoff.

What was perhaps most interesting to me was the juxtaposition of Halamka’s humorous (the Chairman Mao-Meaningful Use analogy was hilarious) yet critical eye towards government regulations with Bush’s obvious ability to make money off of those burdensome, click-inducing regulations. Yes, the top vendors can get together at posh resorts and commit to sharing data with one another (as the picture above shows them doing at the recent KLAS summit.) Yes, they can publicize their pledge to HHS that they will help consumers access and share their health data, preclude information blocking, and implement government-friendly interoperability standards … but what will that look like in practical terms and how long will it take? As CMS Acting Administrator Andy Slavitt mentioned during a media briefing later in the afternoon, we’ve really got to push vendors to do the things they say they’re going to do. There’s no letting up if the journey towards interoperability is ever going to progress.

Things lightened up once I headed over to the HIStalk booth. (If you’re looking to find us in the 5000 row, wind your way through or around Epic then head straight back. We’re near the fun folks at MedData and next to Stericycle, which has a fun array of gummy candies to nosh on. I had the chance to chat with “HIStalk Celebrity Lawyer” David Schoolcraft, who I hope will swing back by and keep me company at some point. I also got to pick the brain of passers by including Michael Paul Gimness, MD (above) of Family Medical Specialists of Florida and Mike Narumiya, director of data and information systems at North Central Texas Trauma.

Gimness, whose practice runs Allscripts and Caresync for CCM was roaming the aisles in search of additional population health tools to help him make the move towards value-based care. Given that I had just spent come out of a media briefing with Andy Slavitt, I asked Gimness about his thoughts as an independent doc on MACRA. “I feel MACRA’s coming, and it’s going to stay. They can say they’re getting away from MU, but they still have to have a carrot and a stick when moving towards population health and value-based care. I don’t like docs getting penalized, but it’s the government’s money and they can do what they want with it. I can’t opt out of Medicare or Medicaid. My staff is not going to take a pay cut.”

Narumiya, meanwhile, was on the hunt for security tools, which were easy to find given that, in his opinion, at least a third of the booths had products related to privacy and security. (Thus far both he and Dr. Paul have validated my initial predictions of cybersecurity and population health management being big items of interest at HIMSS. Validation feels good.) He has shied away from looking into products from the big vendors, opting instead to focus on smaller companies and startups. He also mentioned that his organization has been happy with encryption tools from DataLocker.

The fun folks at Mobile Heartbeat trekked across the aisle to introduce themselves to us. Their booth seemed to have consistently busy traffic. Providers must still have a strong interest in migrating from pagers to mobile clinical communications (or making a vendor switch).

I didn’t spend much time wandering around the exhibit hall today. I’m pretty sure Mr. H and Dr. Jayne will cover that part of the conference in their typically excellent fashion. I did make a point to stop by the Georgia HIMSS reception to say hi to friends. On the way I just had to snap a pic of the ScienceLogic trio above. I wonder if they’ll give me a shirt if I talk nerdy to them?

The reception was buzzing, as was the Intermountain Healthcare bus. I wonder if I could sneak on board and use what I’m sure is far more reliable WiFi than the tenuous exhibit hall connection provides. Intermountain CIO Marc Probst – who was coincidentally up for a HISsie – seemed very excited about the bus when I interviewed him a few weeks ago. He mentioned that he too will be looking for security solutions during the conference.

My last session of the day featured a fireside chat with National Coordinator Karen DeSalvo and Andy Slavitt. The two seemed completely at ease with each other – joking about their tendencies to be positive (DeSalvo) and negative (Slavitt). Slavitt humorously pointed out that of course DeSalvo’s positive – she spends her time with technology and vendors. He, on the other hand, has been spending a lot of time lately with grumpy physicians. The two took a good hour to cover the evolution of Meaningful Use and hopes for MACRA, highlighting the aforementioned pledge from healthcare stakeholders to make EHRs work better for patients and providers, and the just-announced “FHIR Cloud” – a new FHIR app ecosystem that will incorporate app challenges and resources to help providers and consumers take advantage of innovative tools based on open APIs.

My favorite part of the presentation came when Slavitt started getting into the nitty gritty of his recent physician focus groups. The comment above is just one of hundreds he’s been listening to throughout the course of eight meetings with providers. A telling comment: “To order aspirin takes eight clicks on the computer. To order full-strength aspirin, 16. That’s not patient care. It’s clicks.”

My evening ended at the HIMSS Women in Health IT Reception at Madame Tussaud’s –  a unique venue if ever there was one. I spotted DeSalvo mixing and mingling. I wonder if she thought the figurines were slightly creepy like I did. I did end up taking a pic with Andre Agassi, just to show my tennis team. All in all, my second day at HIMSS proved to be fun – great sessions, tremendous networking, and beautiful weather. Now if I could just manage to sleep a little later … 

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