Morning Headlines 12/28/15

Why the AMA president wants the government to back off

AMA president and emergency room physician Steven Stack, MD calls EHRs the leading frustration of providers today, saying that they decimate efficiency and cripple communication.

Faster Medical Attention With App

In Jersey City, public health officials are rolling out an app that will alert nearby first responders if someone calls 911 in need of emergency medical assistance. The project will cost $2 million and includes costs to train and equip volunteer first responders.

Top Defense Contractors have Paid more than $7 Billion in Misconduct Penalties Since 1995

McKesson appears in a watchdog report on government spending for being the most penalized DoD contractor for misconduct, having paid $2.05 billion in fines across 24 instances of misconduct since 1995.

Monday Morning Update 12/28/15

Top News

AMA President Steven Stack, MD says EHRs are the #1 frustration of doctors, explaining,

We live in a world where a 2- or 3-year-old can pick up a smartphone and use it with no instructions. If you’re not careful, they’ll order from Amazon and have something delivered to your house two days later. But we have graduate-educated physicians who are being forced to use software that looks like it’s on an old-fashioned, DOS-based system, a Tandy, an Atari, the kind of software you can only see in a museum. And that’s the software we’ve been given to manage patients’ health and well-being. So you have physicians whose efficiency is decimated. Their ability to communicate with each other is completely crippled. And then they’re told you’re not doing a good job.

Reader Comments

From Coal-Bearing Santa: “Re: Marshfield Clinic. I’ve heard that CareCloud has made a deal for its Cattails system and will white label it as an additional CareCloud product.” I forgot that the organizations announced a deal in April 2015 to sell software and services to large physician groups.

From Frisbee Golfer: “Re: Claritas Mindsciences. The three-person firm (everybody is a consultant), which makes the Craving to Quit app, has asked consultants to work for half their normal rates and is struggling to pay vendors after they failed to raise funds for operations in December.” Unverified. Their executive page still lists four people, but what drew my attention is that the company spelled its own name incorrectly on the exec page and sometimes uses “Mindscience” instead of “Mindsciences.”

From John: “Re: NHS. They have the top Christmas song!” In England, the Lewisham and Greenwich NHS Choir beats out Justin Bieber for the top Christmas song. Bieber encouraged his Twitter followers to buy the record instead of his own, which sent it to the top of the sales chart. Proceeds will be donated to charities.

HIStalk Announcements and Requests

Three-fourths of poll respondents say they had at least as good a year in 2015 as they did in 2014. Pablo says he left the health IT staffing market because business is dying due to EHR vendors expanding their own internal consulting teams, a saturated and commoditized market, and staffing companies that failed to transition into advisory services.

New poll to your right or here: which company did you lose the most respect for in 2015? Vote and then click the poll’s Comment link to explain.

I’ll be closing my reader survey shortly, so you’ll have done your good deed for the next year if you take two minutes to complete it. I’m already contemplating one change as suggested by a reader who would like to see more in-depth reporting in particular areas.

My latest pet peeves: (a) people who say, “I get that” in subtly but indignantly correcting someone who they perceive believes otherwise;  (b) those folks, mostly younger, who respond to a thank you with, “No problem,” thereby devaluing the act that triggered my gratitude by suggesting it wasn’t much effort for them; and (c) Facebook users who excitedly “like” obviously phony stories without bothering to check Snopes.com first, like photos of the Egyptian pyramids covered by snow after a freak storm.

We funded four tablets for three pre-K classrooms in New York via DonorsChoose. Mrs. Martin says many of her students had never seen a tablet. They watch videos on them, trace on-screen letters with their fingers to learn to write, and play educational games. That’s a pretty strong ROI for tablets that cost only $41 each.

An anonymous donor sent $500 for my DonorsChoose project, which was matched by the Bill & Melinda Gates Foundation in a one-day funding special and then the $1,000 total was matched again by my anonymous vendor executive, allowing me to fund these projects (some of these had additional matching funds applied as well):

• 10 sets of headphones for Mr. Ohlinger’s middle school science class, Canton, OH
• A Bluetooth robotic arm, a solar powered robot, and a BoeBot robot kit to create a robotics team at Ms. Sobosan’s high school in Las Vegas, NV
• 15 scientific calculators for Mr. Cho’s Bureau of Indian Affairs high school class in Lower Brule, SD
• Math story books for Ms. Livingston’s third grade class in Las Cruces, NM
• Headphones, whiteboards, privacy partitions, and paper supplies for Mrs. Heinrich’s elementary school class in San Jose, CA
• Three tablets for Ms. W’s second grade class in Oakland, CA

Anonymous Epic QA donated $100, with multiplied into $400 due to Gates Foundation and my vendor exec matching money to buy these items:

• Engineering toys and team building sets for Ms. Medina’s first grade class in Los Angeles, CA
• 25 sets of headphones for Mrs. Riley’s second grade class in Baltimore, MD
• An iPad Mini for Mrs. Ulhaque’s first grade class in Houston, TX

I had a little bit of extra money in the account, so I decided to buy a Chromebook, wireless printer, and supplies for Mrs. Hamilton’s fourth grade class in Carson, CA. I also realized that when I announced that donations had funded $22,000 worth of projects in 2015 that I was off considerably – all of the recent donations were via gift cards and those show on the donor’s totals, not mine. The actual total is a lot higher and even that doesn’t take into account matching funds from foundations.

Last Week’s Most Interesting News

• The Department of Defense expands the scope of the DHMSM project in giving Leidos/Cerner a no-bid hosting contract, saying Cerner’s systems won’t work properly unless the company hosts them itself.
• Medicare releases a dashboard showing its drug-specific spending.
• Martin Shkreli is arrested on securities fraud charges and fired as CEO of the two drug companies in which he holds substantial ownership.
• Congress passes a blanket Meaningful Use hardship exemption.
• Vanderbilt University Medical Center announces that it will replace McKesson’s Horizon Expert Orders, which VUMC originally developed as WizOrder, with Epic.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

A watchdog’s report finds that McKesson paid the most money in misconduct penalties of all Department of Defense contractors since 1995. McKesson paid $2.05 billion in penalties for 24 instances of misconduct while earning $6.2 billion of the Pentagon’s business.

The Greenville, SC paper profiles local personal health records startup ChartSpan, which says it will grow from 20 employees to more than 200 within the next two years.

People

Eric Alper (Lifespan) is named VP/chief clinical informatics officer at UMass Memorial Health Care.

Firelands Regional Medical Center (OH) promotes Denao Ruttino to AVP of operations.

Other

New York-based non-profit United Rescue is spending $2 million to train and equip volunteer first responders in Jersey City, NJ who will be notified via a smartphone app when someone nearby calls 911 with a medical emergency, allowing them to render aid to the victim before paramedics arrive. The program is modeled after one in Israel where 3,000 volunteers respond to 700 emergencies each day for a program cost of $7 million per year.

Impact Advisors sent over photos from their holiday employee gatherings across the country, including this one from Chicago.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

Morning Headlines 12/24/15

Outcomes From Health Information Exchange: Systematic Review and Future Research Needs

OHSU researchers systematically review studies on health information exchange outcomes, concluding that the full impact of HIEs on outcomes are inadequately studied. The researchers recommend more rigorous study designs and creation of standards by which to describe the various types of HIEs.

Mount Sinai Hospital Launches Initiative to Improve Transitions of Care for Venous Thromboembolism Patients

Researchers at the Icahn School of Medicine will receive a $500,000 grant to develop an app for patients recently diagnosed with VTE. The app will support patients as they transition out of the hospital by offering medication adherence support, symptom tracking, and a way of communicating with a dedicated clinical worker that can answer questions.

Bribery probe nets $12M and more than two dozen doctors

Investigators in New Jersey are charging Biodiagnostic Laboratory Services with paying monthly cash bribes to more than two dozen local physicians in exchange for blood work referrals that resulted in more than $100 million in Medicare payments.

Morning Headlines 12/23/15

The 2016 Interoperability Standards Advisory is Here

ONC releases its 2016 Interoperability Standards Advisory, a catalog of federally recognized interoperability standards and specifications.

Defense Healthcare Management System Modernization (DHMSM) – Hosting Scope

DoD modifies the scope of its DHMSM program, adding a no-bid contract to Leidos for hosting services that are expected to cost $5 million per year.

Medicare Drug Spending Dashboard

CMS releases an online dashboard that highlights drug-specific spending trends for Medicare Part B and Part D prescriptions.

Baby Boomers Set Another Trend: More Golden Years In Poorer Health

A USC report predicts that Medicare spending will more than double to $1.2 trillion by 2013, with cost increases attributed to an aging baby-boomer generation that is in poorer health than prior generations, but has a longer life expectancy.

News 12/23/15

Top News

ONC releases its 2016 Interoperability Standards Advisory that lists federally recognized interoperability standards and guidance.

Reader Comments

From Ambient Occlusion: “Re: homegrown EHRs. Regenstrief/Eskanazi signed up for Epic earlier this year.” Somehow I was thinking Marshfield Clinic and my fingers typed Regenstrief instead when I was trying to think of the last few health systems that are using homegrown EHRs (BIDMC is the other) now that Vanderbilt is moving away from WizOrder/Horizon Expert Orders in favor of Epic. I replied as such to Ambient Occlusion, who then pondered what Marshfield will do after pumping so much money into Cattails. He added a theory that they’ve probably capitalized some of their software development costs and would therefore not only need to spend big money to replace their self-developed product, but even more to write down whatever of its depreciated costs that remain on the books. Marshfield has tried to commercialize Cattails, but given that the newest press release on their site is from 2010, I’m guessing it’s not burning up the EHR charts.

From Benign Growth: “Re: HIStalk. I’m new here and I can’t figure out who’s writing what.” That’s easy – every word you read in an HIStalk news post is mine (Mr. HIStalk, aka Mr. H) unless I’m taking a rare day off and Jenn is covering for me. It always amuses me when people refer to the HIStalk “team” as through there’s a bunch of us working full time in an office. I write HIStalk, Jenn writes HIStalk Practice, Lt. Dan writes the HIStalk headlines and HIStalk Connect, and Lorre handles the webinars and sponsor activities. We each do our own thing with minimal contact with each other since we’re spread out and don’t need much supervision. Our past and present day jobs didn’t often support the creativity and fun we enjoy here. It will be 13 years in June since I started HIStalk and I still can’t wait to start filling the blank page every day.

From Rough Taxpayer Sex: “Re: DHMSM. SPAWAR has added a sole-source hosting agreement to Leidos/Cerner. This looks like a total scam. Either they lied in the RFP about what they could provide or they’re lying now.” DoD awards Leidos a no-bid Cerner hosting contract that it claims won’t cost more than $5 million per year, explaining the need to modify the scope of the $4.3 billion award as follows below. Note that it’s nobody’s fault according to the wording – Leidos didn’t suggest that service and the government people involved could not have anticipated the need for it (I expect this excuse to be re-used for future expensive scope changes):

While Leidos solution meets the contract requirements, many of the capabilities of the DHMSM EHR cannot be fully realized unless they are hosted in the Cerner environment. In order to fully enable these functionalities, the DHMSM EHR requires direct access to proprietary Cerner data, which is only available within Cerner-owned and operated data centers. The proprietary data consists of quantitative models and strategies which are the result of extensive Cerner-funded research and development efforts conducted over 15 years. The models are based on analysis of clinical, operational, and financial data associated and incorporate vast amounts of actual longitudinal patient data and information collected through other Cerner applications. Forward deploying the DHMSM EHR into any other hosting solution would prevent access to these models and data. Significant functionality exists within the required system that utilizes machine learning and computational statistics to enable predictive analysis and decision support that directly impact patient outcomes. Therefore, no other contractor can satisfy the requirement. Prior to awarding this performance-based contract, the Government could not have anticipated this solution-specific need, which is why this scope was not included in the original RFP.

HIStalk Announcements and Requests

I use the responses from my once-yearly reader survey figure out what I’m doing well and not so well. I would appreciate two minutes of your time to complete it. That will also place you in the running as the randomly chosen recipient of a $50 Amazon gift card. I used previous survey results to make changes that became into some of the most important attributes of HIStalk, so your time will not be wasted. I get a lot of great ideas from the survey, although I have to be careful not to: (a) fix something that isn’t broken; (b) do something that isn’t true to my personality or passions; (c) take on more work than I can handle effectively; or (d) do something that would make writing HIStalk less fun so that I would be tempted to quit doing it.

An anonymous Epic developer donated $200 for my DonorsChoose project, to which I applied matching funds from my anonymous vendor executive as well as from private foundations to purchase these items:

• Fraction, decimal, and percent learning tools for Mrs. Sutton’s third grade class in Herrin, IL
• A Chromebook for Ms. Marlowe’s kindergarten class in Charlotte, NC
• Math games and learning materials for Ms. Osborne’s elementary school class in Columbia, SC
• Math games and a learning center rug for Mrs. Begg’s middle school class of learning and emotionally disabled students in Baltimore, MD

Ms. Osborn’s Florida second graders, many of whom are children of immigrants and frequently-moving military families, are working in teams using the STEM materials we provided via DonorsChoose to solve real-world engineering problems.

Also checking in is Ms. C from South Carolina, who teaches a class of severely intellectually disabled seventh and eighth graders for whom our DonorsChoose donation provided a library of around 100 high-interest, low-readability books. She provides background on the student in the photo above as an example: “The picture of the boy reading a book with my Dr. Seuss hat on is a child from a low-income family. He will come to school hungry and is usually very sleepy because he can’t sleep at night. He is very capable of reading better than he does right now. He loves to go over to my little classroom library and pick out a book to read. The other day he told us that he is actually leaning something this year. Until this project was funded, I really didn’t have enough books for a classroom library, but now I do.”

It’s that time of year where we’ve now gotten past the shortest day (December 21) and spring and the HIMSS conference aren’t far away. I’ll probably take this Friday and next off since I doubt many folks will be reading on Christmas and New Year’s eve and day. I expected to be mostly loafing around for most of December since it’s usually slow, but I’ve been pretty busy with fresh news and lots of companies are signing up as HIStalk and HIStalkapalooza sponsors. It’s good to keep busy, for which I thank every person who reads HIStalk and every company that supports it.

Thanks to the following sponsors, new and renewing, that have recently support HIStalk, HIStalk Practice, and HIStalk Connect. Click a link for more information.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel

Acquisitions, Funding, Business, and Stock

Invoice Cloud acquires Imagevision.net, which offers the HealthPay24 point-of-service payment product used by 100 hospitals.

The professional regulator in England bars two former finance directors of one-time NHS software supplier iSoft (now owned by CSC) from practicing accounting for eight years for their involvement in the company’s financial irregularities nearly 10 years ago. Four company executives were acquitted in 2013 of securities charges.

Sales

Northern Arizona Healthcare chooses Cerner Business Office Services for its ambulatory clinics and ACO, apparently replacing Athenahealth.

Announcements and Implementations

Summit Healthcare releases a Cerner-specific version of its domain compare-and-sync platform that supports data extraction, analysis, regression, and testing.

Halifax Health (FL) goes live with Wolters Kluwer Health’s POC Advisor for real-time, data-driven sepsis alerts and advice.

Government and Politics

CMS releases the Medicare Drug Spending Dashboard that includes the top 15 drugs by overall annual cost and per Medicare user as well as the drugs whose price jumped the most in 2014. The $1,000 per tablet hepatitis C drug Sovaldi topped the list as Medicare spent $3.1 billion on it at an average per-patient cost of $94,000. The most expensive drug per patient was Remodulin, used to treat pulmonary arterial hypertension, which cost an average of $134,000 per patient per year. You will recall that the Affordable Care Act prohibits Medicare from negotiating drug prices, a carrot added by the White House to appease drug companies who otherwise would have used their political clout to kill its administration-defining initiative.

Kansas state auditors say the state’s delayed Medicaid system rollout was due to unrealistic timelines and unmet functionality promises from contractor Accenture. Federal taxpayers are footing most of the cost of the Accenture contract that is worth $135 million upfront and $50 million for ongoing maintenance. Auditors predict that the project will run $46 million over budget, with nearly all of that bill also being passed along to federal taxpayers.

CMS is investigating complaints filed by two former Theranos employees who claim that the lab company instructed its employees to continue using its proprietary testing technology despite “major stability, precision, and accuracy” problems. The former employees said results varied widely and that quality control checks of the testing method often failed. Theranos says the former employees are just disgruntled. The company continues to claim that it will publish peer-reviewed data proving its claims, but says they aren’t yet ready.

Other

Baseball data analysis expert and Harvard-trained statistician Paul DePodesta, played as a composite character by Jonah Hill in the movie “Moneyball,” joins Scripps Translational Science Institute in a part-time, unspecified role. He says in an interview conducted by his new co-worker Eric Topol, MD:

If there’s a player who has been in the Major League for say five years, we have an awful lot of data on that player. So when we’re making a decision on that player, we may largely be using data to make that decision. Go to the total opposite end of the spectrum – a 15 year old playing in Maracaibo, Venezuela – we don’t have a whole lot of data on him. We have some, what I would call sort of outside data. We know about players form that area, we know players of his size, his strength, his age, his position. Not necessarily specific things about him, but we can create general conceptions about what that player could be expected to do based on all these other players have done who are similar to him in same fashion … people are trying to get their arms around uncertainty and trying to make better decisions for the future and realizing that data can really help them do that. Whether it’s financial services or trucking or farming, I mean there are all sorts of different industries that I never even dreamed of back when the book first came out and even when the movie came out that have reached out to us — to me or to Billy or to others — and have said, “We’re doing this now and it’s really helping — do you have other ideas about what we might be able to do?

Speaking of “Moneyball,” I’ll say again that of the many conference speakers I’ve seen, the best was Billy Beane of the Oakland Athletics. If you haven’t seen the movie, here’s a recap. Beane’s team didn’t have the money to sign or retain big-name players who made occasional crowd-pleasing plays yet failed to achieve consistency, so he measured and analyzed available player performance data to choose lesser-known and therefore less-expensive players who produced consistent but unspectacular results, like getting on base a high percentage of the time, and then managed using those specific strengths to produce team wins. I thought it was bizarre that Health Catalyst chose Beane as a keynote speaker for its first Healthcare Analytics Summit in the fall of 2014 until I heard him.

A USC report predicts that Medicare spending will double to $1.2 trillion by 2030 as per-beneficiary costs rise 50 percent, caused by aging baby boomers who — much more than in previous generations — are overweight, disabled, and suffering from chronic conditions. In other words, people who might have died from now-preventable heart disease will live longer and more expensively in requiring treatment of cancer and Alzheimer’s disease.

CMS identifies at least five drugs whose cost doubled in 2014 from the new Medicare Drug Spending Dashboard that I mentioned above, with the ridiculously unoriginal Vimovo (two old generic drugs combined, naproxen and esomeprazole, the first for pain and the second to reduce side effects caused by the first) leading the list after a new company bought the drug and raised its price 500 percent. Ancient drugs captopril and digoxin were among the leaders, which cries out for some sort of action to stop companies from buying the rights to old drugs and then jacking up their prices to yield pure profit without the inconvenience of performing research studies or creating something new that might benefit patients rather than shareholders.

I also note that Vimovo maker Horizon Pharma is using a now-common drug company trick to increase patient demand while raising societal costs overall – its “support card” promises that patients will pay little or nothing as co-pays even while the company is sticking their insurance company for the inflated cost. Medicare spent $39 million on this lame drug in 2014, which of course means doctors prescribed it quite a bit for reasons that probably aren’t entirely rational.

It hasn’t been a great week for Martin Shkreli, who in addition to being arrested on securities fraud charges and then fired as CEO of Turing Pharmaceticals, has now been fired as CEO and board member of KaloBios, the drug company he bought just a few weeks ago. Meanwhile, Shkreli tells the Wall Street Journal that the government trumped up securities charges in desperately trying to find something to arrest him for. He also claims that his over-the-top behavior is “a social experiment” that makes him an undeserving target. He would make an ideal HIStalk interview, although I’m not holding my breath.

This image has been used so many times without attribution that I can’t tell where it came from, but I saw it on LinkedIn and liked it.

Gallup’s annual poll of most honest and ethical professions finds nurses, pharmacists, and physicians taking the top three spots. The last-place finishers are members of Congress, telemarketers, and lobbyists.

Sponsor Updates

Blog Posts

• Start with Why (Iatric Systems)
• Unified Care Teams Need a Unified Communications Strategy (PatientSafe Solutions)
• Information Management #2 – Bad Data (Clinical Architecture)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

Morning Headlines 12/22/15

Congress passes blanket MU hardship exemption

The House and Senate pass S. 2425, a bill that provides blanket hardship exemptions that will allow practices and hospitals attesting to meaningful use to avoid 2017 reimbursement penalties.

US Probes Theranos Complaints

The Wall Street Journal reports that the FDA is investigating several new complaints it has received from former Theranos employees, including one that questions the accuracy of the company’s only FDA approved blood test.

GOP senator lifts hold on health nominees

Freshman GOP Senator Ben Sasse (NE) has lifted his hold on HHS confirmation hearings after the administration releases documents about ACA co-op performance. The decision paves the way for National Coordinator Karen DeSalvo, MD to be confirmed as the Assistant Secretary for Health.

Shkreli fired from KaloBios

Former Turing Pharmaceuticals CEO Martin Shkreli has been fired from his position as CEO at KaloBios Pharmaceuticals as he awaits his trial for securities fraud.

Curbside Consult with Dr. Jayne 12/21/15

The year is rapidly coming to a close. Typically this is the time when things are relatively slow in the industry trenches, at least until the first of the year when the frenzied run-up to HIMSS begins.

I’ve got my countdown page ready, not because I’m dying to go to HIMSS, but because I’m excited to see many of the friends I’ve made in the IT world that I only get to see once a year. Although we stay in touch through email, it’s just not the same as being able to get together in person, share a drink, and swap stories. Of course I’m also excited about HIStalkapalooza, although I haven’t given a single thought to my shoe wardrobe yet.

Several of my colleagues are still waiting to see if they will be able to make it to HIMSS. Those who are vendor employees have seen cuts in the number of attendees sent by their companies the last several years. Others from the provider side sometimes find HIMSS to be not only overwhelming, but given the current economics of medical practice, not worth the cost. There are also those who work at faith-based organizations that will not pay for conferences held in Las Vegas, but at least those folks know outright that they’re not going to attend unless it’s in Orlando since everywhere else seems to be out of the running.

I’m wondering what the big buzz will be about this year. Meaningful Use is old hat, although there will still be some picking over the bones of Stage 3. Value-based reimbursement has been on the rise, although for many, it’s more of a buzzword than an actual strategy.

The reality of putting together some of the IT infrastructure required to maximize the promise of value-based reimbursement is daunting. Although the large health systems and academic medical centers can be demanding about their networks and try to control their physicians, it’s put a terrible strain on independent practices and also on patients who want to see physicians across multiple systems but are being steered to stay within the vertical. It was bad enough when insurance networks were restricting choice, but to have your physicians negatively incented to refer you to the consultant of your choice is another thing entirely.

Many people think that interoperability should solve this problem, but the reality for many physicians is that interoperability is a joke. Not only are there incentives biased against sharing from the hospital side, but as an independent physician, I can’t even get access to the hospital web portals in my area because I’m not on staff.

Being a member of the medical staff has not only a financial cost but a professional one, with many hospitals requiring physicians to provide call coverage for patients in the hospital. Although that requirement can often be shifted to a hospitalist physician, they also require physicians to be available for outpatient follow-up, which is nearly impossible when you are a part-time physician at a practice that doesn’t have scheduled appointments and doesn’t provide primary care.

I would love to be able to log into a hospital portal and get follow up on the patients I have to transfer to the hospital. We’re seeing more and more of them as cost-shifting drives them to urgent cares when they really should have been in the emergency department in the first place. Although we’re pretty advanced at my facility, the last few shifts I’ve worked have included multiple ambulance transfers for people who were actively having heart attacks. There was one just the other night with a life-threatening stomach bleed, which let me tell you looks pretty much exactly like it does when they show it on TV medical programs.

All of the patients I’ve had to transfer have cited cost and access as the primary reasons they chose us instead of another facility. Since my roots are in primary care, I always wonder how they are doing, but I never see a discharge note or any kind of communication from the hospital despite my multiple Direct addresses that should make it easy. Maybe I should head to the mall and ask Santa to bring me some discharge summaries for Christmas. I’m not sure if the elves have signed a BAA, however.

I’m winding up the year with a last-minute lab interface project that is keeping me pretty busy. The client is super nice and had an issue with their lab vendor canceling their contract with minimal notice, so they’re in a hurry to get a new one live before their interface is shut down. The work is somewhat tedious, but that will be good to keep me busy.

Today is the shortest day of the year and I’m glad it’s here. I’ve missed having light in the evenings and have had to spend more time on the treadmill than I like. I’m looking forward to longer days and being able to get back on the streets without fear of a broken ankle from tripping over something in the dark. We certainly can’t have that in the run-up to HIMSS. Once this project is done, I’m laying low until the New Year.

What are your plans to wind up 2015? Email me.

Email Dr. Jayne.

Readers Write: Inventing the Mid-Cycle with Patient Self-Service

Inventing the Mid-Cycle with Patient Self-Service
By Janie Tremlett

It’s no surprise that payment models in healthcare are transforming. What may come as a surprise, though, is how quickly these models are transforming. Healthcare is rapidly moving to incorporate measures of value into payment models, with more than two-thirds of payments expected to be based on value measurement in five years, up from just one-third today, according to a study conducted by ORC International.[1]

The study goes on to state that most of the key obstacles that need to be overcome during this shift are technology-related, with one of the biggest technology problem areas being data collection, access, and analytics. Hospitals and health systems’ financial health is now come to depend on getting and accessing accurate and current data, documenting data, and ultimately delivering good clinical outcomes.

Defining the Mid-Cycle

The mid-cycle is where revenue cycle meets clinical interactions and patient access. A value-based reimbursement system requires tighter integration of clinical records and other systems with providers’ financial systems. Today, however, a key bottleneck for many hospital revenue cycles occurs in the link with the clinical side. Identifying this bottleneck area and learning how to optimize it is critical for healthy financial performance, solid clinical performance, and for patient satisfaction and engagement. 

How can we optimize it? Start small.

Capturing Data Pre-Service

There is an opportunity to engage patients in a pre-registration workflow pre-service — before they have even stepped foot on premise — on a personal device, such as a laptop, smartphone, or tablet. Several items go into a pre-registration workflow, some of which can include a confirmation or update of a patient’s demographics and insurance information, completion of forms and questionnaires, and bill payment. Capturing that information beforehand has a great impact when it comes to anything that needs to be sent to the patient, such as appointment reminders, billing, mail order prescriptions, and lab results.

In addition to asking for demographic information confirmation, you have the opportunity to ask clinical screening and clinical intake questionnaires relevant to a patient’s appointment as part of the pre-registration process. These questionnaires can help determine any number of issues, like maybe the patient is scheduled for the wrong appointment, before they ever show up on site.

For example, a patient may be scheduled to receive a procedure at a certain location, but, based on his or her answers to a questionnaire, it turns out the patient is in a wheelchair and the original appointment location wouldn’t be appropriate because the spacing and equipment don’t allow for the size of a wheelchair. It could have been a disaster for the patient to actually go to the appointment, not only because it would have been a waste of time for the patient, but also because the hospital would have wasted an appointment time slot with expensive equipment and would have to spend time finding a new appointment time and location for the patient. Through a questionnaire given pre-service, this can be found out and flagged in advance.

Facilitating Data Capture On-site

Just like the airline industry, where travelers can check in for a flight on a kiosk at the airport, patients can do the same at a hospital or health system. The big advantage to having an on-site registration and check-in solution is healthcare facilities can capture patient data on patients who they’re not expecting to arrive, like a walk-in, and thus can’t ask to complete a pre-registration workflow.

Instead of registering and checking in face to face with a member of the hospital staff, kiosks — whether they’re free-standing, wall-mounted, table-top, or tablet kiosks –  can be designed for a quick two-minute interaction. They’re an effective way to identify patients on-site, give them questionnaires, take them through relevant workflows, and triage them. Even the most basic question, “Are you here for a scheduled appointment or are you here as a walk-in?,” can allow healthcare facilities to optimize their patient flow.

If you take it a step further and ask questions like, “What are your symptoms? What is your pain level?” healthcare facilities have the opportunity to prioritize patients and get them to the right place in a timely fashion. Kiosks also can be used to educate or inform patients. For example, if healthcare facilities want to encourage their patient population to get flu shots or to think about getting tested for a certain disease, they could display notifications or reminders on these kiosks.

Automating Clinical Intake Documentation on the Front-End

There is a lot of clinical intake documentation that we can pull out of the clinician workflow that really gets down to them simply interviewing patients. We can take these parts to the patient to do electronically, and then feed it directly into the EMR. We call this concept of patient-directed digital questionnaires a “virtual clipboard,” a tablet or kiosk with the same questionnaires patients would have been given in paper form, but now just automated.

The virtual clipboard is a practical, low-cost way to save time and start providing relief to clinicians during their clinical workflow. Specific areas that can be automated using a virtual clipboard include:

• History of present illness
• Medication reconciliation
• Chief complaint
• HIV, drug, alcohol screening
• Behavioral and mental health screening
• Antibiotic over-prescription screening

Identifying and Optimizing the Mid-Cycle

These results are certainly within reach. By taking a small step in extending patients the ability to enter their own data, healthcare systems can strengthen their documentation initiatives, which will ultimately optimize their revenue cycle and bolster their bottom line.

[1] The 2014 State of Value-Based Reimbursement, ORC International, 2014.

Janie Tremlett is GM pf patient solutions at Vecna Technologies of Cambridge, MA.

Readers Write: Inefficiencies Lost, Productivity Gained: Healthcare Communication Systems the Key

Inefficiencies Lost, Productivity Gained: Healthcare Communication Systems the Key
By Lindy Benton

Healthcare providers continue to seek a unified electronic view of patient’s health data, one that is comprehensive and fully accessible across the enterprise. Considered the health IT holy grail for many hospitals, the benefits of such are far reaching. A unified platform for communication and data collection facilitates better collaboration among care teams, increased productivity, and improved performance across the healthcare continuum.

Progress toward this objective has been a challenge for providers because of the lack of effective methods to capture and manage unstructured data that typically resides outside the EHR. Hospitals struggle to integrate information needed from ancillary systems as well as from disparate sources, such as paper files and even verbal exchanges. Only when data from these sources are aggregated and accessible through a single repository can a truly comprehensive view of the patient’s path across the spectrum be achieved.

Recent advancements in health information exchange and integration, however, have positioned the industry closer than ever to meeting this goal. With new options for solutions that facilitate the secure exchange of health information and management of healthcare communication, providers are within reach of a single integrated platform to view all patient data.

Providers can now document all interactions – phone calls, faxes, web visits, medical records, and even face-to-face conversations – tie them to the patient record, and centrally store them for viewing, processing and retrieval. By combining the capture and management of all communication types, hospitals are able to close gaps in documentation processes and create for themselves a complete view of patient information available and exchangeable across the organization.

Taking such steps has implications not only at the point of care, but also in the revenue cycle. As hospitals continue to invest countless resources to ensure full and accurate reimbursement for services, there are ever-present nuances and variables affecting this process. Documentation of the hospital’s communication surrounding payment, therefore, can protect the investment being made to secure these hard-earned dollars.

Of course, this is just one example of many improvements realized from a unified view of patient data. The following are additional opportunities for health systems to better leverage health information and communication management systems for improved performance, workflow and quality outcomes.

Financial Performance

Performance in denials remains an area of concern for many hospitals. Nearly two-thirds of errors leading to initial denials originate in patient access departments and issues associated with eligibility, authorization, or demographic information. Systems that document hospital efforts to secure authorization – verbal, fax and electronic – can be leveraged to prevent and overturn denials, shorten appeals, and reduce cost to collect. Documentation of the agreed-upon level of care also helps hospitals avoid retro denials for lack of medical necessity, translating into countless thousands in savings for the hospital.

Physician and Staff Alignment

Lost physician orders cause frustration among physicians, increased wait times for patients, and bottlenecks throughout the hospital. Routing fax and electronic exchanges through a central platform allows providers to receive and manage all orders in one location. In so doing, the hospital improves workflow, process times, and service to both physicians and patients. For example, with fax and electronic orders in a single location – searchable by patient and available enterprise-wide – physicians and staff can confirm in advance that orders are complete and accurate for all patients prior to service. Whenever and wherever the patient arrives, staff are able to immediately locate and process the order, reducing delays and cancellations that can result from missing orders.

Centralizing fax and electronic communication also gives providers the opportunity to reduce costs and risks associated with standalone fax machines. By converting to an electronic process, providers gain the benefit of a digital audit trail of individuals who have accessed each record, reducing the risk of a HIPAA violation caused by unauthorized access to paper files. Converting to an electronic fax process can also reduce document delivery costs such as maintenance and paper by up to 90 percent.

Patient Experience

Studies have shown that more than 50 percent of patients say that good communication is the primary reason they chose a hospital or clinic. Similarly, a patient’s rating of provider communication skills has been shown to be the strongest predictor of overall HCAHPS scores. Creating a positive patient experience means managing the hospital’s message from the first point of contact to the last. With systems available to capture and centralize all patient encounters – phone, electronic and in-person – providers can review interactions to improve quality, conduct service recovery, and reinforce communication best practices across departments for a better overall patient experience.

Workflow

Hospitals need convenient access to patient records while ensuring that protected health information remains secure. Secure sharing of records between systems and team members can eliminate time-wasting and error-prone processes. A central point of access to patient data reduces duplication, rework, and back-and-forth between departments.

Patient Safety and Quality

Movement toward a value-based delivery model has placed even greater emphasis on care coordination. Systems that streamline the process of getting the right information to the right people mean faster response times, better care transitions, and possibly improved continuity of care. With quality assurance programs to ensure compliance with hospital policies and procedures, providers can better protect patient safety and promote better outcomes.

Hospitals can now close several gaps in documentation through an enterprise-accessible patient record. Real-time, seamless access to critical patient information fosters an environment for better care outcomes and improved revenue cycle performance. There are clear benefits to aggregating communication and capture systems and pairing them with the electronic health record to tell the full tale of the patient’s story from the moment of entry to the time of exit.

Lindy Benton is president and CEO of MEA|NEA|TWSG of Norcross, GA.

Morning Headlines 12/21/15

Vendor for VUMC clinical systems upgrade named

Vanderbilt University Medical Center will implement Epic, replacing its existing McKesson Horizon system, with a projected go-live of November 2017.

Coloradans Will Put Single-Payer Health Care To A Vote

Next fall, Colorado residents will vote on a proposal to establish a state-run, no deductible, single-payer health system expected to cost $25 billion annually.

Albany health care tech hub could still move forward, despite lack of state funds

Capital Region (NY) loses its bit to secure $500 million in state revitalization funding that would have been used to turn the city into a technology startup hotspot, but still hopes to move forward on a smaller plan to establish an active digital health ecosystem.

Monday Morning Update 12/21/15

Top News

Vanderbilt University Medical Center will implement Epic, replacing the sunsetted McKesson Horizon Expert Orders. VUMC developed WizOrder and sold it to McKesson in 2001, which commercialized it as HEO. VUMC announced in April 2015 that it would choose between Epic and Cerner. It says none of the functionality it self-developed in WizOrder will be lost. I can’t think of any other homegrown systems still in use other than at Beth Israel Deaconess Medical Center and perhaps at Regenstrief.

Reader Comments

From Below the Beltway: “Re: Meaningful Use. A blanket hardship exemption was not included in either the omnibus or the extenders package passed and the matter seemed settled for this year. Surprisingly, the Legislature came to an agreement on a bill with several Medicare reforms, including a change to the hardship exemption on a bill with several other Medicare reforms. The bill, S. 2425, passed the Senate Friday morning and the House Friday afternoon by voice vote and unanimous consent, respectively.” The full text of the bill is here.

From The PACS Designer: “Re: EDWs. TPD isn’t a vendor neutral archive advocate. More VNAs only complicate the storage issues and can result in arguments about what can be put in a VNA. A better idea is the electronic data warehouse (EDW), which encompasses not only using internal data sources, but also can include external ones and can bring more value to the decision-making processes. EDWs are also a better way to communicate with an HIE. What do you think?”

From Spiffy Tie: “Re: Cerner. My organization is a Cerner client and my perception of the company has fluctuated widely over the past 10 years. I’ve been especially disgusted by Cerner’s business plan. Their software has improved in many respects, but to make it functional requires a lot of customization. Cerner will gladly sell consulting time to multiple organizations to make the same changes rather than building it into the base product. Issues that would be bugs or defects in other software is typically said to be WAD (working as designed). If you want it fixed, you can pay for the customization yourself or submit an ‘idea,’ which is almost always rejected as ‘not aligned with current priorities.’ Other new features that are essential (to correct prior defects, safety issues, or gaps in content) are incorporated into new packages that have to be purchased separately rather than being a part of already-purchased upgrades. Despite my disgust with Cerner’s overall approach, I also have very positive feelings about Cerner in terms of their employees. Virtually everyone I’ve worked with is knowledgeable, professional, and willing to go the extra mile to make things work for our staff and our patients. I have very high regard for them and enjoy working with them very much. I think it’s especially egregious that Cerner would turn on its best asset, their employees, with this forced arbitration clause. If other companies and our judicial system have engaged in or supported such abusive extortion of hard-working individuals, then shame on them too.”

HIStalk Announcements and Requests

The vast majority of poll respondents see Cerner’s requirement that employees sign arbitration clauses to continue eligibility for merit increases as negative. Some readers say it’s not just Cerner doing it and perhaps adding the $500 in stock options as a legal “consideration” was required to make the unilateral contract change legal. Several respondents predict that the company will lose good employees who will resent the strong-arm tactics and whose talent gives them career options elsewhere. New poll to your right or here: how was your 2015 compared to 2014? Click the Comments link after voting and explain why.

Readers always enjoy the HCIT Family Tree that shows the acquisition history of all the health IT vendors. Creator Constantine Davides, senior healthcare analyst with AlphaOne Capital Partners, has updated it. Here’s a trivia question I randomly chose from Constantine’s chart: which company owns the former Medifor?

I’ve been using a third-party Rumor Report form for years, never quite getting around to making the easy switch to the form design tool I already own that would have saved me $20 per year. The choice was made for me, which you may have noticed if you tried to use the form recently – the tiny company that hosted it lost their server and didn’t have a backup, so they shut the service down without letting users know. Try the new form instead.

My latest pet peeve: software companies that claim to be “population health management” vendors instead of “population health management software” vendors.

Mrs. Schmidt’s California fourth graders can’t wait to start using the STEM lab kits and library we provided via her DonorsChoose grant request. Also checking in was Mrs. Marler of Alabama, whose third graders are using their new wireless document camera to explain their thought process to the class.

Not much will be happening over the next couple of weeks, so I’ll have less to write about. Then it will get crazy as it always does between New Year’s Day and the HIMSS conference, a frantic 10 weeks.

It’s time for my annual reader survey. Take a couple of minutes to fill it out and you’ll be: (a) helping me, and (b) entering yourself into a random drawing for a $50 Amazon gift card.

Last Week’s Most Interesting News

• Cerner requires its employees to sign away their rights to sue the company in return for remaining eligible for merit increases.
• Robert Wood Johnson Foundation releases a dataset containing details of all marketplace-offered insurance plans for 2015 and 2015.
• CMS gives doctor selection website Amino access to provider-level quality and cost data.
• Five foundations donate $10 million to the OpenNotes initiative.
• National Coordinator Karen DeSalvo, MD, MPH calls for health IT stakeholders to commit to providing consumer access, avoiding information blocking, and following standards
• Dell is again rumored to be trying to sell the former Perot Systems for $5 billion to help pay for its EMC acquisition.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel

Here’s the video of Wednesday’s webinar, “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support,” sponsored by Wolters Kluwer Health and featuring guest presenter Rick Corn, VP/CIO of Huntsville Hospital (AL).

Acquisitions, Funding, Business, and Stock

Columbus, OH-based Aver, which offers software that allows providers to calculate bundled prices based on past claims, raises $11 million, increasing its total to $22 million.

New York’s Capital Region loses its bid for $500 million in state money that would have supported an investment of $100 million to $200 million to create a population health technology hub, but IBM Watson Health and other participants say they will continue their efforts without the state funds.

Sales

China-based Luye Medical Group chooses the InterSystems TrakCare EMR.

University Hospital Southampton NHS Foundation Trust chooses Hyland OnBase for enterprise content management.

Other

Pharma bad boy Martin Shkreli, who was arrested Thursday on securities fraud charges and then resigned (or was fired) as CEO of Turing Pharmaceuticals on Friday, spent Friday just like any other day: vainly live-streaming himself on YouTube as he exchanged messages with fans and critics, played his electric guitar, looked for women on dating sites, and played online chess. Magazines such as Vanity Fair are digging deeper beyond his cartoonish villain personality to acknowledge his brilliance, bluntness, and seldom-mentioned charitable side. Meanwhile, shares in biotech company KaloBios Pharmaceuticals, which Shkreli acquired a few weeks back via shrewd Wall Street betting, were halted on the news of his arrest, having shed half their value in pre-market trading. They had jumped from under $1.00 per share to as high as $40 after Shkreli’s involvement was revealed, all in less than four weeks. His stake in the company, once worth $80 million, is now valued at around $50 million, at least until trading resumes. He is apparently still serving as CEO of KaloBios. A UCSF medical school professor and author reminds those who expressed glee at seeing Shkreli perp walked that his infamous Daraprim price hike wasn’t illegal and in fact still stands:

It easy to demonize him. But if you’re going to let the market drive the pharmaceutical industry, it shouldn’t surprise anyone that he wants to maximize profits. There’s no law that he has to be ethical. His job is not to make drugs available and save patients. His responsibility is to make a profit for his shareholders.

Colorado puts single-payer coverage on the ballot, where the state would pay the medical bills of all citizens not covered by Medicare or military programs. Wage earners would pay 3 percent of their net income with their employers kicking in another 7 percent, with the new taxes covering the program’s estimated cost of $25 billion per year. Critics point out that Vermont already abandoned a similar plan because the state couldn’t afford it.

A California nursing home with a history of quality problems stops the IV antibiotic of a patient transferred from a local hospital after three days instead of the ordered four weeks due to a nurse’s order entry error.

France tackles anorexia head on by requiring models to obtain a doctor’s certification that their weight is healthy. The new law also requires magazines to clearly indicate when photos of a model have been Photoshopped to suggest a larger or smaller waistline, with fines of up to $40,000 for failing to do so.

Sponsor Updates

• Forward Health Group’s PopulationManager earns the highest preliminary rating scores in the KLAS population health management technology report.
• KLAS names Wellcentive among its top five population health management platform vendors.

Blog Posts

• As We Celebrate This Season (TeleTracking)
• 10 Tips for Choosing the Right RTLS for Your Hospital (Versus Technology)
• Happy holidays! (Voalte)
• Imaging Clinical Decision Support (Zynx Health)
• 5 questions with Nordic CEO Bruce Cerullo (Nordic)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

Morning Headlines 12/18/15

Report To Congress: Challenges and Barriers to Interoperability

ONC’s Health IT Policy Committee publishes its congressionally-mandated report on interoperability, covering the technical, operational, and financial barriers to interoperability.

Most Cerner employees are giving up the right to sue — to stay eligible for merit raises

Cerner has reportedly persuaded 93 percent of its 17,000 employees to sign arbitration agreements with the promise of $500 in stock options for those that agree, and the threat of withheld merit-based raises for those that refuse.

Shkreli, Drug Price Gouger, Denies Fraud and Posts Bail

Turing Pharmaceuticals CEO Martin Shkreli is arrested by the FBI on fraud charges stemming from his time as a hedge fund owner and manager.

HHS wants more states to data-mine for Medicaid fraud

HHS reports that few states have taken it up on its offer to receive federal funding to bolster data-mining programs in state Medicare fraud units, despite fraudulent payment rates continuing to climb.

News 12/18/15

Top News

ONC’s Health IT Policy Committee issues its congressionally-mandated interoperability report that includes these recommendations:

• Create outcomes measures that reward well-coordinated and affordable care, such as not paying for performing duplicate lab tests.
• Publish EHR vendor interoperability scores based on actual customer use.
• Add Medicare payment incentives for technology-driven care coordination.
• Convene a summit meeting to start the operationalization of ONC’s Interoperability Roadmap and the recommendations in the document.

Reader Comments

From Fair and Balanced: “Re: Epic. Our support rep has been asking questions about one of our projects, saying Epic recently started an intra-company contest for writing news stories about positive client developments. She and I both speculate that Epic is looking for stories to feed to actual media outlets. If that’s the case, I’m uneasy that Epic is going to this length to promote itself in relying on its own employees for good news rather than for it to come about via independent parties noticing it.” Unverified. I’m not sure I would find that practice objectionable other than it seems to violate Epic’s unconvincing insistence that it doesn’t practice sales and marketing. Industry magazines and sites will cover anything that a vendor or provider hands them on a silver platter regardless of news value, but it’s a tougher sell to newspapers. I was once approached by the local big-city newspaper about a story that their highly visible technology reporter was writing about mobile devices. As I was taking him around to interview people at our hospital, I was surprised at how clueless and generally weird he was (he carried what looked like a purse and stopped every five minutes to squirt drops into his eyes, plus he didn’t seem to know much about technology). The resulting piece was superficial and not insightful since he simply regurgitated selective quotes from our folks, which is probably why I’m disdainful of former reporters who proclaim themselves health IT experts simply because they’ve spent a few years working at that superficial level.

HIStalk Announcements and Requests

This week on HIStalk Practice: AMA opens up its Physician Innovation Network to beta testers. Connecticut physicians detail their telemedicine challenges. Wisconsin joins the Interstate Medical Licensure Compact. Clinicians don’t seem convinced when it comes to HIE ROI. Stericycle VP Lyn Triffletti offers physicians tips to get a handle on HIPAA. Kaiser Permanente Northwest offers members urgent care video visits. Telemedicine keeps operations running smoothly at the North Pole. Dr. Gregg describes his user experience of e-prescribing in the dark.

This week on HIStalk Connect: Rock Health publishes its annual VC funding report which says that digital health startups raised $4.3 billion in investment capital this year, matching 2014’s total. Google partners with Johnson & Johnson to launch a new surgical robot solutions business. Medtronic partners with Samsung to develop smartphone apps for patients receiving neuromodulation therapy. Four foundations invest $10 million to fund the expansion of the OpenNotes program nationally, with a goal of reaching 50 million patients within the next three years.

Listening: Intronaut, LA-based jazzy progressive rock whose sound ranges from a jamming Alice in Chains to a heavier Tool. Also, one of my favorite bands, Zip Tang, masters of complex progressive rock now evolved to a power trio with the departure of the amazing Marcus Padgett (saxophone, keyboards, vocals, and most relevant to health IT, SVP of Experian Health).

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Insurance company/PPO Clover Health, which analyzes insurance claims to target high-risk patients with specific care manager interventions, raises $35 million in Series B funding led by Sequoia Capital, increasing its total to $135 million.

Data-driven physician performance website MD Insider raises $12 million, increasing its total to $24 million. The round was led by Summation Health Ventures, an investment fund started by Cedars-Sinai and MemorialCare Health Systems, with Cedars-Sinai CIO Darren Dworkin joining the company’s board.

California startup Kumba Health launches a marketplace for consumers willing to pay cash to choose physicians, labs, and imaging centers.

Oration, which offers prescription buying tools for the employees of large, self-insured companies, releases its first app and announces $11.2 million in Series A funding.

Toronto-based customer management software vendor NexJ Systems spins off its population health management software business into a new company, NexJ Health Holdings.

WellDoc, which offers a prescription-only diabetes management app, raises $22 million in Series B funding, increasing its total to $27 million.

Cerner says 93 percent of its 17,000 US employees have  signed away their right to sue the company in return for $500 in stock options and ongoing eligibility for merit increases. An expert says it’s the only example he’s seen where a company will limit future merit increases to employees who decline to sign its arbitration clause.

Sales

King’s College Hospital NHS Foundation Trust chooses Allscripts Sunrise.

The VA contracts with Cogito Corporation, which sells voice guidance technology for telephone salespeople, for software that can assess the mental health of participating veterans by analyzing their telephone conversations.

People

Paul Kleeberg,MD (Stratis Health) joins Aledade as medical director. He served on the HIMSS board from 2011 through 2015 and was its chair through June 2015.

Practice Fusion hires Steve Filler (Oliver Wyman) as COO and promotes Octavia Petrovici to SVP of product management.

Dan Orenstein (Athenahealth) joins Health Catalyst as general counsel.

Divurgent promotes Shane Danaher to national partner of client services.

Announcements and Implementations

Robert Wood Johnson Foundation releases a dataset of all insurance plans offered on health insurance marketplaces in 2015 and 2016, supporting state-by-state analysis of premiums, deductibles, and other plan attributes. For example, the dataset shows that prices increased an average of 10 percent for all tiers in 2016, while silver plans in Alaska saw the largest jump at 35 percent to an average premium of $643.

LauraLynn, Ireland’s children’s hospice, goes live on Oneview Healthcare’s patient engagement solutions in providing entertainment for patients and bedside access to clinical applications for clinicians.

Health information service provider MedAllies will use IBM-owned Merge Healthcare’s iConnect Network Services for image ordering and results delivery for its members. 

Columbus, OH-based CrossChx launches its Queue fingerprint-based check-in kiosk for hospitals that it says reduces wait times by 80 percent. The company says it links a fingerprint to hospital EHR data to provide interoperability when its customers check in somewhere else. Founder and CEO Sean Lane is a former Air Force intelligence officer and NSA fellow who served five tours in Afghanistan and Iraq before founding Battlefield Telecommunications Systems.

Government and Politics

CMS names Amino as its second national Qualified Entity, giving the doctor selection website access to Medicare’s provider-level quality and cost data. Amino has raised $20 million in three funding rounds.

HHS says few states have accepted available federal money to support data-driven Medicaid fraud detection even as improper payments have nearly doubled to 10 percent. The states that were contacted by Modern Healthcare gave several reasons: they have their own data mining efforts, they are trying to figure out if it would help, or they’re waiting to see what other states do before jumping in.

Privacy and Security

LifeLock will pay $100 million to settle FTC charges that it overstated its data protection capabilities and engaged in deceptive advertising.

Innovation and Research

Researchers at NYU Langone Medical Center release a free app that uses Apple’s ResearchKit to track the symptoms of concussion patients.

Other

Madison magazine reviews the impact of Epic on Wisconsin, observing that it attracts huge numbers of liberal arts degreed young professionals who often leave the company after a few years but remain in the Madison area, giving Wisconsin an enviable population of high-achieving Millennials.

Turing Pharmaceutics CEO Martin Shkreli, the most-hated man on the Internet for hiking the price of old but important drug Daraprim by 5,000 percent after acquiring it, is arrested by federal agents and charged with securities fraud. Prosecutors claim Shkreli played a Ponzi-like financial shell game while with Retrophin, a drug company he started before Turing that eventually fired and sued him. Shkreli had previously mocked the lawsuit, saying, “The $65 million Retrophin wants from me would not dent me. I feel great. I’m licking my chops over the suits I’m going to file against them.” A wag observed that Shkreli was arrested only after he bought a rap album and started wearing hoodies, another dubbed him “Karma Bro,” while The New Yorker’s satirical piece was headlined, “Lawyer for Martin Shkreli Hikes Fees Five Thousand Per Cent.”

Former BIDMC CEO Paul Levy writes that news media misreported details about President Jimmy Carter’s cancer, running click-baiting headlines that gave credit to a “miracle drug” (which has actually performed poorly in clinical trials) while downplaying the likely impact of surgery and radiation therapy. Levy quotes a freelance health reporter’s comments at a medical summit in 2009 that sums up the state of medical and health IT journalism pretty well:

It is not our job to satisfy you [physicians], but to keep our readers reading and our viewers viewing. The more responsible the press becomes, the less readers seem to like it.

A fourth co-conspirator pleads guilty to impersonating a Cerner employee in selling medical equipment and $6 million in investments from 50 physicians.

Kaiser Permanente will start its own medical school that will train students on its integrated style of care. The California-based Kaiser Permanente School of Medicine will admit its first class of 48 students in 2019.

Another medical helicopter goes down as two crew members die in an Arizona crash. It was operated by the publicly traded, Colorado-based Air Methods, the self-styled “defenders of tomorrow” that operates medical transport services as well as its 60-aircraft helicopter tourism operation (the recently acquired Blue Hawaiian in Hawaii and Sundance Helicopters in Las Vegas). It also runs a billing company for other medical transport companies, including EMS agencies and ambulance services. The company earned $741 million in revenue where it staffs its own aircraft with medical personnel and bills the patient directly, as well as $162 million from hospital contracts. It earns an average of $12,000 in net revenue per patient transported. As the pie chart above illustrates, federal taxpayers provide 60 percent of the company’s patient revenue. Air Methods likes healthcare reform, predicting that more widespread insurance to pay for its transport services will increase its annual revenue by $31 million. The company’s investor presentation lists its #1 operational challenge as “accidents.” The Glassdoor reviews of Air Methods are pretty bad, with a common theme being that it isn’t really focused on the safety of patients and staff. It has a commendably obtuse and high-falutin’ but questionably punctuated mission statement: “To be the dominant global expert of comprehensive, vertically-integrated, critical care access solutions supporting patient logistics—the movement of patients and their medical analytics.”

Sponsor Updates

• Medicity is positioned in the Leaders category in the 2015 IDC MarketScape.
• LiveProcess is selected as one of 50 Most Promising Healthcare Solution Providers for 2015.
• Medication management solutions vendor HighFive will replace manual mapping of data with SyTrue’s natural language processing and terminology tools.
• CareSync founder and CEO Travis Bond will speak at an SXSW Interactive Festival session titled “Apps and Better Medical Outcomes: Real Solutions.”
• Orion Health launches version 6.2 of its Rhapsody integration engine.
• T-System names five of its ED customers as winners of its client excellence award.
• MedData celebrates its 35th anniversary.
• Inc. Magazine names Lexmark as a new corporate logo that went viral in 2015.
• RedHat makes Glassdoor’s list of companies with the happiest employees.

Blog Posts

• IoT Security: Is Your Fitbit a Key for Criminals? (ID Experts)
• A View through the ICD-10 Looking Glass (Impact Advisors)
• The Data Awakens (Forward Health Group)
• Why SEO is a Must for Hospitals (Influence Health)
• So long spreadsheets! Your transplant data deserves better (Liaison Technologies)
• The Top 10 Elf ICD-10 Moments (MedAptus)
• What do cross-country skis have to do with your EHR running more efficiently? (Nordic)
• Revolutions in Healthcare Analytics Part 4 of 6 – Organizational Readiness (Optimum Healthcare IT)
• Mobile Activates and Engages Patients in their Care (PatientSafe Solutions)
• 3 Reasons Why Healthcare Providers Should Take EMV Seriously (Patientco)
•  Med Wreck (PatientKeeper)
• Painting the Future of OB (PeriGen)
• Inaccurate Provider Data is Causing Problems for Patients and Healthcare Providers (Phynd Technologies)
• A Radiologists, a Pathologist … and a Pigeon? (PMD)
• Why the CFO should care about health IT as much as the CIO (Qpid Health)
• Meaningful Use 3: Patient Access (Sagacious Consultants)
• The Business Case for Interoperability: A Q&A with Salim Kizaraly, Founder and SVP, Stella Technology (Stella Technology)
• HDHPs: Patient Engagement for the Checkbook (Streamline Health)
• Sunquest Value of the Month – Agility (Sunquest Information Systems)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

EPtalk by Dr.Jayne 12/17/15

Time is flying and it’s hard to believe that HIMSS16 is barely two months ahead. My annual preparations have started, including the creation of the social schedule. It can be difficult to juggle meeting up with colleagues I only see once a year, sessions, sponsor events, and of course stalking the exhibit hall with some of my BFFs.

I booked my flights really early this year and didn’t realize that HIMSS had shifted to the Monday start, but it was easy to fill Sunday with some spa time. I have a penchant for something called Watsu, which is water-based Shiatsu massage, and there aren’t many practitioners in my part of the country. The Bellagio has a wonderful therapeutic pool, so I’m definitely going to get my Watsu on so I’m plenty relaxed for the week.

Flu season is upon us and we’re already being inundated with patients, many of whom opted out of vaccination. It’s not too late to get yours if you’re interested. Although it takes several weeks for them to reach maximum effect, flu season runs through April, so it can still be useful.

I was surprised to learn that payers are playing games with vaccination payments. Vaccines are one of the most cost-effective interventions we have in our arsenal and the flu vaccine is pretty inexpensive in the grand scheme of things. We have one payer who refuses to cover any vaccines when administered at our practice, simply because we’re an urgent care. Even if a patient comes in with a laceration that merits a tetanus shot, we can’t give it unless the patient pays out of pocket.

Patients are already paying big dollars for their healthcare premiums and don’t want to have to pay cash on top of it, so some of them decline and plan to follow up with their primary care physician. That can lead to gaps in care, and frankly PCPs have better things to do than give vaccines sometimes, like managing chronic illnesses and diagnosing new problems. Plus, the hardship of patients having to go two places to be treated for a single problem when we should be able to do it all at once is just a waste of resources. Just another aspect to our broken healthcare system. Although coverage is mandated, payers are finding a way around it.

I’ve been spending a lot of time in the practice and have picked up some kind of a respiratory virus. If we weren’t so focused on patient experience I’d love to hang out a sign that says, “If you’re not sicker than the doctor, you need to go home and try some cold remedies.” That’s not how we roll, though, so I apologize to the patients who are subjected to my sniffles. I like to think that I’m providing some level of patient education, since if I’m still sniffling it’s clear there’s no magic bullet to resolve all the symptoms.

I’ve been sad ever since the decongestant phenylpropanolamine was pulled from the market, because it actually worked. One of the most-used products around, phenylephrine, has been re-examined and found to be ineffective. But it’s easier to obtain than pseudoephedrine, so a lot of people try it anyway. Still, I’ll keep up with my humidifier and hot tea and hope for the best.

I’ve been playing around this week with my new technology purchase, a Microsoft Surface Pro 4. I am enjoying it, although I can’t get Outlook 2016 allow me to set up my inbox like I had it on my old computer. The change is just enough that it’s making a mess of my muscle memory, but I’ve tried everything I can think of. The settings screen looks just like it does in Outlook 2013, but it doesn’t behave the same way. Maybe it’s a bug or maybe I should just get used to it.

Speaking of bugs, the American Medical Association emailed yesterday to offer me tips and resources on how to pass the USMLE Step 3 licensing exam. Since I’ve been licensed for more than 15 years, they’re a little late. They did send a follow-up email asking me to disregard it and to enjoy my complimentary 2016 resident membership, which is even funnier.

Speaking of funny, I spent some time surfing Glassdoor looking at reviews for a couple of employers that are clearly in a downward spiral. A friend had sent me a few links and the email arrived at a time when I really needed a laugh. For the one employer, it’s clear that they have someone occasionally posting anonymously that the company is great, but 95 percent of the other reviews are negative and the themes go back several years.

I’m sure disgruntled employees make up a good chunk of the postings, but everyone has disgruntled employees and when you look at similar companies, you don’t see that kind of skew towards the negative. If you’re in HR and you haven’t looked at your own employer’s reviews, it might be worth a few minutes of your time. Reviews with titles like “Rome is Burning” should definitely catch your attention.

I’ve also been catching up on my holiday baking, and in the spirit of the holidays, I’ll share one of my favorite recipes. Double Chocolate Peanut Butter Chubbies are one of my favorites the last few years. They’re insanely chocolatey and you can modify the recipe by using different kinds of chocolate (or non-chocolate if you prefer) chips or different kinds of nuts. Personally, I like mine with Hershey’s Special Dark chips and chunky peanut butter.

What’s your favorite holiday cookie? Email me.

Email Dr. Jayne.

Morning Headlines 12/17/15

Long-delayed cyber bill included in omnibus

House leaders have reached a deal on the 2016 omnibus spending bill. The bill, which was introduced Wednesday, includes the last minute addition of the Cybersecurity Information Sharing Act, a controversial bill with government surveillance implications that was designed to help the federal investigators work with private industry to combat hackers.

FDA Launches precisionFDA to Harness the Power of Scientific Collaboration

The FDA launches its web-based, genetics research platform, precisionFDA.

New data shows experts were wrong about where healthcare costs less

A study investigating geographical differences in the cost of care have analyzed 92 billion private health insurance claims and have found that spending patterns for the privately insured are not the same as those for Medicare.

RWJF releases massive health exchange data set

The Robert Wood Johnson Foundation has published a dataset containing pricing information for public exchange insurance plans, concluding that the average premium will spike between 11 and 16 percent between 2015 and 2016.

Morning Headlines 12/16/15

Foundations Unite to Support Access to Clinical Notes for 50 Million Patients Nationwide

A group of foundations will spend $10 million funding the expansion of the OpenNotes project with the goal of expanding access to 50 million patients over the next three years.

Dell Looks to Sell Perot Systems for More Than $5 Billion to Raise Cash for EMC Deal

Dells is seeking a buyer for its Perot Systems business unit, hoping to raise $5 billion from the sale to help cover the cost of its EMC acquisition.

Is Your Doctor Getting Too Much Screen Time?

The Wall Street Journal covers a recent study finding that patients rated the care they received lower when doctors looked at a computer screen more during patient examinations.

The Corporate Takeover of the Red Cross

A ProPublica report analyzes corporate challenges at the Red Cross five years after an executive team from AT&T was brought in to streamline operations. Since their arrival, the Red Cross has cut payroll by a third, eliminated thousands of jobs, and closed 450 of its 700 chapters.

News 12/16/15

Top News

Five foundations, including the Gordon and Betty Moore Foundation and Robert Wood Johnson Foundation, provide $10 million to expand the reach of the OpenNotes initiative to give patients access to their visit notes.

Reader Comments

From Mutual Arbitration: “Re: arbitration clauses. Now Uber is doing them, only they are blasting them to the smartphones of their drives who have to tap ‘agree’ to keep driving. Leave it to Uber to get 400,000 agreements signed almost instantly.”

From Petal Pusher: “Re: another outrageous hospital billing practice. A friend who was admitted to a major NYC hospital says a clinical psychologist came to his bedside, introduced herself, and asked if he wanted to talk about how he was feeling. Sure, he said, so they spoke for 20-30 minutes. She came back a few days later. Surprise – this was charged to his bill even though it wasn’t told it would be billable, he didn’t ask for it, and it was never ordered for him. He thought it was part of the hospital service, for which they billed $7,700 per day.” I suppose the message here is that when you’re hospitalized, just answering the “how are you doing” question from some stranger who wanders into your room could trigger a bill.

HIStalk Announcements and Requests

Mrs. Shaw reports that not only were her fourth graders named the top math class in her Pennsylvania school, two of her students were among the top individual scorers as well thanks to the Chromebook and accessories we provided for math practice via DonorsChoose.

I sent the email blast and tweet on my interview with Gerry McCarthy late Monday afternoon. Gerry emailed me four hours later to let me know that he had already received over 300 emails, calls, and LinkedIn messages in response. I appreciate knowing that since, as I told Gerry in reply, HIStalk is to me just an empty room in which I sit while attempting to fill an empty screen each day in a quite personal way, so I don’t have a good view of what it looks like on the other side of that screen even though I’ve been doing it for nearly 13 years.

Webinars

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

December 16 (Wednesday) 2:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

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

Here’s the inimitable Vince Ciotti and Frank Poggio doing Tuesday’s webinar, “CPSI Takeover of Healthland, Are You Ready?” You will no doubt be entertained by their wry humor even if you have no horse in that particular race.

Acquisitions, Funding, Business, and Stock

Telehealth and videoconferencing platform vendor Vidyo receives a $10 million investment from the venture capital arm of Kaiser Permanente, increasing its total to $163 million.

Telemedicine platform vendor Chiron Health raises $2.3 million in a seed round and releases its patient-facing app. The company allows practices to conduct video visits with guaranteed reimbursement.

Dell is reported to be trying to sell the former Perot Systems for more than $5 billion to help pay for its EMC acquisition, which was previously rumored in early November and reported here. Dell acquired Perot for $3.9 billion in 2009 and is rumored to be talking to Tata, Atos, Genpact, and CGI about buying it.

In a stellar example of how American healthcare is an ugly mix of compassion and profit-seeking, Daughters of Charity Health System (CA) receives a $260 million investment from a hedge fund that also has the option to buy the six-hospital system outright after three years.

Sales

SPH Analytics chooses Clinical Architecture’s Symedical platform for management of clinical and administrative terminologies as well as its SIFT free text semantic interpretation tool.

People

Bill Howard (Caradigm) joins Audacious Inquiry as senior director.

MedSys Group promotes Ann Bartnik to VP of client services.

Lisa Gallagher (HIMSS) and Arien Malec (RelayHealth) will replace John Halamka as co-chairs of the Health IT Standards Committee upon expiration of Halamka’s term in January.

Drug company marketing software vendor OptimizeRX names James Brooks (iCare) as SVP of business development.

Announcements and Implementations

Allscripts adds self-pay capability to its FollowMyHealth patient portal by integrating functionality of its Payerpath products.

Bethesda Hospital (MN) goes live hospital-wide with Epic’s MyChart Bedside tablet app for patients and families.

GetWellNetwork announces several recent new sales of its Marbella patient rounding data collection system.

Southwestern Vermont Medical Center goes live on the NetRelay secure messaging tool from Interbit Data.

Technology

Microsoft will end support and updates for Internet Explorer 8 on January 12 but is selling custom support agreements for customers unable to upgrade their browser, many of which I would guess are in health systems. IE8 was released in March 2009, replaced by IE9 in March 2011.

FDA approves the tricorder-like Checkme Pro health monitor from China-based Viatom Technology. It performs one-lead EKGs, pulse oximetry, temperature measurement, movement sensing, and cuffless blood pressure measurement.

Other

A federal judge denies a motion brought by the Texas Medical Board that sought to dismiss Teladoc’s lawsuit against it, allowing the lawsuit to proceed. Teladoc successfully argued that the board’s rule that allows telemedicine sessions only after an initial face-to-face visit unfairly limits competition.

Eric Topol, MD lists his top developments from 2015 that will change medicine.

In England, dating app Tinder helps the NHS raise organ donation awareness among its younger users by suggesting they sign up as donors when they swipe a supporter’s photo.

A Wall Street Journal article recaps recent studies showing that patients resent doctors who spend a significant portion of their encounter working on a computer instead of making eye contact, suggesting that computers aren’t the problem but rather how they are physically positioned and how the doctors choose to use them. It will be interesting to see what happens as medicine shifts to newer graduates unaccustomed to looking up from their phones to see the actual world around them, or perhaps newer patients will be perfectly happy receiving their medical care from the equivalent of a Facebook post and reply.

An interesting New York Times article by Abigail Zuger, MD describes the common situation in which she uses around 10 information systems that each have their own password composition rules and expiration dates, forcing her to keep an index card listing them all in her pocket at all times. She adds, as the subject of the article suggests, that she’s seeing a “retro explosion of paper” as non-interoperable systems force reliance on hand-delivered paper or faxes. She describes what it’s like: “Who knows what the biblical stonemasons sang to themselves during work hours at their Tower of Babel? This is the soundtrack at ours: ‘What exactly did the kidney guy tell you to do?’ ‘Are you sure?’ ‘How did the ER explain that?’ ‘Could you just bring in the new pills next time?’”

ProPublica digs into significant problems at the American Red Cross in an article called “The Corporate Takeover of the Red Cross” as the charity struggles in the fifth year under a leadership team that was mostly brought over from AT&T. The article says Red Cross has cut its payroll by a third, eliminated jobs, closed chapters in reducing their number from 700 to 250, alienated volunteers, and bungled several emergency response efforts to the point that some emergency planners have decided not to use its services. Surprisingly, its business of selling donated blood to hospitals lost $100 million in the most recent fiscal year because of revised clinical guidelines that reduced blood demand and its failure to adopt industry standard scannable labels. It plans to increase sales of its CPR training programs from $150 million per year to $700 million fizzled as actual revenue instead dropped. An internal survey found that only 35 percent of employees trust the organization’s executives — many employees call the charity “the AT&T retirement plan” — and volunteer satisfaction dropped 20 percent in one year to 32 percent. The CEO of the Center of Volunteer and Nonprofit Leadership, in observing the inept response by Red Cross after a California wildfire while running billboards using the event to solicit donations, concludes, “I view them more as a fundraising and marketing organization than a disaster relief or charity group.”

Sponsor Updates

• Perigen wins an innovation award in clinical information management.
• Black Book ranks Nuance as the leading vendor for clinical documentation improvement solutions.
• DataMotion releases a free Dr. Seuss-like electronic book titled “A Healthcare Holiday Tale: Horace & the Messaging Miracle.”
• Medicat will integrate terminology management software and patient education content from Wolters Kluwer Health with its college health service software.
• PatientPay customer Kids First Pediatrics Group in the Atlanta area reports that it is successfully using the company’s solutions to address the shift from 90 percent insurance-paid claims to 50-percent patient responsibility due to more widespread high-deductible health plans. 
• KLAS names Divurgent as the top-rated vendor in go-live support delivery.
• EClinicalWorks client HealthNet is awarded the 2015 HIMSS Ambulatory Davies Award of Excellence.
• Healthwise’s Catherine Serio publishes “Alone, Adrift, and Hoping for Health.”

Blog Posts

• Meaningful Use Modified Stage 2 (AdvancedMD)
• Innovating at the Intersection of IT and Care (AirStrip)
• The role of patients in readmissions (Besler Consulting)
• Ready or Not? How to gauge your organization’s readiness for new patient engagement technology (Burwood Group)
• Prior Authorization Renewals in CoverMyMeds (CoverMyMeds)
• Please Get Rid of That Superbill (Galen Healthcare Solutions)
• Best Practices for Documentation during Rapid Change (Hayes Management Consulting)

Contacts

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

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