Monday Morning Update 2/8/16

Top News

National medical practice operator One Medical Group pays $20 million to acquire nine-employee Rise, whose app connects users with nutritionists for meal planning and diet advice. The company had raised $4 million. One founder was previously with Groupon while the other worked for Mozilla.

San Francisco-based One Medical Group, which has raised $182 million and runs practices in seven cities, was founded by former Epocrates CMO Tom X. Lee, MD.

Reader Comments

From Lib B Z: “Re: NYU’s Langone Medical Center. Doctors are unhappy with the new EMR added because the changes are confusing and time wasting. The new system supplied by Optum is supposed to work alongside Epic. Langone is reportedly looking at dismantling the recent additions that were hurriedly bolted on.” Unverified.

From Curly Endive: “Re: Epic hosting. We’re also concerned about scanning with McKesson. There seem to be mixed opinions among us whether Epic really gets what a big problem this is. I understand keeping a competitor’s product off their hardware, but my sense is they got caught with their pants down in anticipating that hosting customers would need a solution. They don’t seem to have a fast solution in the works.” Unverified.

From Ex-Epic: “Re: Epic customers in Canada. Children’s Hospital of Eastern Ontario: Beaker (I think), MyChart, Ambulatory and I think inpatient as well.  Women’s College Hospital: scheduling/registration, Ambulatory only. Alberta Health Services: Mychart/Amb and there was rumor when I was at Epic that they were expanding to enterprise (they already have the license). Mackenzie is full enterprise. I think you covered this in the past, but Epic lost out on University Health Network in Toronto, which is the largest hospital network in Canada.”

HIStalk Announcements and Requests

More than 80 percent of poll respondents say their reaction to recent CMS statements about Meaningful Use is negative. New poll to your right or here: if you’re going to the HIMSS conference, what is your primary reason for attending?

Welcome to new HIStalk Gold Sponsor Carevive Systems. The Philadelphia-based company offers an oncology care planning system that combines electronic patient-reported outcomes with clinical data and evidence-based content authored by thousands of oncologists to generate initial, supportive, and survivorship care patient care plans and to link patients to clinical trials. Its rules engine auto-populates the 13 elements of the IOM care management plan required for the Oncology Care Model. As a client reports, “What I really like about the platform is the patient’s ability to report his or her own symptoms, and then we can generate evidence-based practice data to manage those symptoms. Subsequently, we provide an intensive care plan for them … we’re able to see what patients are truly experiencing and help them manage their symptoms more effectively.” Thanks to Carevive Systems for supporting HIStalk.

Mrs. Brunetti says her rural Arkansas students are able to remember math concepts better by using the books and manipulatives we provided in funding her DonorsChoose grant request.

Also checking in is Mr. Garcia, who needed speakers for the six computer workstations he built himself for students of his inner city Dallas school (he’s an Army veteran and computer engineering graduate). We also provided a weatherproof Bluetooth speaker whose use he describes as, “The portable speaker was a hit. We took it to the hallway for the Sphero robotic ball to draw 2D figures. Every time there was a sound it was deep, loud and catchy — our principal came to see us and was very impressed with my students listening to instructions from Sphero. Teaching coordinates X and Y for ordered pairs was very memorable for them. My plan is now to take Sphero, the tablet, and the portable speaker to the basketball court and teach angles, time to distance ratio, problem solving, and critical thinking.”

I’ve been surprised at the number of people who are shocked and indignant at Martin Shkreli’s 50-fold price increase for Daraprim, sputtering that his company should behave “fairly.” That’s the most ridiculous thing I’ve heard lately, that anyone would expect a former hedge fund trader and drug company CEO to take any action that doesn’t best serve him or his shareholders, or for that matter that less-annoying healthcare overlords are working selflessly for the good of their customers in some manner everybody else might consider “fair.” Shkreli is working the system that we all created where we made healthcare a capitalistic, obscenely profitable business, no different than everybody else lapping at the sick people’s trough (McKesson doesn’t pay John Hammergren $150 million per year for being “fair.”) The politicians he refused to answer last week seem to think it’s Shkreli’s job and not their own to fix our healthcare mess. As the New Yorker observes with apparent tongue in cheek,

Nancy Retzlaff, Turing’s chief commercial officer, told the committee about her company’s efforts to get the drug to people who can’t afford it. The arrangement she described sounded like a hodge-podge, an ungainly combination of dizzyingly high prices, mysterious corporate bargaining, and occasional charitable acts—which is to say, it sounded not so much different from the rest of our medical system … True, he has those indictments to worry about. But he is also a self-made celebrity, thanks to a business plan that makes it harder for us to ignore the incoherence and inefficiency of our medical industry. He rolls his eyes at members of Congress, he carries on thoughtful conversations with random Internet commenters, and, unlike most of our public figures, he may never learn the arts of pandering and grovelling. He is the American Dream, a rude reminder of the spirit that makes this country great, or at any rate exceptional.

Meanwhile, a fascinating video interview shows Shkreli casually slurping from a $5,000 bottle of wine while playing chess with the interviewer, describing that he’s a hero among dishonorable drug companies and explaining why hospitals and doctors are healthcare’s real cost problem. We’re still trying to convince him to hang out at our HIMSS booth. I told Lorre to bribe him by offering to buy one full-priced Daraprim tablet.

Last Week’s Most Interesting News

• Practice Fusion lays off 74 employees as it struggles to reach profitability.
• The White House asks Congress to fund a $1 billion “cancer moonshot.”
• Theranos declines to fulfill its promise to allow partner Cleveland Clinic to verify its technology and says it won’t publish FDA testing data until all of its tests are approved.
• A Surescripts survey finds that few New York doctors have the technology required to send all prescriptions electronically by March 27, 2016 as state law requires.
• The Hurley Medical Center pediatrician credits her use of EHR-mined data in proving Flint, Michigan’s water crisis to skeptical state officials.
• A bipartisan Senate bill calls for expanding Medicare coverage of telemedicine.

Webinars

February 23 (Tuesday) 1:00 ET. “Completing your EMR with a Medical Image Sharing Strategy.” Sponsored by LifeImage. Presenters: Don K. Dennison, consultant; Jim Forrester, director of imaging informatics, UR Medicine. Care coordination can suffer without an effective, cost-efficient way to share images across provider networks. Consolidating image management systems into a single platform such as VNA or PACS doesn’t address the need to exchange images with external organizations. This webinar will address incorporating the right image sharing methods into your health IT strategy.

Acquisitions, Funding, Business, and Stock

From Friday’s Athenahealth earnings call:

• The company has 4,600 employees.
• The recently announced development partnership with University of Toledo Medical center will help the company move from its “sub-50 bed hospitals” to larger facilities that need “chemotherapy or more advanced pharmacy and lab or surgery, pre-op, post-op, more sophisticated discharge planning.”
• When pressed on University of Toledo’s  timeline to replace its sunsetting systems, Bush said, “There are a very large number of older inpatient systems that are turning into a pumpkin in 2018. And, yes, we would like to be able to gobble up as much of that as possible. The number one feedback that we get in focus groups with health system executives around Athena is, they don’t do inpatient … they think they need that one throat to choke. So, we’ve got to be there with inpatient and outpatient. And it’s true — 2018 is a bellwether year for us if we’re ready.”
• Jonathan Bush says of practices taking risk, “The awkward truth is that not many doctors, not many lives are truly, truly at risk. They are part of ACOs and other things where the government takes the first two cents and then they spend the year figuring out what the savings might be and then they give you half the savings. Then if you created savings in past years, they rebate you at a later year.”
• The company is working on mapping all providers and AthenaNet patients individually into master directories in creating an instant-on experience so that new clients can instantly receive information about their patients and referral patterns.
• Bush describes the company’s horizontal expansion as, “If you just imagine that the doctor is the guy who launches that pinball up into the pinball machine, the most important guy to get is that ball launcher at the bottom … We are loved more than anyone else. We are the only likeable cafeteria food in all of undergraduate education. That ball is the patient. They shoot up and bounce against labs, pharmacies, clinics, hospitals, surgery centers. We’ve been starting with the most frequent bumpers.”
• Bush says of McKesson Horizon customers who will be forced to make a replacement system decision soon, “We don’t want these beautiful animals to bolt off the cliff in panic and go enter themselves into another 10-year amortization and another nightmare of capital encumberment for their balance sheet and a nightmare of administrative complexity for their IT teams. We want them to believe. Some will bolt, but the partnership with Toledo, the partnership with Beth Israel, the progress through larger and larger hospitals, and the fact that we have a pretty darned good reputation as an entity that delivers in this space, we’re hoping will save some people from unfortunate decisions.”

Above is the one-year share price of ATHN ((blue, down 9 percent) vs. the Nasdaq (red, down 7.7 percent). The company is worth nearly $5 billion.

Meanwhile, Bush weighs in on Turing Pharmaceuticals Founder Martin Shkreli, saying he would “fight and die for Shkreli’s right to be a douche,” adding that drug companies should be able to charge whatever they want for drugs that keep people out of expensive hospitals. 

MMRGlobal, the purported personal health record vendor whose real focus is shaking down EHR vendors by filing nuisance patent infringement lawsuits against them in forcing licensing agreements, conducts a reverse stock split. The company’s one billion plus shares were worth less than a fifth of a penny, valuing it at $2.5 million. The company lost $490,000 on sales of $80,000 in the most recent quarter.

Sales

In Australia, Bendigo Health chooses InterSystems TrakCare as the EHR for its new hospital that opens next year.

Announcements and Implementations

The Ann Arbor, MI VA hospital goes live on LiveData PeriOp Manager in its operating rooms, where it will synchronize perioperative workflow.

Government and Politics

A Forbes editorial says exchange-sold medical insurance will get worse, evidenced not only by enrollment numbers that are 40 percent less than originally estimated, but also by the “adverse selection” of high plan-switching rates indicating that healthy enrollees are trying to minimize the implicit tax in subsidizing sick enrollees who are seeking out the most comprehensive coverage. It concludes that insurance companies that offer the best coverage will be forced out of the marketplaces as federal subsidies run out for their overly sick risk pool.

A proposed Florida bill would require hospitals to verify the identity of Medicaid recipients using biometrics and a link to the state’s driver’s license database.

Privacy and Security

Above is a nice quote from Ministry Health Care CIO Will Weider.

Jackson Memorial Hospital (FL) fires two employees who provided an ESPN reporter with photos of the medical information of NFL player Jason Pierre-Paul, who blew off his right index finger in a July 4 fireworks accident.

Technology

Pebble releases its first health-related smartwatch updates, including a Pebble Health watch face. It’s seems to be purely a step counter and sleep tracker so far. The company’s Valentine’s Day special offers two of its Pebble Time Round Black and Silver for $360, much cheaper than the Apple Watch but equally pointless for me personally. 

Other

Johns Hopkins University launches the Malone Center for Engineering in Healthcare, which will link engineers with clinicians to focus on data analytics, systems design and analysis, and technology and devices. It is funded by cable TV billionaire John Malone, who earned a MS and PhD from Hopkins.

Actress Selma Hayek posts a photo of her posing with the ED doctors who were treating her after an on-set head injury, apologizing for her interesting shirt in saying, “Unfortunately, my wardrobe for the scene was completely inappropriate for the hospital.” She didn’t name the facility, but the doctors appear to work for Northwell Health (the former North Shore-LIJ). I found the Halloween costume shirt she’s wearing for sale here, although I’m torn between that and the company’s mullet wig for my HIMSS attire.

The CEO of Union General Hospital (GA) and four members of his family are arrested for distributing narcotics after an investigation finds that a local doctor had written him 15,000 painkiller prescriptions in three years. The CEO’s brother, who is an ED doctor and former hospital board member, was also arrested, as was their sister, a nurse practitioner. The private practice doctor, who is also a board member of the hospital, was arrested and charged with 41 counts of unauthorized distribution of a controlled substance. It’s fascinating that America’s profitable self-doping has reached such epidemic levels that a hospital’s board apparently conspired to cash in on it. That doesn’t even count the cost of locking up our prisoners of war (on drugs) that has long since been lost in trying to limit supply rather than demand and driving up prices, crime, and overdose deaths as a result.

Yet another study finds that high-deductible medical insurance doesn’t encourage Americans to seek better healthcare services deals – it just causes them to skip getting the care they need. I bet there’s a newly occurring “seasonality” in doctor visits during the first half of the year when patients are paying out of their own pockets again, followed by a surge later once they have – expectedly or unexpectedly – met their deductibles that run nearly $7,000 on exchange-sold plans.

A reader dug up a copy of Epic’s comic book from HIMSS 2000 as produced by “editor in chief Judith R. Faulkner.” The page on the right describes the “unsupported hyperbole decoder ring” that has translated the competitor’s sales pitch as, “We will go public, make gazillions, and retire to an island paradise.” Another page references publicly traded health IT vendors with, “You know what people are saying about the whole Internet stock craze.” That was the year the HIMSS conference in Dallas was pushed back to April to give hospital IT people time to fix unexpected Y2K problems, rocketing attendance to a then-lofty 17,000 (it was 43,000 last year).

Weird News Andy calls the story of the doctor convicted of murder for overprescribing drugs “Rx Wrecks,” with his favorite line being that the perp “sometimes made up medical records” of patients that she described as “druggies.”

Sponsor Updates

• Vital Images employees wear red for National Wear Red Day in support of heart health.
• Reminder and patient engagement service vendor Talksoft announces integration with Greenway Intergy.
• Versus Technology becomes a founding member of the Electronic Hand Hygiene Compliance Organization.
• VitalWare publishes a client success interview with Liz Knisel from ProMedica.
• Huron Consulting Group will exhibit at the Annual AHA Rural Healthcare Leadership Conference February 7-10 in Phoenix.

Blog Posts

• Leading with Passion: the Power of the Human Connection (T-System)
• Patient Flow: A View from Across the Pond (TeleTracking)
• Evaluating Risk with Population Health Analytics (Verisk Health)
• Brand-new buildings, brand-new communication (Voalte)
• Patient Engagement: A Call to Action (West Corp.)
• Beyond the Hippocratic Oath (Zynx Health)

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 2/5/16

Health IT & Health Information Services: 2015 Year-End Market Review

Healthcare Growth Partners publishes its annual market review, noting that “at this point in the market cycle, health IT behaves more like a policy-based economy than a market-based economy.”

Athenahealth, Inc. Q4 Earnings Retreat 21 percent

Athenahealth reports Q4 results: revenue of $257 million compared to $213 million during the same quarter last year, adjusted EPS $0.45 vs. $0.58, missing analyst estimates on revenue but beating on earnings.

Head Of California Exchange Scolds UnitedHealth For Blaming Woes On Obamacare

California health insurance exchange executive director Peter Lee criticizes UnitedHealth for blaming Obamacare exchanges for its financial losses, explaining “Instead of saying we screwed up, they said Obamacare is the problem and we may not play any more. It was giving an excuse to Wall Street and throwing the Affordable Care Act under the bus.”

Top 20 Employee Benefits & Perks

Glassdoor ranks Epic 16th on its list of Top 20 Employee Benefits and Perks, citing the company’s policy of granting a paid four-week sabbatical to employees after five years of employment.

News 2/5/16

Top News

Free practice EHR vendor Practice Fusion lays off 74 employees – around 25 percent of its workforce – in the face of ongoing losses.

Reader Comments

From Bottled Lightning: “Re: Practice Fusion layoffs. Its IPO has been off the table since Ryan Howard left. I’m not sure why the press keeps propagating that fantasy when the company hasn’t been pitching IPO. They’ve been trying to find a buyer with no luck. Now they’re hunkering down and will try to survive with a much smaller team, filling functionality gaps in the product and trying to make it viable in a real market. You get what you pay for, and since most of its customers pay nothing, the product has some pretty deep gaps.” Unverified. Other readers have said the IPO story was floated as an excuse for dismissing founder and CEO Ryan Howard in August 2015. Investors have poured $155 million into the free EHR vendor in the past seven years. Companies yearning to IPO don’t usually fire the CEO, replace him with someone with no CEO experience, and conduct mass layoffs. It’s a tough time to be in the post-Meaningful Use EHR business.

From Boom Goes the Dynamite: “Re: Practice Fusion layoffs. The CEO is nice but unqualified – the board seems to think he can sell the company so they can get their $300 million (or more) back. Steve Filler quit his Oliver Wyman consulting job to become PF’s COO with much internal fanfare in November 2015 and he’s already gone. The CFO was let go and the chief marketing guy from Google didn’t take long to run away. The company’s 2015 revenue was $15 million, all of it from pharma, and its burn rate is $3 million per month. The board just forked over another $30 million to keep the lights on. Tom the new CEO predicts that they will become revenue positive by Q3 2017, but I don’t see a path to the top of that mountain.” Of the 13 executives listed on Practice Fusion’s website a year ago, only six are still there. If that $15 million annual revenue estimate is accurate, then Practice Fusion is a tiny, struggling company in a shrinking market segment in which it’s not among the top 10 companies (based on Meaningful Use attestation numbers). I don’t see even one attribute that would make me want to buy shares if indeed the company survives long enough to do a Hail Mary IPO.

From Karen Green: “Re: lack of technology vs. lack of adoption. We have plenty of technologies that have begun to interoperate – DSM and HIE messages from acute care partners to post-acute specialists. MU attestation? Check! Not so on the continuum of care, where we are getting care summaries 1-3 days after discharge, rendering them useless for transitions of care. Why? Because the discharge and admissions planners on the front line are still using phone calls and fax to refer the patient. We have to enable the ‘intoperators’ on the front line and within the clinical practice so they can be informed about their patients in a timely way. Gartner suggests that CIOs have to be ‘digital humanists’ to lead the design of systems and technology to ‘enable people to achieve things they never thought possible.’ We must provide solutions that make it easy to give up proven convention for something that goes beyond the automation of processes.” Karen is CIO at Brooks Rehabilitation (FL).

From Brass Ones: “Re: Mackenzie Health in Ontario. Going Epic.” Verified from their job postings. I don’t know of any other hospitals in Canada that run Epic inpatient.

From The PACS Designer: “Re: augmented reality in healthcare. There’s a new term that created a buzz at the recent Consumer Electronics Show and that’s augmented reality. AR works differently than virtual reality (VR) in that the viewing device can be worn while doing other activities like walking or at work.” The mock-up above is from Microsoft’s HoloLens, which will start shipping soon. The company offers a $3,000 developer edition.

HIStalk Announcements and Requests

Ms. Johnson from Oklahoma says her students, many of whom begin school speaking only Spanish, are using the five MP3 players we provided via DonorsChoose to listen to the recordings of books she creates. Meanwhile, Ms. Johnson from Pennsylvania reports that her inner-city third graders are using their new Chromebook and accessories to access online reading and math interventions as well as to perform research – they previously had computer access in just one class three times per week.

This week on HIStalk Connect: Doctor on Demand announces that it will offer psychiatry sessions over its telehealth platform, expanding nationwide by mid-year. Pear Therapeutics raises $20 million in funding to roll out its substance abuse recovery support app. The University of Southern California announces eight strategic partners that will support its Virtual Care Clinic initiative.

HIStalkapalooza

HIStalkapalooza Featured Sponsor – NextGen Healthcare

Visit NextGen Healthcare at HIMSS16 Booth #4421. See for yourself how we help ambulatory organizations achieve real interoperability, improve population health, and transition to value-based care. By focusing less on IT and more on care, our clients are driving the changes you hear about in healthcare. Of course, we’re not all work and no play! We’ll also be taking professional headshot photos in the booth; not to mention Happy Hour the last hour of each day at our booth, #4421!  Stop by after a long day pounding the convention floor for a pick-me-up.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Houston-based Decisio Health raises $2 million as it starts marketing its FDA-approved patient dashboard that uses technology licensed from University of Texas Health Science Center of Houston.

Health information vendor IMS Health acquires AlphaImpactRx, which apparently pays doctors to provide feedback about drug salespeople via a mobile app and then sells that information to drug companies. The company also surveys oncologists and pathologists about oncology molecular diagnostic testing, pitching itself to drug companies by, “It’s important to understand how testing is impacting the oncologist’s choice of brand.” I like that doctors want consumer drug advertising to stop, but I also wish they would stop giving or selling their own information to companies like IMS that help drug companies sell drugs that might not be the best option. Drug companies target those doctors using the information they themselves provided.

Athenahealth announces Q4 results: revenue up 21 percent, adjusted EPS $0.45 vs. $0.58, missing revenue estimates but beating on earnings. 

People

David Crutchfield (Maestro Strategies) joins Conway Medical Center (SC) in the newly created position of VP/CIO.

Don Soucy (Orion Health) joins Spok as EVP of global sales.

Leidos names Donald Kosiak, Jr., MD, MBA (Avera Health) as chief medical officer. I’m not sure if he’s trying appear edgy or to hide a bald spot with his head-cropping LinkedIn photo, but kudos for his 18 years of service in the Army National Guard with deployments to Iraq.

E-MDs names Derek Pickell (Convergent Healthcare) as CEO and board director. He replaces David Winn, who retired with the March 2015 announcement of the company’s acquisition by Marlin Equity Partners.

Vocera hires Kathy English, RN (Cisco) as VP of marketing.

Announcements and Implementations

Orchestrate Healthcare launches an information security practice.

KLAS announces members of its Interoperability Measurement Advisory Team. The press release’s headline mentions an inaugural meeting that someone forgot to include in the release itself. 

Philips will use Validic’s technology to integrate consumer health data with its HealthSuite connected health products.

CCSI Distributors, a subsidiary of Clinical Computer Systems, Inc., obtains exclusive US distribution rights to the OB-Tools TrueLabor Maternal Fetal Monitor.

VCU Health (VA) used its Spok communications technology to manage its medical coverage of the nine-day UCI Road World Cycling Championships, which attracted 1,000 cyclists and 640,000 spectators to Richmond, VA.

Healthcare Growth Partners publishes its “2015 Year-End Market Review.” HGP’s reports are brilliant and eloquent and I savor every one of them. Even folks who aren’t interested in business or investing will find them to be concise and insightful, with passages like this:

We urge innovators to approach the market pragmatically and not get carried away by idealism during this transitionary time of policy-based innovation. In health IT, disruption seems to come in increments versus all at once. We find that when health IT companies fail to achieve objectives (or founders get significantly diluted), it’s most often because the product or strategy arrives on the scene too early versus too late.

Government and Politics

A group of senators and representatives introduces the CONNECT for Health Act, which would promote expanded use of telemedicine in Medicare by removing existing restrictions.

Pharma bad boy Martin Shkreli pleads the Fifth Amendment in refusing to answer questions posed to him during a House committee hearing on drug pricing.

A VA care alert warns that its CPRS system rejected an large number of consult/procedure orders, which it discovered while reviewing the system after the October 1, 2015 ICD-10 switch. Clicking the warning’s OK button cancelled the order. The VA says it fixed the problem in a December 29 patch, adding that a few examples were found to have occurred before October 1.

Federal judges reverse the VA’s demotion of two executives who had schemed to force their subordinates to transfer jobs so they could take those lower-level jobs themselves while keeping their executive pay. The judges ruled that the pair’s bosses knew what they were doing and did nothing to stop them. The same two VA executives are being investigated for being reimbursed $400,000 for questionable moving expenses.

The head of California’s insurance marketplace says UnitedHealth Group is “driving me bonkers” for blaming the Affordable Care Act for its losses from selling individual policies. He says the company’s competitors participated and learned from the beginning while UHG initially stayed on the sidelines, then set its rates higher than everyone else and offered broad networks that attract sicker people to sign up.

Privacy and Security

A second former Tampa General Hospital (FL) employee is charged with stealing patient information used to file fraudulent tax forms.

Other

Melissa Memorial Hospital (CO) brings self-pay billing back in house and goes back to separate inpatient and ambulatory statements following problems with First Party Receivable Solutions and its “OK, but not stellar” NextGen billing system.

Glassdoor places Epic as #16 on its list of “Top 20 Employee Benefits & Perks,” scoring the company four spots ahead of Google for offering a paid four-week sabbatical after five years.

The Charlotte newspaper notes that Carolinas HealthCare paid its retiring CEO $6.6 million in 2015, with all of the health system’s top 10 executives earning more than $1 million in total compensation. Even the chief HR officer made $1.3 million.

I like this graphic, available here. The only problem I see is that it seems to be aimed at providers who probably either won’t see it or will ignore what it says. A patient-focused version would be nice if there was a way to blast it to the masses.

OpenNotes sponsor Robert Wood Johnson Foundation lists its three-year goals for the project: (a) expand OpenNotes to 50 million people; (b) conduct pilot projects to see how clinical notes are being used to engage patients and families; and (c) measure the value of sharing notes.

Sponsor Updates

• PharmaPoint incorporates the Surescripts Medication History for Panel Management solution into Xchange Point 5.0.
• InterSystems is listed among the top 25 privately held companies in Massachusetts in the 2016 Boston Business Journal Book of Lists.
• Premier awards Versus Technology a group purchasing agreement for its RTLS/RFID products.
• Leidos Health will exhibit at McKesson Southeast February 10-11 in Charlotte, NC.
• Outsourcing Gazette names MedData one of its Top 25 Most Promising Healthcare Services Providers of 2016.
• Medicomp Systems will host Quipstar at HIMSS16.
• Orion Health will present with CAL Index on March 1 at HIMSS16.
• Sunquest announces UPMC, BSA Health Systems, and Carolinas HealthCare as winners of its client innovation awards.
• PeriGen announces a new online training tool for its Patterns systems.
• Red Hat releases a now viral employee rap video paying homage to its hometown of Raleigh, NC.
• RelayHealth shares a video interview with VP Arien Malec.
• The SSI Group opens registration for its 2016 user group events.
• Streamline Health will exhibit at the 2016 Florida HFMA Regional – Space Coast event on February 5 in Titusville.

Blog Posts

• The Virality of Secure Messaging (pMD)
• Revolutions in Healthcare Analytics (Part 6 of 6, Future Think) (Optimum Healthcare IT)
• Reflections on 2015: Paving the Way to Value-Based Care (Medicity)
• Integration Trends Roundup for 2016 (Liaison Technologies)
• Three Key Tips to Implementing an Imaging Interoperability Platform (LifeImage)
• Insights from a KLAS Category Leader – Integration (MedAptus)
• Finding the Perfect Number of Patients (Nordic)
• Invest in Your Data: How Clinical Mobility Solutions Liberate Data and Drive Cost Savings (PatientSafe Solutions)
• 4 Benefits to Integrating Secure Texting Apps with EMRs (PracticeUnite)
• Investments in Healthcare IT Are Shifting Focus (Phynd Technologies)
• The Virality of Secure Messaging (PMD)
• On the Road to Interoperability, Industry Collaboration Drivers Wanted (Surescripts)

Contacts

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

EPtalk by Dr. Jayne 2/4/16

This week we celebrated the creation of National Women Physicians Day on the birthday of Dr. Elizabeth Blackwell. As the first woman to receive a medical degree in the United States, she helped pave the way for many of our careers.

There has been some backlash about adding another recognition “day” and jokes about whether we’re going to also have National Men Physicians Day. For those of us who trained and continue to work in environments that can range from covertly sexist to outright discriminatory, it’s nice to be recognized. In some areas, girls are still discouraged from pursuing science and technical careers.

I vividly remember my oh-so-Southern college roommate being told by her parents to just “paint your nails and do your hair and find a good husband and let daddy and me worry about the rest.” She was shocked to have been paired with a roommate who actually planned to be “pre-med” and not just use biology 101 to be “pre-wed.”

My medical school class at Prestigious University was the first to be more than half women. We crammed more than 60 women into a locker room designed for 20 as we changed for gross anatomy. The school refused to provide any other accommodation. Some of my gutsier classmates protested by changing in the hallway. You’d have thought they’d seen the admissions trends and made some preparations, but apparently it didn’t occur to the administration.

Despite having trained in the last two decades (when we should have known better), I’ve been sexually harassed more times than I can remember and have had to watch male residents harass a female faculty surgeon without repercussions. The joke was on them, however, because in their refusal to staff her cases they left the door open for the rest of us to actually perform procedures while they were three-deep holding retractors for a male surgeon.

Although we’ve come a long way, subtle sexism still exists. I look forward to the day where our children and grandchildren can choose whatever career suits them without sex- or gender-based comments. I’ve never heard anyone ask a male executive how he balances his family and career, but I hear it asked of women all the time.

It goes both ways, though, and I sympathize with men who have chosen careers that have been historically “female.” No one should ever have to justify their vocation based on chromosomes. If people take issue with that, I have a Marine Corps pastry chef I’d be delighted to introduce.

In other news, this week has been chock-full of things that are almost too ridiculous to put into words. Unfortunately, most of them involved fairly specific situations with vendors and hospital executives that I can’t write about without risking my anonymity.

That’s one of the hardest things about being on the HIStalk team – not being able to share the best stories because they would out us. Often I go ahead and write things up but let them sit for a couple of months until memories fade, but several of these were so over the top I don’t think I’ll ever be able to use them. A couple of them though were general enough to have occurred anywhere, so I’ll offer some pro tips.

If you are creating recorded training materials that are going to be viewed by not only your internal staff but also by your strategic partners, you might want to have some “webinar hygiene” requirements for the staff conducting the sessions. First, address the barking dogs before they bark or figure out how to pause the recording while you do it. I now know the names of your dogs and the fact that they don’t listen to you at all. BTW, the kissing noises were cute.

Second (and I thought this went without saying), use a headset and not your speakerphone. Make sure your microphone gain is adjusted properly. Otherwise, you end up yelling at your audience or being nearly inaudible.

Third, close your Outlook or hide your alerts.

Finally, for the love of all things, please turn off your instant messenger. I saw some things pop up during one session that were completely NSFW. Since it was a recording, they’re preserved for posterity.

Whether you’re recording content or just presenting, it might be a good idea to ask someone to peer-review your slide deck. Typos are embarrassing in front of hundreds of people. Also, when introducing a guest speaker or secondary presenter, make sure you’ve vetted the introduction with them first. I was completely embarrassed when I was recently introduced as “the CMIO of Big Medical Center” when in fact I haven’t been there for months.

I’m not ashamed of being without a title other than “independent consultant” and provided a bio prior to the session that was essentially a three-line introduction suitable for the call and edited for the audience. Apparently the moderator missed it, however.

Adding to the ridiculousness of the week was the arrival of some malware on my laptop. Thank goodness it was my older one that I’m only using for music, movies, and browsing. Its arrival was suspiciously timed with a visit from my nephew who spent quite a bit of time on it, showing off his skills with Scratch and Python. I fought with it for several hours and finally gave up, having tried most of my own tricks and several from friends. I’m taking it tomorrow to my favorite “will trade Jameson for IT support” guy and hopefully we’ll get it back on its feet.

Regardless of his contribution to my stress level, my nephew is a great kid and I’m impressed by his technology skills. In his school district, they offer a program where students can sign up to spend a day at work with alumni in various fields. He was disappointed that they don’t have anyone who writes code for a living, but his eyes lit up when I suggested that I might just know some people who build EHRs every day. Looks like we’ll be cashing in some frequent flyer points for a spring break adventure of the health IT kind.

I spent some time away from the craziness working on my HIMSS schedule. I already have lunch scheduled with one of my favorite start-ups and am eager to hear about what they’ve been doing. We spend some time catching up at Midway after HIMSS last year and have checked in once since then, but I’m sure their product has grown in leaps and bounds. I also tracked down the truth behind the rumor that Medicomp was planning something different for their Quipstar game show this year. Indeed they are!

This year will feature teams (!) competing using their new Quippe Clinical Lens product. I’m pleased to announce that I’ll be captaining “Team HIStalk” on March 1 (Tuesday) at 11 a.m. We need four readers to join me in kicking off the week’s game show play at booth 1354. If you’re interested, email me with your credentials, witty comments, outright bribery, or a photo of your favorite shoes and tell me why you want to play on Team HIStalk. I can’t promise much more than the opportunity to meet me and have some fun, but you never know what you’ll see at their booth.

Last year’s appearance by Jonathan Bush was one for the highlight reel. I’m looking forward to having some team backup to make up for my appearance a few years ago when I blanked on David Brailer’s name even though I could see his picture in my head.

I don’t know who we will be competing against, but I hope it’s someone fun. Could it be Karen DeSalvo? Perennial contestant Jacob Reider? John Halamka? My not-so-secret crush Farzad Mostashari? Or the dashingly hilarious Matthew Holt?

Are you ready to get your game show on? Email me.

Email Dr. Jayne.

Morning Headlines 2/4/16

Practice Fusion Lays Off 25% Of Workers To Create Positive Cash Flow

Practice Fusion confirms that it has laid of 25 percent of its workforce, across all divisions, in an effort to become cash positive.

Bipartisan Senate bill seeks to expand telemedicine services

A group of bipartisan senators introduce the CONNECT for Health Act, a bill aimed at expanding telemedicine services through expanded Medicare benefits.

2016 Clinical Analytics for Population Health Management Market Trends Report

A Chilmark report predicts that the data analytics market will grow as more health systems shift to value-based reimbursement models.

Healthcare: For here or to go?

An Accenture report predicts that startups working in the on-demand healthcare market will see investment levels quadruple by 2017, growing to nearly a billion dollars in annual investment.

Readers Write: Read This Before You Sponsor Another Hackathon

Read This Before You Sponsor Another Hackathon
By Niko Skievaski

Innovation is undoubtedly a hot topic right now in healthcare. For good reason: it’s said that one-third of spend is waste and payment models are shifting in an attempt to drive efficiency.

Technology is the obvious place to look for efficiency gains and health systems around the country are getting creative with ways to better utilize it. We see rampant partnerships with startup accelerator programs, direct early stage investments, innovation teams, and the advent of the “chief innovation officer” whose primary goals seems to be a gating mechanism for the army of entrepreneurs trying to make an impact.

We’ve directly participated in a dozen flavors of enterprise innovation programs over the past two years. With this experience, I’d like to ask health systems to try a different sort of program: just try our products.

That’s a lot easier said than done. Your organizations weren’t designed to adopt new technology. Over the past decades, data centers were constructed to house your intranet, EHR, ERP, LIS, MIS, and a slew of other acronyms. IT departments were invented to manage the onslaught of hardware and software subsequently installed on their machines. The systems are weaved together in a web of interfaces managed by graying whizzes from their cubicles.

Each new piece of technology requires budget, a new install project to be prioritized, FTE to be allocated, and expertise to be acquired. Why would any IT head want to shake up their delicate game of Jenga with new software? Especially software from an unproven startup. Especially software in the cloud.

This is poles apart from the modern, tech-savvy organization. Other industries felt market pressures and profit motives to become agile and modernize incrementally. Meanwhile, health systems felt little market pressure as costs inched up year over year.

Pressure later came from well-meaning government subsidies to adopt adequate electronic health record software, however exacerbating rather than toppling the Jenga tower. While health systems upgraded their hardware, the rest of the world moved to SaaS-based tools that eliminated the need for designated IT departments to show you where to click.

The mounting inefficiencies observed in everyday healthcare interactions could cause any millennial to quit her job and start a digital health startup attempting to bring a modern Web experience and level of service to an industry worth saving. This is the core of my request. We don’t need help starting more startups. We don’t need accelerators. We don’t need strategic investments. We need feedback.

I’m not referring to conference panels of CIOs or experienced entrepreneurs tearing startups apart. The feedback required to build an effective product comes at the front lines in the real world. It needs to get all the way into the hands of the doctors, nurses, support staff, and patients.

The technology crisis in healthcare is rooted in the lack of adoption of technology, not in the lack of technology. Similarly, your innovation won’t be in the tech you help to create — it will be in your ability to more rapidly adopt the tech that already exists.

Focus enterprise innovation efforts on decentralizing technology adoption. Figure out ways to let departments choose how to manage their work. Decentralize new technology budgets to get that decision-making process as close to the front line as possible.

The vendors will figure out ways to make it cheap enough by eliminating upfront capital and installation projects. IT should invest in infrastructure technology that allows modern technology to work within your facilities: fast Wi-Fi, modern browsers and devices, API layers, make SSO easy, etc.

Don’t partner with accelerators unless you plan allowing them to outsource your technology selection process. The primary reason those companies participate is to sell to you. And don’t invest in digital health companies unless you’ve used the product. Put your money where your mouth is. Otherwise, your investment is not strategic, it’s just money.

This will also force the business development teams to work closely with clinical teams for product validation. You’re all on the same team — align incentives. You don’t need to depend on accelerators and suits with MBAs to help you figure out if a startup’s product will improve care or increase efficiency at your hospital. The front line will tell you in 10 minutes if you let them use the product.

Niko Skievaski is  co-founder of Redox.

Readers Write: Dealing with the Aftermath of Hurricane ICD-10

Dealing with the Aftermath of Hurricane ICD-10
By Michael Nissenbaum

It seems only fitting to compare the October 1, 2015 transition from ICD-9 to ICD-10 to a hurricane. Like a hurricane, we tracked the pending event well in advance. The news media were filled with stories speculating whether ICD-10 would hit as expected and what the potential impact might be.

Even as we braced for the worst, ICD-10 made landfall with a great deal of noise and fury. But according to a Porter Research and Navicure survey, 99 percent of the 360 organizations who responded said they were ready for it and survived the event itself, meaning they were able to begin using ICD-10 when the deadline hit.

Yet Hurricane ICD-10 also shares another characteristic with its physical world counterparts: the aftermath may have a longer-term effect than the event itself. So while all the cork-popping and victory laps back in October may have been well deserved, providers are realizing the forecast is not all sunshine and light tropical breezes just yet.

As you address the ICD-10 aftermath, be wary of some of the issues that may still crop up  and prepare in advance to deal with them.

1. Be prepared to set up specialized “per payer” rules. While it would be great if every payer organization was now fully converted to ICD-10, it’s still not the case. For example, some smaller workers compensation carriers still aren’t accepting ICD-10 codes, so providers must process their claims differently. Ideally providers can set up special rules in their electronic health records (EHR) and/or practice management (PM) systems to automate this conversion and avoid the need to make manual changes, or even worse, submit paper claims.
2. Make sure your team is fully trained on the changes. While there is currently a grace period for unspecified ICD-10 codes, that leeway is scheduled to come to an end within the next year. Denials will then increase if you’re not prepared. The best approach is to act as if the grace period doesn’t exist. Ensure your team is trained to submit documentation that is specific enough to support the selected ICD-10 code in the event you’re ever audited. If your users are still struggling in this area, partnering with an expert third party for training may be a worthwhile investment.
3. Become experts on your most common codes first. We have gone from 13,000 codes in ICD-9 to 69,000 in ICD-10. That’s a lot to learn, but your team doesn’t have to master all 69,000 at once. Identify your practice’s most commonly used codes and make sure you can get them right every time. Once those are in good order you can expand the training on a prioritized basis.
4. Make the most commonly used codes available quickly through adaptive learning. Take advantage of technologies that “remember” the codes that are used most frequently and make them readily available without a lengthy search process. This will enhance user productivity and minimize user frustration.
5. Consider technologies that take advantage of natural language search. Another way to improve productivity under ICD-10 is help providers find specific codes faster. Natural language search allows a user to type in “chest pain,” for example, and be presented with answers that match chest pain specifically, as well as related terms such as angina and other heart-related diagnoses. This significantly reduces the time it takes for providers to search for the right level of specificity, especially when first learning new codes.
6. Take advantage of automated correlation between ICD-9 and ICD-10. Providers that are still learning ICD-10 may benefit from technologies that allow them to type in a familiar ICD-9 code and have the system narrow the choices to a closely related ICD-10 subset. While there will not be many one-to-one relationship between codes, trimming the options can be a huge time-saver.
7. Speed the selection process with filters. Technologies that use filters to navigate the ICD-10 coding process can also enhance productivity. These solutions deliver a step-by-step approach to drill down to the correct category (e.g., diabetes or chest pain,) followed by more precise options (e.g., left or right.)
8. Make sure your team understands the importance of these changes. It’s human nature to resist change and providers have had more than their share of changes thrust upon them in the last few years. But failure to comply with ICD-10 affects reimbursements for both the practice and the individual providers. Be as encouraging as possible and keep working to ease the transition.

While Hurricane ICD-10 may have passed through in October, there’s still work to be done. Many organizations are still suffering from productivity losses that could impact their financial success for a long time to come. If your organization is still not recovered from the ICD-10 aftermath, consider the implementation of time-saving technologies and partnerships with knowledgeable experts that can deliver the training and support you need.

Finally, it’s worthwhile to remember that the ICD-10 implementation date was pushed back twice, which is akin to giving providers 15 days warning for an impending storm versus a mere five days. Take note, all you rule-making bodies, and consider how a more sensible implementation pace contributed to the relative success of the ICD-10 transition. Something to keep in mind next time anyone considers cramming providers with a new round of arduous regulations in unreasonable timeframes.

Michael Nissenbaum is president and CEO of Aprima Medical Software of Carrollton, TX.

Readers Write: The Importance of HIT Succession Planning

The Importance of HIT Succession Planning
By Frank Myeroff

While getting ready for HIMSS 2016 Conference & Exhibition, I’ve had the opportunity to speak with many healthcare IT leaders about what’s on their priority list this year when it comes to acquiring, promoting, and retaining key HIT talent. One response that I heard over and over again was “Succession Planning.”

The HIT profession is seeing shortages of talent, making succession planning more important than ever. Having a well-developed and current strategic plan in place will help your organization prepare for the future in these vital areas:

• Prevent vacancies when baby boomers retire. As senior HIT personnel begin to retire, including many CIOs, the industry will lose leadership, knowledge, and skills and that won’t be easy to replace. However, even after having this advanced notice, many organizations are still unprepared for their absence. Therefore, they will find themselves with many vacancies, and consequently may cause them to make quick and rash hiring decisions.
• Recognize and develop future leaders. As we face a leadership shortage in HIT and in just about every industry across the board, companies must identify and foster those individuals demonstrating leadership skills and abilities through mentoring, training, and stretch assignments so they are ready to take the helm when the time comes.
• Prevent turnover and costs associated. Employees at all levels are less likely to leave a company that is committed to providing meaningful work and opportunities to grow. A continuous flow of engaged people with defined career paths will stop the revolving door which can be detrimental to any firm. A high turnover is quite costly. According to the Wall Street Journal, experts estimate that it costs upwards of twice an employee’s salary to find and train a replacement.
• Maximize organizational value. Healthcare organizations with an HIT succession plan in place are more attractive. Management teams having a strategy for when a key player exits protects the value, integrity, and longevity of the company. As a result, your company’s reputation stays positive and in turn, attracts top performers to your company.
• Meet growing demands for high quality, cost-effective care patient care. Healthcare leaders face unprecedented pressure to meet the ambitious expectations of health reform, i.e. to reduce costs and simultaneously assure high quality patient care. Therefore, the industry needs to better prepare their HIT professionals to manage the complex organizations that provide and finance care.
• Guarantee the stability of business operations. HIT succession planning helps to mitigate risks and ensures business continuity. People are your greatest asset. They can also be its greatest downfall. If your company becomes overly dependent on the services of a few key individuals, it can lead to operational risks that can cause damage when one or more of those key people are no longer there.

With HIT succession planning on the minds of so many organizations right now, there are a number of ways to find the HIT talent who can ultimately step-in to fill those current and future roles:

• Hire more military technology veterans. Organizations are on a mission to find, hire, train, and accommodate US military veterans who possess the IT skills in high demand, such as cybersecurity. The military represents a large IT talent pool even though military technology experts may not have civilian HIT certifications or experience. Savvy organizations are able to look past that when onboarding and then later assist returning vets in obtaining those civilian credentials, including IT certifications. In addition, when hiring military veterans, they bring so much more to the job such as leadership skills, ability to perform under pressure, teamwork, respect for procedures, and integrity.
• Implement college-level internships. More and more organizations are moving towards creating HIT internship programs at the college level. They consider it a year-round recruiting tool which means having an ongoing pipeline of future HIT talent. In addition, interns are an inexpensive resource while at the same time are some of the most highly motivated members of the workforce. Internships.com allows a company to post a profile free of charge. This way, a company gets exposure to top colleges and candidates without breaking their budget.
• Re-hire retirees for expertise and training. One way organizations will succession plan is to pay retirees to come back. Many IT professionals are now returning as consultants operating under one- to two-year contracts for their help and expertise. In addition, they are being asked to train and mentor promising IT professionals. These seasoned workers have experience and a tremendous amount of knowledge to share.
• Hire and promote from within. In many cases, organizations lay out an HIT career path that they use to retain quality people. This approach fosters loyalty and also positions your company as a place that career-minded individuals want to work. If you hire or promote from within, it also helps you to retain other key people.
• Acquire talent from outside or competitors. If an organization does not have confidence that an internal candidate is ready for the position, they may have to recruit from outside and from the competition. Hiring from a rival firm can mean bringing aboard someone who already knows your industry, your HIT initiatives, and/or can bring valuable new project knowledge.

Healthcare IT succession planning should be a part of every company’s strategic plan. It’s vital for the vision of where your company will be going in the future and how it will get there.

Most importantly, succession planning in general will shape how your organization develops and nurtures its people, assures a continuing sequence and pipeline of qualified people to move up and take over when needed, and assures that key positions will be filled with the right people able to carry your company into the future.

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

HIStalk Interviews Laurens van der Tang, CEO, VitalHealth Software

Laurens van der Tang is CEO of VitalHealth Software of Minneapolis, MN.

Tell me about yourself and the company.

VitalHealth was founded by Mayo Clinic and Noaber Foundation from the Netherlands. We deliver a cloud platform that efficiently captures patient-centered outcome data for quality improvement and cost reduction. We are healthy and growing, selling our solutions in the US, Europe, China, and India. Already more than 120,000 healthcare professionals use our software, and that number is growing rapidly.

I’m the CEO of the company and have been since the start.

Was intellectual property from Mayo Clinic licensed to VitalHealth? Do they have ongoing involvement with the product?

Mayo Clinic has been and still is very involved as launch customer and development partner. Mayo licensed intellectual property related to point-of-care decision support. The Mayo relationship means a lot to us. Our software is used by thousands of medical professionals at Mayo and we continue to jointly develop new innovative solutions that enhance patient care.

What is the product that you sell?

Our main focus is on patient engagement. We provide solutions for patient-reported outcome measurement – PROs– for instance using standard sets as developed by ICHOM, the International Consortium for Health Outcome Measurement. Customers include Boston Children’s, Duke Clinical, and AO Foundation.

Describe patient-reported outcomes, how they are collected, and how they are used.

As part of the move to value-based healthcare, it’s increasingly important for providers to measure quality of care, not just in clinical terms, but in terms that matter from a patient point of view. So, you get a hip replacement. Am I able to walk again? How long can I walk? Do I still experience pain?

What VitalHealth provides is the tooling that allows providers to engage with patients digitally in order to collect meaningful outcome data and to use patient-collected outcome data to improve the quality of the care. We provide seamless integration into the workflow of providers by connecting to different EMRs that are used.

Organizations learn and improve faster based on continuous specific feedback about outcomes coming directly from patients.

This is more than just measuring the patient’s perception of how well they were treated, correct?

Absolutely. This is based on validated standard sets developed by leading specialists from different countries. We are noticing increased adoption of PROMs around the world. It is a not only a great way to continuously improve quality of care, it also provides a way to make quality transparent for patients looking for the best provider to be treated by.

The main driver is the move to value-based healthcare in general. In addition we are seeing examples of payers mandating PROMs.

Do you have to sell the concept of patient-reported outcomes as well as your product, or have prospects already decided they want to move ahead with them?

There’s a little bit of both, but I would say that by now most providers have specialists that are very aware of organizations such as ICHOM and that are starting to take initiatives to implement PRO strategies within their organization.

Where do you see the company in the next five years?

I think we are seeing just the beginning. Today we collect data through questionnaires. Tomorrow we will add outcome measurements from many other sources, including wearables, sensors, and many other sources. We will do so real time and it will allow us to personalize care extremely effectively and efficiently.

Increasingly, treatment decisions will become shared decisions, with the physician and the patient being equal partners. Our goal is to be the global leader in this market.

Morning Headlines 2/3/16

White House To Request $1 Billion For Cancer ‘Moonshot’

President Obama will ask Congress to back his recently announced Cancer Moonshot project with $755 million for  cancer research. Congress already approved $195 million in research funding for 2016, bringing the projects total budget to nearly $1 billion over the next two years.

Aetna Reports Surge in Profit and a Dark Spot

Aetna reports Q4 results: revenue of $15 billion contributed to a 38 percent increase in profit, EPS $0.91 vs $0.65, missing on earnings but meeting revenue expectations. Like UnitedHealth, the company noted that its public exchange business was losing money.

Roper Industries Misses Q4 Street Views On EPS, Revenues

Roper Industries, parent company of Sunquest, reports Q4 results: revenue was flat at $943 million compared to $946 million during the same quarter last year, EPS $1.82 vs. $1.85, missing analyst estimates for both.

Theranos continues to dodge opportunities to validate its inventions

Theranos indefinitely delays its promise to allow its partner Cleveland Clinic to independently verify its technologies, while also confirming that it would not publish data to validate its tests before securing FDA approval for them.

News 2/3/16

Top News

The White House will ask Congress to approve $1 billion for President Obama’s so-called “cancer moonshot.” Some of the areas to be funded within HHS are early detection via genomics, enhanced data sharing among institutions, and a virtual FDA Oncology Center of Excellence to review new combination products.

Reader Comments

From Judo Chop: “Re: Florida Hospital and Athenahealth. This is part of the December announcement by its parent company Adventist Health System selecting Athenahealth. Florida Hospital will replace a combination of Epic ambulatory EHR that’s used in a handful of clinics, Cerner ambulatory EHR, and Allscripts (the old Misys product) PM. Most of the rest of AHS is using NextGen’s EHR/PM.“ Adventist announced in December that it will be deploying Athenahealth’s PM/EHR to 1,600 employed physicians.

From Polecat: “Re: Meaningful Use hardship exception. The new form doesn’t even ask the EP or EH to submit documentation of their claimed reason.” Correct. I think we can assume that this wink-wink form means CMS will allow anyone to avoid EHR penalties. MU is an embarrassment to everyone involved at this point and even the government is trying to distance itself from it. Just check “EHR Certification/Vendor Issues” and you’re done.

HIStalk Announcements and Requests

Mrs. Haley from Georgia couldn’t wait to send photos of her special education and gifted students using the three tablets we provided in funding her DonorsChoose grant request. She took these photos the day they arrived, where she had already installed reading and testing apps.

Also checking in was Mrs. B from North Carolina, who just got word that we had funded her request for science activity tubs. She says, “I couldn’t believe the email I received with information about my project … I yelled out loud and other staff members came to my classroom to see what was going on … I try to purchase what I can, but it seems as if my money is not going very far these days. Thank you very much from the bottom of my heart. You have made one teacher very happy … You will never know if a future mineralogist, petrologist, or geologist will be inspired by these kits!”

I was thinking today: has anyone actually ever heeded the warning to, “If this is a medical emergency, hang up and dial 911” after hearing those boring, time-wasting phone tree warnings when calling everyone from a dermatologist to a drugstore?

HIStalkapalooza

HIStalkapalooza Sponsor Profile – Fujifilm

With 16 years of industry-leading experience, our TeraMedica division remains independently focused on advancing VNA technology and healthcare interoperability while now leveraging Fujifilm‘s clinical capabilities. As the centerpiece of Fujifilm’s comprehensive medical informatics portfolio, Synapse VNA provides the industry’s leading image management solution. Fujifilm is proud to sponsor HIStalkapalooza. Visit us during HIMSS16 for all your medical informatics requirements, Booth #1024.

HIStalkapalooza Sponsor Profile – PatientSafe Solutions

PatientSafe Solutions has mobilized clinicians and redefined clinical workflows for more than a decade. Meet our team in Booth #4257 to learn how our Clinical Communications platform improves patient care and satisfaction while decreasing costs. Meet us at HIMSS. Our team can’t wait for HIStalkapalooza this year. Look for us at the event to get your picture taken for the 2016 HIStalkapalooza video!

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Huron Consulting Group acquires 25-employee, Denver-based MyRounding, which offers a mobile rounding and survey tool for hospitals.

Aetna announces that its profit jumped 38 percent in the most recent quarter, mostly due to its Medicare and Medicaid business, but says it lost money on its exchange-issued policies and warns that it has “serious concerns about the sustainability of the public exchanges.”

Alphabet, the recently formed parent company of Google, surpasses Apple as the world’s most valuable company after reporting impressive numbers in its first detailed report. Alphabet made $4.9 billion in profit on $21.3 billion in revenue for the quarter. Share price jumped 8 percent on the news, raising the company’s market capitalization to $559 billion.

Sunquest parent Roper Technologies reports Q4 results: revenue flat, EPS $1.82 vs. $1.85, missing estimates for both and issuing 2016 guidance below expectations. The CEO said in the earnings call, “We think we will have mid-single digit organic growth in Medical throughout 2016 and we think that will get stronger as the year goes on. Sunquest has a number of version changes and software release updates that are rolling out in the second half that will be quite beneficial. And then Strata, Data Innovations, and SoftWriters which are growing rapidly, will become organic in the second half. Verathon and Northern Digital are going to continue to grow at a relatively high rate in 2016. And then we closed on January 7 the CliniSys acquisition in the UK, which is a European hospital laboratory software provider, and it will add to our acquisition sales growth in 2016.”

Machine learning vendor Digital Reasoning, which acquired Shareable on January 8 to create its healthcare business, raises $18.6 million, increasing its total to $53 million.

A New York Times article questions whether it was wise for the struggling Theranos to hire star litigator and company director David Boies as its legal representative, given that he would be representing Theranos management as a lawyer while his responsibility as a director is to the company’s shareholders. It concludes,

The potential for conflict is particularly great. What if Ms. Holmes resists changes that would be in the interest of shareholders? What if the board decides that it is time for her to go — and she stands her ground? The board could do little more than throw up its collective hands under the current governance structure. Mr. Boies and the other outside directors could resign in protest. But why would anyone, particularly Mr. Boies, be a director on a board that lacked the power to make fundamental changes? Indeed, what is Mr. Boies thinking? He may be paid lots of money for his roles, but for someone so successful and savvy to put himself in a position that is bound to be problematic is puzzling.

Meanwhile, Theranos finds another foot to shoot in indefinitely delaying its October promise to allow Cleveland Clinic to validate its technologies and insisting that it won’t publish anything about those technologies in peer-reviewed journals until it receives FDA approval for all 120 of its tests.

Sales

Joseph Brant Hospital (Ontario) chooses FDB MedsTracker MedRec for medication reconciliation.

Craneware signs a $7.5 million contract with an unnamed hospital operator.

People

Seattle Children’s Hospital (WA) names interim SVP/CIO Jeff Brown (Lawrence General Hospital) to the permanent role. He holds three master’s degrees in business administration, executive management, and health informatics.

Allscripts names Melinda Whittington (Kraft Foods Group) as CFO.

CareSync hires Russell Dumas (Napier HealthCare) as VP of clinical operations, David Antle (BobCAD-CAM) as VP of client services, and Teri Spencer (GTE Financial) as VP of human resources.

Cumberland Consulting Group hires Terrell Warnberg (QHR) as partner over its new performance improvement practice.

The Health Information Trust Alliance (HITRUST) appoints Epic President Carl Dvorak to its board and names David Muntz (GetWellNetwork) as senior advisor of public policy.

Athenahealh hires Prakash Khot (Kaseya) as CTO.

Laura Momplet, RN (Dignity Health) joins CTG as chief operations officer and chief clinical officer.

Employee health platform vendor Healthcare Interactive names John Capobianco (KickStart Partners) as president and chief marketing officer.

Announcements and Implementations

Craneware will offer patient payment plan technology from VestaCare with its medical necessity and price estimation products.

Premier announces that it will conduct Innovator Research using Medicare data from CMS’s Virtual Research Data Center. Premier’s research division will analyze episodes of care to identify best clinical practices for care improvement and cost reduction.

A Surescripts study of New York providers finds that 93 percent of pharmacies can receive electronic prescriptions for controlled substances while only 27 percent of prescribers have the technology to issue them. It also finds that 58 percent of prescribers are issuing electronic prescriptions in general. New York’s I-STOP law requires that all prescriptions be transmitted electronically by March 27, 2016, meaning a huge number of prescribers need to take action in the next seven weeks.

Government and Politics

New York Mayor Bill de Blasio hires a consulting firm to figure out what to do about the city’s 11-hospital Health + Hospitals Corporation, which despite extensive city support is expected to run a deficit of $2 billion within the next three years. The health system hopes to convince more patients with commercial insurance to use its facilities than those of its competitors, all of which have similar ambitions.

Privacy and Security

Australia’s Royal Melbourne Hospital says it hasn’t completely eradicated the Qbot malware that infected its Windows XP computers two weeks ago. The hospital says the virus mutated six times in a single day. The keystroke-capturing malware penetrated the hospital’s pathology computers via a Windows XP exploit, managing to evade detection by the hospital’s updated antivirus product.

Other

A study finds that mobile text messaging increases medication adherence rates in chronic disease patients from an assumed baseline of 50 percent to 68 percent, although the sites that are screaming this out as big news failed to note that:

• It’s a meta-analysis, meaning that instead of doing new research it just combines information from previously published studies.
• The studies it reviewed involved fewer than 3,000 patients combined.
• Texting results were measured only for a short duration.
• The studies relied on what patients said they did rather than measuring what they actually did.
• The text messaging in each study was not consistent as to frequency and style.

This is not newsworthy other than the fact that it was published in JAMA Internal Medicine, where it will reach a wide audience. It’s also surprising that the journal misspelled the name of the Johns Hopkins Bloomberg School of Public Health in its author affiliation section.

Duke University Health System (NC) reports making a record profit of $355 million for 2015, explaining that, “For the three or four years leading up to this past year, we had made a series of investments in facilities and information systems that helped to relieve capacity constraints limiting growth … With our new IT capabilities, we are able to better manage care across the spectrum and become more efficient in that way.” The system said it made a lot of money by buying up oncology practices to increase inpatient volume.

I received a survey link from HIMSS about its Learning Center, which sells thinly disguised advertising via its HIMSS Media business. Being a member of HIMSS means being inundated with its vendor-sponsored pitches, in this case disguised as “education,” where high-paying vendor members pay dearly to be hooked up with low-paying provider members in the “ladies drink free” business model. 

The Virginia Tech professor who led the study proving that the water in Flint, MI contains dangerous levels of lead says public science is broken as university faculty members are pressured to get funding and to become famous. He explains, “Where were we as academics for all this time before it became financially in our interest to help? … Science should be about pursuing the truth and helping people. If you’re doing it for any other reason, you really ought to question your motives … Everyone’s invested in just cranking out more crap papers … when you reach out to them, as I did with the Centers for Disease Control and Prevention, and they do not return your phone calls, they do not share data, they do not respond to FOIA … every single rock you turn over, something slimy comes out.”

A Congressional investigation finds that despite the patient-focused claims of since-fired Turing Pharmaceuticals CEO Martin Shkreli, the company was gloating with delight at the profits it would make by jacking up the price of ancient drug Daraprim by 50-fold.

Weird News Andy titles this sad story “Out of the frying pan and into the fryer.” A patient with mental illness jumps out of a moving ambulance while being transported from a hospital and is struck and killed by a driver who then fled the scene.

Sponsor Updates

• Catalyze co-founder and CEO Travis Good, MD will speak on “Excitement in Healthcare Regulation” at the 2016 Hosting Milestone Summit Series on February 4 in Las Vegas.
• Divurgent will attend the South Carolina HIMSS Networking Reception & Dinner February 4 in Columbia.
• FormFast gears up for HIMSS16.

Blog Posts

• Stop Leaking Revenue in your Private Practice; 3 Areas Where You’re Probably Losing Money (AdvancedMD)
• Your Medicare cost report as a source of additional revenue (Besler Consulting)
• New Year, New Security Posture: Top Defenses for 2016 (Burwood Group)
• Building a Culture of Physician Engagement in Population Health (Caradigm)
• CareSync Shares CCM Insights in Letter to Senate’s Chronic Care Working Group (CareSync)
• CodeMash 2016 (CoverMyMeds)
• Leaving No Stones Unturned – Post Live Revenue Challenges & Tools to Help (Culbert Healthcare Solutions)
• Top Ten Reasons Why Good People Quit (Direct Consulting Associates)
• Considering Optimization? Don’t forget about Chart Prep (Galen Healthcare Solutions)
• 11 Pitfalls of a System Conversion and How to Avoid Them (Hayes Management Consulting)
• The Three C’s of the Right Secure Text Messaging Solution (Spok)

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 2/2/16

Athenahealth Names Prakash Khot as Chief Technology Officer

Athenahealth hires Prakash Khot as its new CTO. Khot was previously the CTO of Kaseya, and spent several years with Salesforce prior to that, where he rose to the position of SVP of Engineering, overseeing big data and analytics development.

American Heart Association, IBM Watson Health and Welltok Team Up to Transform Heart Health

American Heart Association announces a strategic partnership with IBM Watson and patient engagement vendor Welltok to develop employer-focused solutions to improve heart health.

Certification Frequency and Requirements for the Reporting of Quality Measures under CMS Programs; Extension of Comment Period

CMS issues a 15-day extension to the public comment period for its RFI seeking input on certification and testing of EHR products used for quality measure reporting.

Defining Value in Health Care: CMS Releases Updated Benchmarks for ACOs

Aledade publishes a blog analyzing the recent CMS update to ACO benchmarks.

Curbside Consult with Dr. Jayne 2/1/16

A wise man once told me to take as many business and finance classes as I could, even though I planned to go to medical school. That advice has served me well over the years, particularly as medicine has become more of a business and less of a calling.

Although my residency program provided solid education in practice management, it still didn’t fully prepare me to run my own solo practice. I was lucky to have some good advisors who could point me in the right direction and were willing to mentor me in learning more about healthcare economics.

As we move into the realm of value-based care, the ability to understand economics and finance will be critical for physicians and other care providers if they want to remain solvent. There has to be a return on investment — not only on technology and infrastructure expenditures, but also on staff.

The latter seems to be the hardest for some organizations to understand. I have worked with quite a few employers over the last several years that don’t have a working knowledge of productivity benchmarks. I’m not saying that everyone needs to go out to national sites and compare their staff right off the bat, but at a minimum, organizations should understand productivity within their own site, practice, or location. If they’re serious about operating in the value space, they’re going to have to get very cozy with benchmarking and determining the total cost of various episodes of care.

It’s hard to reconcile complaints about the EHR being too clicky or too cumbersome when you have physicians seeing dramatically different numbers of patients. I was recently at a site where providers were seeing 16 patients a day in the primary care setting. Personally, I haven’t seen that few patients since I was a first-year resident and still had to review every patient visit with a supervising physician. After getting them past their initial arguments about how their patients were sicker or more complex than anyone else’s, the physicians in question were eager to blame everything on the technology, when a careful review of their office process revealed otherwise.

I spent several days in the office observing workflows and what I saw was shocking. Staff were blatantly surfing the Internet on their phones and ignoring patient-related tasks that were waiting for their attention. The amount of gossip and chatter reminded me of a middle school lunch room.

The Hawthorne Effect poses that when people are observed, they change their behavior simply because they are being studied. I couldn’t help but think that if this is what they were doing in front of someone observing them, the amount of waste when they weren’t being observed might be staggering. And yet the physicians felt that they couldn’t give the staff any more work because they were “too busy” and therefore were taking on more non-value-added work for themselves, such as filling out forms and looking for missing lab results.

After documenting the current state thoroughly with not only summary statements but actual time studies, I presented my case to the physicians and practice managers. Generally, I expect a little push back, including concerns about being able to hire better staff or that staff will leave if they are confronted with a lack of productivity or with rising expectations.

This organization, however, had worked its way into a seriously co-dependent state, with the physicians mounting a strong defense of the status quo even though it was adding to their misery. They continued to blame the EHR and government mandates even when presented with data from high-functioning practices using the same EHR under the same government mandates. The practice’s leadership was unwilling to accept the possibility that the staff (and lack of management thereof) was a significant part of their problem even though it was directly impacting physician satisfaction and the bottom line.

After presentation of a proposed set of future state workflows, we had several hours of discussion. I used all my Jedi mind tricks, but was unable to get them to consensus around what needed to be done to take their practice to the next level. They have it in their minds that they want to achieve Level 3 Patient-Centered Medical Home recognition. How are they going to create a highly functional team care structure when they are unwilling to take the time to even discipline a staff that is obviously goofing off?

They also want to join an Accountable Care Organization because they’ve heard it’s the way of the future. Don’t get me started on changing your model of care just because you read somewhere that you should. Furthermore, if they’re not willing to address both staff and provider performance issues, how do they think they are going to use data to address patient compliance issues and drive outcomes?

Knowing that I was getting nowhere fast with the idea of practice accountability, I tried to appeal to their understanding of economics. We discussed the money they are losing by not making the most of their existing resources as well as the potential cost of hiring incremental resources to accomplish their goals. Again, they tried to throw the technology out as a cause, citing what they perceive as a high cost of ownership of their current client-server EHR.

One of the doctors mentioned that they were considering chucking the system in favor of the free online EHR that he saw an ad for in one of his journals. I asked how much they thought it would cost to migrate 10 years of data from their existing system to a new one and how much they might lose in the transition. It was clear that those thoughts had never crossed their mind.

I know they have at least a minimum desire to move to a better place. Otherwise, they would not have hired me to come in and do an assessment. I have to say, though, that I was grateful that my engagement with them only included the assessment and the creation of a report with basic findings, and not the actual optimization effort. Without committed leadership that “gets it,” they are doomed to stay right where they are.

Frankly, I don’t think I can handle another train wreck client right now. I know they’re going to push me to provide a proposal for the next phase, but I think I’m going to have to respectfully decline for my own sanity.

There is at least one health system in the area that is in acquisition mode. I wonder if this practice will become a potential target. Despite the mess they’re in, they have a fairly large patient base and a decent location. Stronger leadership with a better understanding of the big picture and a willingness to ruffle some feathers (if not getting rid of the chickens all together) could turn this into a much more successful situation.

Although some of the practice’s leadership thought I would be able to force change from the outside, I had told them that it rarely works that way and played out exactly as I had predicted. Unless they’re willing to give an outsider control of their staffing or are willing to take charge themselves, they’ll likely just keep running in circles. Worst case, they’ll run themselves into the ground if they attempt to do an EHR replacement no matter how “free” they think it is. I’ve never seen that turn out well despite the claims of the vendors.

What do you think about free EHRs? Email me.

Email Dr. Jayne.

HIStalk Interviews Marc Probst, VP/CIO, Intermountain Healthcare

Marc Probst is VP/CIO at Intermountain Healthcare of Salt Lake City, UT.

You have a history of speaking out about Meaningful Use. How has your opinion of it changed over the last several years?

Meaningful Use came out as a stimulus package. Did it stimulate the economy and health IT? It clearly did. If that was the plan, it was successful. Did it get more EHRs in physicians’ offices and in hospitals? It clearly did.

Did it move healthcare dramatically to lower costs, or even incrementally, to lower costs and higher quality? It has not. It has a long way to go, and because of the way we approached it, with check-the-box certification and achievement of Meaningful Use, it just didn’t deal with the underlying challenges of things like standards of interoperability.

The last point on that is simply how much money we’ve spent for the value that we’ve gotten. It’s minimal. All along, I felt we should have dealt with that and that’s why I’ve been so outspoken, a thorn, probably, in the side of my colleagues at ONC.

What was your reaction to Andy Slavitt’s remarks at the JP Morgan Health Care Conference, and then in the follow-up CMS blog?

On one hand, it’s disappointing because we’d like to see the end of Meaningful Use. I don’t speak for every CIO, but the ones I know were kind of excited to see it end. It wasn’t achieving necessarily all the objectives we want to achieve, so that was the negative.

The good side is that the national conversations picked up around what is the value of Meaningful Use and how the program should be changed to become more effective. I think that’s positive. The water under the bridge is how much money we’ve spent and the steps we’ve taken to this point.

The optimist in me things we’re going to have a good conversation about it. We’re going to talk a lot more about outcomes and how organizations can achieve outcomes that are better with technology. If properly done, properly incentivized by the government or not disincentivized by penalties, I think we can make some really important strides.

How would you like to see Meaningful Use transition into something truly beneficial?

I’d like to see it become outcomes-driven. If I can prove to you that I have lowered the incidence of diabetes or some of the clinical outcomes that are associated with diabetes because I’ve used information systems and data to do that, that’s a good thing. It lowers cost for the country and improves healthcare.

If we can do that with diabetes, let’s go to heart disease. Let’s go to incidence of jaundice in or around birth. There’s so many areas we could focus on, and if we turned it to that direction, you’re going to have clinicians and technologists working together to leverage these tools we’ve put in place to improve care and lower cost.

That ought to be our outcome, not whether or not we placed 60 or 90 percent of our orders through CPOE. If we can shift that conversation and then the incentives around that, I can just see massive innovation and much more benefit come out of these systems.

Intermountain is just over two years into its contract with Cerner. How is the partnership going?

It’s going very well. I think like every other organization, our very first go-live was a learning experience. Having to help physicians and other clinicians understand how to use the system was a tad painful. It wasn’t easy. We were Intermountain Healthcare. We thought we knew everything, but we had a few things we had to learn.

We did that last March. We went live with our first two facilities on clinical and rev cycle. That was two hospitals and about 20 clinics. Then we went live in late October with two more hospitals much larger in size, one of them our second-largest hospital.

Then probably 60 more clinics and rev cycle and everything surrounding it. That one went much better because we had learned so much from our first implementation and we’re now ready to go much more quickly. We’re going to probably bring up probably 12 to 15 more hospitals in 2016. We know how to do it better now, so I would say it’s going very well.

If you had to pinpoint one lesson learned that you’d like to share with other CIOs and IT teams, what would that be?

Adequate resources on the clinical side to help physicians adopt their work flows, without a doubt. It wasn’t technical issues. Technically, this thing went swimmingly. It’s all around adoption, use of the system, and changing work flows.

Did you bring in any consultants to help with those initial implementations?

The second one we did. The first one we did all on our own with Cerner’s help. The second one we brought in Leidos, primarily, to really help us get it done. They were very, very helpful. We’ll use them going forward.

What’s the biggest lesson you think your end users have learned or are in the process of learning?

Just how involved they have to be. You must have leadership on all levels. We’re divided into regions and then those regions have multiple facilities in them. That local leadership has to participate. This isn’t something that can be done to them. It has to be done with them. As they participate, our success rate goes way up.

What sort of ROI are you looking to get from your partnership with Cerner?

I don’t think any of us have fooled ourselves into thinking it’s going to be cheaper than our self-developed systems. What we’re getting with Cerner is a much more comprehensive solution. That’s been really positive.

Given that we’ve built systems very unique to the needs of Intermountain, our concern in transitioning to a system we didn’t build was, would we be able to retain that level of … I hate to use the word interoperability … tightness between what we’re doing from data analytics and what we’re trying to do from a process and workflow perspective to obtain those levels of best practice care and cost that Intermountain is known for. It’s actually what drove us to Cerner, because we thought we had a much better chance of doing it with them than we might with one of their competitors.

To date, that’s become much less of a concern. We’ve achieved a lot. We’ve done a lot of work in enhancing the core Cerner model system to have more of those capabilities, so I think our ROI is with this more comprehensive system and the greater amount of data that it provides.

We can go to the next level of best practice care. We don’t think we’ve gotten there. We think we can build in a lot more activity-based procedures and cost mechanisms so that we can even better understand where we’re spending money and where we can lower our costs and improve our quality. That’s really been our focus and that’s where we see the ROI.

The expense of doing something like this … did we lower IS costs or workforce costs? We haven’t really focused on that and we won’t. We know the benefit comes from providing better care and doing it at a cost that’s lower than what we’re doing today.

What is Intermountain looking to accomplish from a population health management standpoint this year?

We’re building a digital health strategy, and so this year we’ll be looking at how to engage patients with portals, mobile, that kind of thing. We’re really building out the strategy on how to do that. To suggest in 2016 we’ll accomplish a ton, I don’t think so. We’re just getting our ducks in a row this year as to how we’ll pull it off.

However, from the data side, we’re looking at understanding where our opportunities are around population health. How do we get to value-based payment and how do we contract with physicians that are going to be moving to population health and value-based care? We’re working with Cerner with HealtheIntent to support that exercise, but we’re also depending upon our legacy electronic data warehouse and traditional analytics.

What will you be looking at on the HIMSS show floor this year?

Security’s going to be a big issue. In fact, I just got out of a meeting to have this call, an all-day meeting that’s got some big players in town talking security.

Also, I think anything around population health and more visible things like portals, mobile, and wearables, that kind of thing. That’ll be pretty interesting to me.

Plus, I’m looking forward to connecting with old friends. I’ve been in the industry a long time and it’s a pretty small one, all things considered. It’s a great industry.

Morning Headlines 2/1/16

New Proposal to Give Providers and Employers Access to Information to Drive Quality and Patient Care Improvement

A proposed rule by CMS will allow qualified entities to sell de-identified Medicare and private payer claims data to providers, employers and other groups interested in using the data to support quality improvement projects.

Flint doctor used Epic Systems records to expose lead crisis

The pediatrician who brought the water crisis in Flint, MI credits EHRs for allowing her to quickly calculate the recent rise in lead poisoning among local children, noting “If we did not have Epic, if we did not have (EHRs), if we were still on paper, it would have taken forever to get these results.”

Meditech Form 10-K Annual Report

Meditech reports its 2015 year end results: total revenue was $475 million, down eight percent from 2014, driven down by decreased product revenue. Net income was $70 million.

Quality Systems Beats Q3 Earnings, Lags Revenue Estimates

Quality Systems, parent company of NextGen, reports Q3 results: revenue fell 1.6 percent to $117 million compared to the same quarter last year, adjusted EPS $0.16 vs. $0.16.

Monday Morning Update 2/1/16

Top News

CMS proposes a rule that would allow qualified entities – of which 13 have been approved so far — to provide or sell Medicare and private claims data to providers to support quality improvement. Only two of the qualified entities report provider performance nationally — Health Care Cost Institute and Amino. Physician practices (or employers paying for their services) would be able to review all-payer data for their patients.

Reader Comments

From Eddie T. Head: “Re: CHIME’s patient identifier challenge. A 100 percent match is unrealistic. Even in countries with a national medical identifier the accuracy is about 95 percent. The 100 percent goal will get in the way of creating a real solution nationwide.”

From AthenaAscending: “Re: Florida Hospital. Is replacing Epic’s PM/EHR with Athenahealth.” Unverified.

From Unintended Consequences: “Re: AGH in Pittsburgh. Its Epic acute go-live has created medical care havoc in peripheral LTAC and SNF facilities that had relied on Allscripts Sunrise for order entry and results retrieval. They are not on Epic and have resorted to a 1980s paper requisition and lab retrieval system. Doctors cannot see a list of their patients. AGH’s command team has informed doctors that stat orders must be called in and cases ordered as consultations won’t appear on the consultant’s patient list.” Unverified. 

HIStalk Announcements and Requests

A reader asked me to post a single summary of my unsuccessful quest to obtain an electronic copy of my hospital stay information, which I’ve done here.

A surprising 80 percent of poll respondents aren’t fans of the idea of the ONC-published EHR star rating that Congress is considering. Jacob Reider commented that it’s a terrible idea and is outside of the government’s role. Ross Koppel says summarizing complex systems with a single star rating is simplistic. Barbara Hillock thinks such ratings would be misleading since they would be driven by the expectations of customers who don’t always follow the vendor’s implementation recommendations. Meltoots commented that ONC and CMS need to stop getting in the way of patient care with new programs.

New poll to your right or here: how have recent statements from CMS affected your perception of HHS/CMS/ONC?

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

Mrs. Johnson from Illinois sent photos of her kindergarten class using the math tools we providing in funding her DonorsChoose grant request. She says, “It was so generous of you to help us succeed in getting some of the tools we need to make learning math engaging and fun! The look in these kids’ eyes when I tell them we have something new that will help us learn is motivation for me. I couldn’t have provided these materials on my own and appreciate the support you have given.”

Epic consulting firm BlueTree Network donated $1,000 to secure a spot at my CIO lunch at the HIMSS conference, which allowed me to fully fund these DonorsChoose teacher grant requests with the help of matching funds:

• Science activity tubs for Mrs. B’s first grade class in Richfield, NC.
• Three iPad Minis, cases, and a document camera for the second grade class of Mrs. Mann of West Newton, PA.
• Electricity and magnetism activity tubs for Ms. Anderson’s fourth grade class in Phoenix, AZ.
• Two Osmo gaming systems for Mrs. Boyd’s elementary school class in Chocowinity, NC.
• Three programmable robots and engineering components for the new middle school robotics club started by Mr. Rector in Beebe, AR.
• STEM challenge kits and for Mrs. May’s special education classes in Edgewater, FL.

HIStalkapalooza

I have received over 1,200 requests to attend HIStalkapalooza, so I’m closing signups Monday. Sign up now or never. I’ll be able to invite most of the people who signed up. We’ll be handling invitations, RSVPs, reminders, and electronic check-in through Eventbrite this time and I expect the invitation emails will go out this week. This is where the annoying part of throwing a free party begins as it does every year when I vow that this year’s event will be the last because of the time and energy it requires:

• People will email me asking if they can bring a guest. If you didn’t sign up your guest like the form clearly states, then they can’t come – it’s like going to an Adele concert or traveling on American Airlines –everybody needs a ticket, with the only difference being that HIStalkapalooza tickets are free.
• I’ll hear from folks who claim to be the most loyal and careful readers who swear they mysteriously missed the dozens of times I’ve provided signup instructions and wanted to be added after the fact. Sorry, no, it’s only a party and your life won’t be ruined if you miss it because you couldn’t follow the rules everybody else figured out.
• Vendor administrative assistants who don’t read HIStalk and who signed up bunches of their executives (who rarely actually show up) will start bugging us about why they haven’t received invitations. That’s actually already happened as the admin of one company keeps asking why her 23 executives haven’t been invited yet. This isn’t a company outing and we have more important things to do than swap party-related emails, so I’m hitting “delete” on those.

Last Week’s Most Interesting News

• CMS warns Theranos that its California lab practices are dangerous to patients and that it has 10 days to fix the problems or face suspension from Medicare.
• Leidos announces that it will acquire the IT business of Lockheed Martin for $5 billion.
• Cerner Chairman and CEO Neal Patterson notifies shareholders that he is being treated for soft tissue cancer.
• A Texas hospital regains access to its EHR after being locked out for more than a week by ransomware.
• Flint, MI-based Hurley Medical Center says it was hit by a cyberattack by hacker group Anonymous, which is protesting the city’s water crisis.
• Big Bucks Equals Big Interest in CHIME’s National Patient ID Challenge.
• McKesson’s Paragon Dilemma.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Capital BlueCross orders Theranos to stop performing blood draws in Capital’s storefront in Hampden Township, PA following a CMS investigation that found deficiencies in the California lab of Theranos that “pose immediate jeopardy to patient health and safety.”

Xerox will split itself into two companies, responding to pressure from activist investor Carl Icahn to separate its $11 billion document imaging business from its $7 billion business process outsourcing. Xerox, which acquired Affiliated Computer Services for $5.6 billion in 2010 and will now basically spin it back off, has 104,000 employees who will be part of the new BPO company. Xerox announced Q4 results with the announcement: revenue down 8 percent (its 15th consecutive quarter of declining sales), adjusted EPS $0.32 vs. $0.31, beating earnings expectations.

WeiserMazars acquires Lion & Company CPAs, which includes healthcare consulting among its offerings.

Quality Systems (NextGen) announces Q3 results: revenue down 1.7 percent, EPS $0.16 vs. $0.16, missing on revenue but beating on earnings. Shares dropped nearly 20 percent Friday on the news. Above is the one-year share price of QSII (blue, down 20.7 percent) vs. the Nasdaq (red, down 1.34 percent). Five-year performance looks a lot worse, as Quality Systems shares dropped 67 percent as the Nasdaq gained 67 percent.

The HCI Group acquires Houston-based Expert Technical Advisors.

Philadelphia-based orthopedic practice The Rothman Institute and the University of Virginia Health System participate in a $4 million funding round for Locus Health, a remote care management company of which both organizations are customers.

Meditech publishes its FY2015 annual report. Revenue was down 8 percent for the year (“primarily due to lower product bookings”) and net income dropped from $124 million to $70 million. Neil Pappalardo owns about $450 million worth of shares.  

Announcements and Implementations

Recondo Technology launches MySurePayHealth, which allows patients to estimate their out-of-pocket cost for a given procedure.

An emerging technology site profiles Valdic co-founder and CTO Drew Schiller as part of its “Today’s Entrepreneur” series, in which he lists his top three lessons learned:  (a) if someone isn’t interested in paying for your product, ask them what they would pay for; (b) reputations follow you, so treat everyone well; and (c) we are so fortunate to be living in an era where it is this easy to start a new company and iterate on ideas.

Government and Politics

Ashkan Soltani, senior advisor to White House CTO Megan Smith on loan from the Federal Trade Commission, announces that he has effectively been fired after just six weeks on the job when the Office of Personnel Security denies his security clearance. Soltani, whose White House assignment involved privacy, data ethics, and recruiting technologists for government service, previously won a Pulitzer prize as part of the Washington Post investigative team that revealed the extent to which the National Security Agency spies on American citizens.

This might be the highest-profile bungling of the HIMSS acronym. Pedantic grammarians such as myself smugly note that HIMSS and HIPAA are “acronyms” as opposed to “initialisms” (acronyms are sounded out as words, while initialisms are pronounced as their individual letters, as in “CIA” or “IBM”).

Privacy and Security

Scientific American’s “How Data Brokers Make Money Off Your Medical Records” contains no new information, but gives the public a glimpse at how companies are buying and selling their de-identified medical information. It mentions IMS Health, which takes in $2.6 billion per year by combining and repackaging information on 500 million people worldwide and then selling insights to drug companies and other to help them target sales. It repeats the now-obvious concept that it’s not hard to re-identify people by linking multiple databases. Drug company Pfizer spends $12 million per year to buy health data, but even its own analytics director says patients own their data, should be told how it’s being used, and should be given the ability to opt out of data that’s being collected for purely commercial purposes.

Technology

A Fast Company article describes the use of robots in long-term care, giving as an example Luvozo’s SAM “robotic concierge” that uses remote care staff. 

Other

A good interview with WebMD’s dethroned founder Jeff Arnold, now CEO of Atlanta-based Sharecare, describes how the company uses individual results from its acquired RealAge health questionnaire to push content to users. Sharecare also offers personal health consultations via its AskMD app and publishes a voice-analyzing app to detect stress. On the downside, the company’s co-founder is the pseudo-medical huckster Dr. Oz.

Kaiser Health News describes the enthusiasm patients of Newport Orthopedic Institute are expressing for the empathetic, automated post-surgery daily emails they receive from the practice’s HealthLoop system. The article provides an example of a knee surgery patient who responded to a system-generated, emailed question about calf pain, which triggered his doctor to see him immediately and diagnosis his dangerous blood clot.

The Hurley Medical Center pediatrician who uncovered the human effects of the Flint, MI water crisis credits the hospital’s Epic system and EHRs in general for allowing her to quickly discover the increasing number of children with high levels of lead in their bloodstream. “If we did not have Epic, if we did not have (electronic medical records), if we were still on paper, it would have taken forever to get these results,” says Mona Hanna-Attisha, MD, MPH. She cross-referenced the abnormal blood levels to home addresses using geographic information system software to prove what was happening despite the denials of state officials. She is also adding an Epic flag to allow doctors to track those children for lead poisoning symptoms that can take years to emerge. Note once again the key involvement of a doctor trained in public health when discovering and responding to a regional crisis.

Chester County, PA commissioners proclaim January 29 as R. James Macaleer Day, honoring the recently deceased local charitable benefactor and founder of Shared Medical Systems on his birthday.

The US Army Reserve highlights the actions of three members of the 345th Combat Support Hospital of Jacksonville, FL who are deployed to Kosovo and who saved the life of a motorcycle accident victim while on leave in Greece. Those involved were Major David Whaley, who is a doctor of pharmacy; Colonel Edward Perez-Conde, brigade surgeon; and Major Kirk Shimamoto, a doctor of dental surgery. Perez-Conde says he considered using a pocketknife and ball point pen to relieve the victim’s pneumothorax, but, “we didn’t know how the police would react to a medical procedure using a pocketknife and we certainly didn’t want to go to jail.”

Flint-based McLaren Health Care (MI) will centralize its 13 billing and collections offices, saying it lags in standardizing its revenue cycle processes but hopes it can increase revenue by $30 million by reducing denials and increasing collections. The health system also says it is working on integrating Cerner’s EHR and patient billing systems.

An article describing how ad-supported publishers are “freaking out” over their readers using ad-blocking software provides an example in Modern Healthcare. The Interactive Advertising Bureau calls AdBlock Plus, which has been downloaded 500 million times, “unethical” and “immoral,” declining to note that publishers are producing content that few people are willing to pay for in any form, including by the viewing of ads.

A New Hampshire jury awards $32 million to a former Walmart pharmacist who claims she suffered gender discrimination in being wrongfully terminated for notifying the state’s board of pharmacy about the large number of errors the pharmacy was making, some of which the store manager inappropriately blamed on her. Mauren McPadden, who had worked for the company for 18 years, also says Walmart violated her HIPAA rights by accessing her PHI and telling co-workers that she had suffered a nervous breakdown. Walmart claims it fired her because she lost her pharmacy keys.

Sponsor Updates

• T-System offers free tool to providers for documentation and diagnosis of influenza patients.
• Valence Health will exhibit at the HFMA First Illinois Managed Care Meeting February 4 in Chicago.
• Huron Consulting Group releases a new clinical research management briefing.
• ZirMed will exhibit at the AAPAN Annual Forum February 1-2 in Laguna Niguel, CA.
• Aprima launches its redesigned website. 
• Caradigm completes the ConCert by HIMSS interoperability testing and certification program.
• Sandlot Solutions will exhibit at the Louisiana Hospital Association’s Winter Leadership Symposium February 2-3 in Baton Rouge.
• Surescripts will exhibit at the EHealth Initiative 2016 Annual Conference February 3-4 in Washington, DC.

Blog Posts

• Best-of-Breed Solutions (Voalte)
• 3 Places to Find Patientco at HIMSS16 (Patientco)
• A Luxury Beyond Belief (PatientKeeper)
• How Secure Texting Apps Improve Physician-Physician Communication (PracticeUnite)
• Education Minimizes the Impact of Healthcare Hackers (PerfectServe)
• Predictions of Apple Q1 Earnings from Medical Charge Capture and Secure Messaging Users (PMD)
• Why our expansion at Partners matters (QPID Health)
• Content Interoperability: Achieving Clinical Data Quality Success (Stella Technology)
• 2016 IHE Connectathon in Full Swing! (Summit Healthcare)

Contacts

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

Why I Still Don’t Have an Electronic Copy of My Medical Records Six Months After Asking

I decided in June 2015 to go through the exercise of requesting an electronic copy of my medical records. They’re from an Epic-using, Most Wired-winning, EMRAM Stage 7 academic medical center at which my only encounter was an unplanned, uneventful one-night stay while traveling. I wanted to see how the records request process might work for the average patient.

I also tried using the hospital’s MyChart portal to look up my own records as a second experiment. That’s a different process managed by the hospital’s MyChart support team. I was not successful since my visit was not listed and the polite but baffled technician couldn’t figure out why. The technician did not offer to research the problem further.

Day 1

The records request page on the hospital’s website offers two options: dropping by personally to the hospital’s health information management department (which they clearly prefer) or downloading, completing, and faxing a form. Scanning and emailing the signed form was not possible, they said – it has to be faxed. Requests for images must be made separately by calling a different telephone number.

The form is complicated since it was primarily designed for patients who want to give someone else access to their records, such as for a workers compensation claim. The hospital really should create separate forms to avoid awkward references to “the patient” when it’s the patient making the request. It also asked for “patient medical record number or other identifiers” which hospitals frustratingly and somewhat arrogantly expect patients to learn and remember.

I completed the paper form as best I could, but it was not easy to figure out what they were looking for. Then I had to scan the signed form and find an online fax service to send it to the HIM department’s release of information fax machine.

The paper form did not provide an option for how I wanted to receive the information, stating flatly that paper copies would be mailed and that an unstated per-page fee would be charged by its contracted release of information vendor (it’s scary to agree to pay the fee upfront without knowing how many pages are involved or what the per-page charge is). It didn’t ask how I preferred to be contacted (not that it mattered since they never contacted me), but it did ask for a telephone number and physical address, again oddly worded since the multi-purpose form isn’t intended for patients only, with fields such as, “Phone (if known)” as though the patient might not know their own telephone number.

Day 11

I called the hospital’s HIM department since I hadn’t heard back from my request. They said they hadn’t taken any action because I hadn’t provided dates of service for my one and only encounter with the health system (since I couldn’t remember the date – it was more than a year before). They looked it up and said they would mail the records. I told them I wanted them in electronic form.

The HIM person said they don’t provide electronic information to patients, only to physicians. I said they were obligated to give me an electronic copy if I wanted it. She said she would get back with me after she talked to her supervisor.

Day 13

I hadn’t heard back from HIM, so I called them again. The supervisor repeated that they are not obligated to give patients electronic copies of their records and would provide only mailed paper copies. I repeated that they are indeed obligated to provide electronic copies. I said I would file a Office for Civil Rights complaint if they refused. Which they did, again.

I filed the OCR complaint. It was an easy online form to complete and I received quick email confirmation that it had been received.

Day 39

A letter-sized envelope arrived in the mail from the hospital. My name and address were scrawled nearly illegibly on the front with no indication of what was inside. I opened it up and there was my visit summary, contained on two pages front and back as printed off from the hospital’s Epic system. The hospital didn’t include a greeting or explanation or anything to indicate why they had sent the copies – it was just two Epic-generated pages that I finally figured out. I can’t imagine the average patient receiving the same document and making sense of it. At least they didn’t charge me for the two pages.

Day 211

I received a letter from the Office for Civil Rights informing me that my complaint was being closed without formal investigation. Instead, OCR said it had decided to “resolve this matter informally through the provision of technical assistance to the hospital.”

I haven’t heard from the hospital. I still don’t have an electronic copy of my records. My visit still doesn’t display in MyChart.

I invite readers to try this same process with their hospital or physician practice and let me know how it goes.