Monday Morning Update 9/21/15

September 20, 2015 News 3 Comments

Top News

A hobbyist geek prowling around the publicly accessible subdomains on Amazon Web Services finds unencrypted SQL database backups, apparently from claims management vendor Systema Software, that contain the personal and medical information of at least 1.5 million people. He also found a complete backup of the Kansas State Self-Insurance Fund, thousands of PDF scans from Golden State Risk Management Authority, insurance files, fraud investigation notes, and a 570,000-entry address book. The SQL backups also contained user login information and proprietary information. Vendors and health systems that use AWS might want to double check their security settings.

Reader Comments

From With a Spoon: “Re: vendor gag clauses. You are right and the online magazine is wrong. A gag clause is a specific set of contract language that prohibits a customer from saying or writing something negative about their vendor. Nothing else is a gag clause, especially intellectual property limitations, and nothing else has a negative impact on patient safety. Plus, just because a customer isn’t prohibited from alerting other users about a vendor software problem doesn’t mean they will – like information blocking, it’s not just what the vendor prohibits, but what customers are willing to actually do when it doesn’t benefit them.” Congress is hearing from people who don’t know what they’re talking about that gag clauses exist and they’ve provided no evidence. I also agree that everybody assumes it’s the bad old vendors who are responsible for the lack of information sharing among customers, which doesn’t hold water in most cases because it’s the customer who benefits from walling off their data.

Contrast Politico’s much-hyped headline with its non-story that obviously confuses IP clauses with non-disparagement clauses and provides no evidence of what the headline claims. Meanwhile, the folks at HIMSS Analytics have graciously offered to give me access to the CapSite contract database, so I’ll do my own looking for such clauses and will let you know what I find.

From Screener: “Re: sharing software screen shots. The reason vendors require customers to ask permission first is that much of a vendor’s product design and internal algorithms can be deduced from a screen shot. Collecting all screens of a vendor exposes the heart and soul of their design. Without a ‘you can’t post our screens without asking’ default, certain people would apply their personal critique indiscriminately, possibly funded by special interests or even competitors (some sites have on-site doctors who work for the competitors of their EHR vendor).” I admit that a couple of times early in my career, I used a vendor’s screen I remembered having seen as a basis for writing a program for my own hospital, although it didn’t affect that vendor since my stuff was for internal use only. Courts have ruled that vendors can’t claim copyright infringement for look and feel, screen layouts, and algorithms, meaning the only physical parts of software that are protected are the actual programming code and database schema. Therefore, the only way a vendor can protect itself from outright theft is to add terms of service that make customers responsible for not sharing sensitive information that can’t be copyrighted. Those terms also often protect the customer as well, giving them ownership and control of their own customizations instead of automatically conveying those rights to the vendor.

From Prior Restraint: “Re: sharing software screen shots. Say for example that someone who is seeking publicity asks permission to use an EHR’s screen shots to prove that the software is unsafe, but then alters the images to hide the big warnings that users ignored. The vendor could probably sue that person if their intent was to make the vendor look bad, but it’s easier for everyone for the vendor to make sure their product is represented accurately before giving permission.” Every person I’ve seen who publicly and bitterly complained that they personally ran afoul of a vendor’s terms on screen shot use works for an academic medical center that signed their vendor’s confidentiality terms. When enforcement of those terms impedes the complainer’s moonlighting projects (writing books, delivering keynote addresses, pontificating, etc.), they go public in charging that their free speech has been violated and the vendor is trying to hide something that the public needs to know (via their project, of course). Why aren’t they using their academic freedom to criticize their bosses who signed the contract in the first place? However, a researcher whose employer hasn’t signed a contract with the vendor they’re writing about should be legally OK, although just the threat of defending an unjustified lawsuit would deter most of us. Here’s a challenge: if an EHR vendor has threatened you (as a non-vendor employee) for going public with safety concerns, give me the details. I will keep you anonymous.

From Bowdlerizer: “Re: gag clauses. If someone wants health systems to call potentially safety-endangering vendor software issues to the public’s attention, wouldn’t it be equally beneficial for EHR vendors to find examples of provider medical errors and publish that information on the web? Transparency that benefits the public should work both ways, but health systems are fanatical about not allowing employees or vendors to say anything about mistakes they’ve made that might make them look bad. In fact, I bet some of them insert their own software contract gag clauses that prevent their vendors from saying anything about their operation or using their name without their approval.”

From Vendor Diesel CEO: “Re: ICD-10 preparations. We’ve been in high-volume test mode for nearly a year. We worked with users at our conference to find any one-off situations they could think of. Our entire RCM staff has been trained, not only on the practice side, but on the consultative side to address practice needs. Our EDI, product, training and implementation, and support groups have been trained as well. We have prepared videos and conducted free, continuous webinars to ensure an orderly transition and customers are getting regular countdown bulletins. We have brainstormed as to what we can’t control (payers) and worked with our clearinghouse partner to have rejections handled expediently. ICD-10 is a challenge, but also an opportunity to shine and perform. As Ed Harris said in ‘Apollo 13,’ failure is not an option.”

From Mike: “Re: grammar pet peeves. An item that continues to annoy me greatly is using modifiers to the term ‘unique.’ Something is either unique or it’s not; there is no such thing as ‘very unique’ or ‘highly unique.’” That one bugs me, too, along with recent others such as using the non-word “irregardless,” using “disinterested” when “uninterested” is intended, and people who say “less” instead of “fewer” when referring to a discrete unit (“fewer people” is correct, “less people” is not). Not surprisingly, people who don’t have the knowledge or respect for others to use words correctly strenuously object to the very idea that language can be right or wrong, figuring it’s easier for them to be sloppy and let the other guy figure it out (a smug indifference to personal responsibility grates on me like nothing else).

From Devious Septum: “Re: jury duty. I was called for a minimum of three months, but I knew my health IT vendor employer would either fire or reassign me to a ‘dangle position’ if I was away from my director-level job for that long. Was I wrong to wangle out of it with an excuse?” Most people can’t afford to miss work for weeks or months to serve on a jury, so society ends up with major legal decisions being made by students, the unemployed, and retirees as everybody else figures out how to pass the buck and then complain bitterly later that juries are irrational. I would never lie to avoid jury duty, but everybody has to figure out their own acceptable level of expedient dishonesty. A programmer who worked for me got stuck on a months-long, high-profile case and did his work after the court let out each day (often early since the legal system doesn’t feel much urgency despite claimed case backlogs), which worked out well all around. Corporations seem to have a habit of feel-good bragging about how wonderfully they treat and value their employees, which may be true collectively, but it takes only one nasty VP to make your life miserable by acknowledging your commendable desire to practice civic responsibility with, “Can’t you get out of it?” I was at jury duty once in March and a self-employed CPA tried to convince the judge (somewhat snottily, I thought) that she should be excused since her most important and most profitable work would occur in the upcoming weeks – the judge admonished her for suggesting that her work was more important than her duties as a citizen or that she should receive preferential treatment because she was more important than others in the jury pool who would have to cover her desired absence.

From Donald Keyhotay: “Re: DonorsChoose. I didn’t see instructions on how I can donate.” DonorsChoose came up with this process:

Purchase a gift card in the amount you’d like to donate.
Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
I’ll be notified of your donation and you can print your own receipt for tax purposes.
I’ll apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers. I fund only projects that have received no donations so far, so all the projects I mention were fully funded by readers with matching funds made available by an anonymous vendor executive.

HIStalk Announcements and Requests

Poll respondents aren’t too optimistic about Salesforce’s potential health IT success. Dr. Ed says tech firms who have forayed into healthcare is “a trail of tears,” while Olivia says it’s all hype since Salesforce can’t handle H7 natively and nobody’s going to want to work with them. Brian hopes Salesforce can bring their CRM approach to patient engagement, helping them follow clinical guidelines. New poll to your right or here: what is your reaction when a company changes its name?

My WiFi signal didn’t reach the the back yard, preventing me from using the laptop there or causing me to worry that streaming Pandora to a Bluetooth speaker was burning up my cell plan’s data allocation. I was finally inspired to see if I could install some kind of WiFi extender to carry the signal back there and Amazon had my solution: the TP-Link wireless range extender. It took literally two minutes to set it up since my router has WPS – you just plug the unit into a power outlet, push the WPS button on the router and the unit to establish wireless connectivity, and then unplug the unit and move it to a good spot inside the house (about halfway between the router and the desired location is ideal). Nothing has to be reset or reconfigured – your existing network just goes further. Now I have strong WiFi coverage all over the back yard, which I tested by shutting off cellular data and running Speedtest, which tells me I’m getting nearly the same speed as indoors. Best of all, the nicely packaged and documented extender costs only $19.99. Now I can freely stream music from my phone and use my laptop and tablet outside. I’ve used powerline network adapters and those work great as well, but those require you to plug in your connected device via Ethernet cable. Check out the variety of similar extender devices if you have rooms, a workshop, or outdoor location with poor WiFi reception.

Reader Karen contributed $100 to my DonorsChoose project, which I put on the educational street immediately. I chose a large library of math manipulatives for Mrs. Brunetti’s elementary school class in Hector, AR (this was a $400 grant that required only $95 to fund since Economic Arkansas paid most of the money with the stipulation that the teacher find a donor for the rest). I also bought interactive math, letters, and comprehension software for Mrs. Wallace’s class of second- and third-graders with autism in Indianapolis, IN (with matching funds from the IPS Education Foundation). Karen got a lot of educational bang for her 100 bucks thanks to my anonymous vendor executive and other matching funds. It may well happen 30 years from now that one of these kids will do something amazing (even if that’s only leading a happy, productive life) and credit the time when a big box was delivered to their classroom, evidence that anonymous, distant strangers were willing to stand shoulder to shoulder with them in their education.

Mrs. Rose from New York City emailed to say that her students “were graciously overwhelmed” by our donation of a robotics kit and books. They’re building a robot for a city competition, for which they now have current robotics technology rather than the outdated version. She says the students are writing programs to learn the new Lego Mindstorms EV3 and have already built two robots as practice.

The stages of third-party data usefulness that I just made up:

I don’t have any information that you want or need.
I have information that you want or need, but I won’t give it to you.
I have information that you want or need, but I will make it available only in a static, text-based form on a non-real time schedule.
I have information that you want or need. I will put it on my own site in a schedule extract and you can log in and look at it.
I have information that you want or need and I’ll push it to your system in real time, where you can just look at it more conveniently.
I have information that you want or need and I’ll push it to your system in real time as discrete data that can automatically interact with your system in a helpful and non-intrusive way.

Last Week’s Most Interesting News

The Senate’s HELP committee and a bunch of provider organizations demand that HHS delay Meaningful Use Stage 3.
HP announces plans to lay off another 30,000 people when it splits into two companies later this year.
ONC announces availability of a Health IT Complaint Form, which is actually brought live a few days later.
A report finds that of 165,000 mHealth apps, most are primitive and seldom downloaded, with just 36 of them (mostly consumer and fitness tracker focused) making up half of all downloads. Providers hesitate to recommend apps because they operate in silos and haven’t been proven to be effective.
An HHS OIG report finds that CMS failed to manage its Healthcare.gov contractors, causing delays and cost overruns.
Two India-based technology executives launch a $500 million fund to acquire US digital health companies.
Qualcomm acquires medical device data integration vendor Capsule.

Webinars

September 22 (Tuesday) noon ET. “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements Using Simple but Predictive Adoption Metrics.” Sponsored by The Breakaway Group. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group; Gene Thomas, VP/CIO, Memorial Hospital at Gulfport. Simple performance metrics such as those measuring end-user proficiency and clinical leadership engagement can accurately assess EHR adoption. This presentation will describe how Memorial Hospital at Gulfport used an EHR adoption assessment to quickly target priorities in gaining value from its large Cerner implementation, with real-life results proving the need for a disciplined approach to set and measure key success factors. Commit to taking that scary first step and step onto the scale, knowing that it will get measurably better every day.

September 22 (Tuesday) 5 p.m. ET. “Laying the Groundwork for an Effective CDS Strategy: Prepare for CMS’s Mandate for Advanced Imaging, Reduce Costs, and Improve Care.” Sponsored by Stanson Health. Presenters: Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai; Anne Wellington, VP of informatics, Stanson Health. Medicare will soon penalize physicians in specific settings who do not certify that they consulted "appropriate use" criteria before ordering advanced imaging services such as CT, MRI, nuclear medicine, and PET. This webinar will provide an overview of how this critical payment change is evolving, how it will likely be expanded, and how to begin preparations now. A key part of the CMS proposal is clinical decision support, which will help meet the new requirements while immediately unlocking EHR return on investment. Cedars-Sinai will discuss how they decreased inappropriate utilization of diagnostic tests and treatments, including imaging.

Acquisitions, Funding, Business, and Stock

Raleigh, NC-based referral management technology vendor Cguros receives $5.5 million in funding. Perhaps they can use some of the funding to hire an English professor to explain why their tagline is appallingly incorrect, which is also true of quite a bit of their website prose.

Insurance company Clover Health, which analyzes insurance claims to target high-risk patients with specific care manager interventions, raises $100 million in funding.

People

ONC policy director Jodi Daniel, JD, MPH has resigned, she says in her Twitter feed. She joined ONC in October 2005, moving over from HHS’s Office of the General Counsel.

Beth Israel Deaconess Medical Center (MA) promotes Manu Tandon to CIO. John Halamka, MD will move full time to CIO of the BIDMC system.

Jake Brewer, a senior policy advisor in the White House’s CTO office, died Saturday when he lost control of his bicycle in a cancer research fundraising ride. He was 34.

Privacy and Security

ABC News posts a breezy, click-me-please article called “The Medical Identify Theft Apocalypse? Fear the Walking Files.” Its list of ridiculous tips (or as it says, “How to Tell If You’ve Been Bit by the Medical ID Theft Zombie”) includes such gems as:

Don’t answer one-ring telephone calls.
Ask medical debt collectors to describe what you were billed.
Read all mail from healthcare providers and call them if something doesn’t look right (duh).
If you can’t access your medical records online, “ask your doctor to read it to you.” (let me know how that works out).

Other

A Robert Wood Johnson Foundation report reviews the state of health IT in updating previous versions of the report with these findings:

Three-quarters of US hospitals have at least a basic EHR, but many of them won’t be able to meet Meaningful Use Stage 2.
Community HIEs are trying to evolve to find financial viability after struggling. They face many survival challenges that they will need to prioritize.
HITECH spurred EHR adoption but failed to achieve its goal of increasing healthcare efficiency and effectiveness through the use of IT. ONC was naive in overlooking barriers beyond its control and ran each of its grant programs in their own silos.
Big data isn’t a new concept in healthcare but it holds promise for transforming healthcare if issues related to security, analytics capability, stakeholder collaboration, and consumer engagement are addressed. Big data won’t be a silver bullet despite its position in the Gartner Hype Cycle’s “Peak of Inflated Expectations.” Bigger data isn’t necessarily better data. Not all providers are interested in providing information from their systems for public aggregation (which has minimal funding available to accomplish anyway) and dumping together information of unknown validation from a variety of sources adds additional potential for error.
Regional Extension Centers helped providers implement EHRs but they have not been successful in helping them meet Meaningful Use criteria.
The hundreds of millions in grants ONC handed out for HIE development failed to meet ONC’s goals, with no state being able to offer all its providers bi-directional exchange. The federal government let states figure out their own approaches, leaving them on their own to figure out incomplete or inconsistently implemented national standards and lack of a national patient identifier or single patient-matching technology. Health system competition also stood in the way.
The report characterizes the uptake in EHR adoption as converting analog to digital within individual organizations that it calls “corporate islands.” It concludes that information exchange among health professionals hasn’t improved in 10 years, but new payment models will eliminate some of the boundaries.
The report says HL7 failed as a standard because it allows too much implementation variation and requires hand-coded programming changes with every implementation, saying HL7v2 is “an artifact of the economic incentives of the organizations that wanted and created it.” It adds that HL7v3 has also failed because its adoption rate is “dismal” and it still doesn’t address semantic interoperability, but expresses hope that HL7 FHIR will allow developers to work more constructively with informaticists while SMART will allow them to build applications on top of EHRs without having to learn the underlying EHR.
ONC has embraced the PCAST, JASON, and JTF reports and favors API access and exchange languages with stakeholder involvement, which is bringing into focus a national interoperable HIT infrastructure.

Some interesting quotes from the report:

Some of these corporate islands have grown to incorporate smaller neighbors and create larger fiefdoms, increasing the number of patients on whom they zealously guard information; but they’ve also widened the barriers between every other corporate island … the larger vertically “integrated” health systems are rushing to warehouse clinical and financial data, but ultimately for the wrong reason. They simply want to enhance their private holdings.

[HITECH] corrupted the markets like all subsidies do … Once the government pays for certain behaviors, two things happen. First, the recipients figure out how to game the requirements to get the most from the least work. Second, they wait to do new things, trying to goad the government into paying for that also. Together, these undermine the very entrepreneurship and innovation that we need to move health care to a better future … The market will be wary of new investments if there is ever the potential for new government money to pay for it. (former National Coordinator David Brailer)

We want, in effect, for BMW to share its client list and their proclivities, their purchasing power, their use of services with Toyota. That’s what we’re asking the healthcare market. And we want it to be done free. Not just free, but we want Toyota and BMW to pay for the opportunity to give away some of their most precious proprietary assets. (former National Coordinator David Blumenthal)

Multi-billionaire Elizabeth Holmes, CEO of disruptive medical laboratory Theranos and featured on Inc.’s cover as “The Next Steve Jobs,” responds to concerns that average patients aren’t capable of understanding their test results:

The idea that I as a human should not be free to access my own health information, especially using my own money — even though I can buy weapons and anything else I want — and rather should be legally prohibited from doing so, summarizes the root of the fundamental flaw we’re working to change in our healthcare system.

In New Zealand, a pharmacy that provided 100 percent acetic acid instead of the 5 percent concentration needed for a woman’s colposcopy offers compensation for her severe intestinal burns and resulting medical bills – a letter of apology for its error and a $50 gas voucher “to cover your travel costs related to your readmission to the clinic.”

Sponsor Updates

The SSI Group will exhibit at the Texas Ambulatory Surgery Center 2015 Annual Meeting September 24-25 in San Antonio.
TriZetto Provider Solutions receives the Visionary for Children Award from the Children’s Home Society of Missouri.
Valence Health will exhibit at the Center for Healthcare Governance Fall Symposia September 20-22 in Chicago.
Visage Imaging will exhibit at the New York Medical Imaging Informatics Symposium September 21 in New York City.
Vital Images will exhibit at the North American Society for Cardiovascular Imaging Annual Meeting September 26-29 in San Francisco.
Huron Consulting Group is recognized by Consulting Magazine as a Best Firm to Work For for the fifth consecutive year.
XG Health Solutions Glenn Steele Jr., MD will speak at Geisinger Health System’s A Century of Transformation and Innovation Centennial Symposia September 24-25 in Danville, PA.
Recondo Technology CEO Jay Deady will speak at AGC’s Annual East Coast Technology Growth Conference September 21 in Boston.

Blog Posts

The Role of Technology in Genetic Testing (Sunquest Information Technology)
The Ever Evolving Role of the Chief Information Security Officer (Surescripts)
How I Got Into Healthcare: Janie Schumaker (T-System)
Managing Hospital Bed Turnover (TeleTracking)
Why Transitioning to ICD-10 is More Than a Mandate (Verisk Health)
Are Your Clinicians Familiar with ICD-10 Coding and Documentation Concepts? (VitalWare)
Majority Opinion (Voalte)
How to Change Lives and Create Opportunities in IT (Xerox)
Making a Difference Thousands of Patients at a Time (Zynx Health)
Patient engagement: strategies, barriers, and quick wins (Nordic)

HIStalk sponsors exhibiting at the AHIMA conference September 26-30 in New Orleans include:

Access
Anthelio Healthcare Solutions
ChartMaxx
Clinical Architecture
Elsevier
Experian Health
FormFast
HCTec Partners
Imprivata
Lexmark
MModal
MEA|NEA
Streamline Health
T-System
VitalWare
Wolters Kluwer Health

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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3 Comments

Morning Headlines 9/18/15

September 17, 2015 Headlines Comments Off

HP spinoff to cut up to 30K jobs

HP announces that it will layoff 30,000 employees later this year as part of a restructuring plan that will split the company into two separate entities, HP Enterprise which will run the company’s enterprise business, and HP Inc, which will focus on hardware.

Health IT Complaint Form

ONC fixes early access problems with its health IT complaint form.

Why It’s Hard to Measure Improved Population Health

A Harvard Business Review article argues that organizations engaging in population health management are more likely to put efforts into improving care for easier or more cooperative patients, resulting in a further marginalized community.

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EPtalk by Dr. Jayne 9/17/15

September 17, 2015 Dr. Jayne Comments Off

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Even though I’m no longer on staff, I’m glad that my former employer still hasn’t taken me off its mailing list. The quarterly Medical Staff Newsletter is a nice way to keep up with my former colleagues. I was excited to see that the hospital recently launched a new community outreach program. In an attempt to prevent readmissions, it uses paramedics with advanced training to perform scheduled home visits. Patients can be assessed for signs that their chronic health conditions are progressing are becoming unstable. The paramedics also provide disease management counseling.

For an initial panel of pilot patients, emergency department usage was reduced by 67 percent. Since I work in a couple of different practices, I wondered how they are contacting the providers of record and whether we’d be seeing any communications in our EHR. Unfortunately they are using a standalone system that was designed for home health and it isn’t connected to anything but the hospital’s clinical data repository. The mode of communication to attending physicians: fax.

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I also chuckled at its promotion of staff physicians who appeared in the “Best Doctors” edition of a local magazine. The methodology used by some publications to create those lists is sometimes questionable and reminds me of a high school homecoming court election. People often vote for the names they’ve heard most often, regardless of personal experience or knowledge. Two of the providers on the list have been gone from our community for more than 18 months, so they’d be hard to refer to. Another one is retired. My favorite entry is a physician who has been disciplined multiple times and who sexually harassed me in the operating room. It’s bad enough that they were included on the magazine’s list, but I’m embarrassed at the hospital using them for marketing purposes.

The newsletter also included the first communication I’ve seen about the new EHR conversion project. The vendor was officially selected in December, but planning has been kept fairly quiet. They’re still not saying which facilities will go first, but they’re at least warning clinicians that it’s going to take more than three years to complete the migration across all business entities. Although I wish them the best, I’m glad to not be fighting in that particular skirmish.

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A reader sent me this awesome ICD-10 countdown clock, which I’ve added to my personal website. As I continue my practice road show, I’m seeing people who are seriously worried about the crash of the revenue cycle as we know it.

I’m thinking about making one of those construction paper chains that we used to do in elementary school as we counted down to holiday break. Tearing off a link each day as we march towards what some are describing as “billpocalpyse” might be therapeutic. One physician I trained today actually talked about provisioning a safe room in his house in case staff comes with pitchforks and torches when he can’t pay the bills. Although I think it was a joke, at some level I think he was actually consider it.

Several readers wrote in about their ICD-10 training experiences. One works is tasked with helping clients navigate the transition. At a recent client forum, he describes comments that, “Most of the training that is out there is useless. The only content that had any agreement on whether it was not it was useful was CMS’s Road to 10 specialty content – specifically the coding scenarios for each specialty.” As a physician (and purveyor of training myself), I agree that scenario-based practice is essential. In addition to making sure they know how to code items that are on specialty-society or CMS lists, providers should also ask their IT staff to run a list of their top 10 or 20 diagnoses and practice coding those. If your docs haven’t done it, please make the suggestion. You’ll be glad you did.

Another reader commented on my recent mention of electronic prescribing of controlled substances. Apparently Imprivata has a hands-free authentication solution, capturing the token code from a cell phone without requiring manual entry. I’m pretty sure we could get away with having phones as long as they stayed in our pockets. I’m definitely going to check it out and appreciate the tip because as much as I try to stay on top of new products and offerings, it’s impossible.

As part of one of my ICD-10 engagements this week, I also presented to a group of physicians about Meaningful Use. Although we know a final rule for Stage 3 is imminent, many of my colleagues think it has become a big joke. I’m hearing from more and more that they’re willing to take the penalties just to regain control of their practices. Of course I’m not hearing that from physicians who sold out to large health systems or to hospitals – they’re stuck with whatever is handed down. Many organizations have already budgeted the incentives and planned not to incur penalties and don’t seem open to altering the future balance sheet.

Have you opted out of Meaningful Use? Email me.

Email Dr. Jayne.

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News 9/18/15

September 17, 2015 News 1 Comment

Top News

Senate HELP Committee Chairman Lamar Alexander (R-TN) calls for Meaningful Use Stage 3 to be pushed back until January 1, 2017, saying that hospitals have told him that they are “terrified” of Stage 3 and patients won’t benefit from a rush job. He also wants the modified requirements for MU Stage 2 adopted to keep Meaningful Use moving.

Reader Comments

From Epic ICD-10er: “Re: Dr. Jayne’s piece on ICD-10 readiness, especially that of smaller vendors. Just to let you know where Epic stands: we’ve supported ICD-10 since 2008 and the entire customer base has been live on the supported software (the 2010 release) for over a year. Ninety-five percent of customers are documenting with ICD-10 clinical terminology today and 92 percent are dual coding accounts (the number doesn’t have to hit 100 percent since some organizations use ICD-10 without impacting coding resources). In early CMS calls, not many vendors were offering documentation using ICD-10 and dual coding. I’m pushing CMS to initiate vendor calls starting October 1 so we can communicate across the entire industry about issues we find and how to resolve them.” I like the idea of CMS opening an ICD-10 conference bridge as a hospital would do for a big IT go-live. Somehow I think the email inbox of its ICD-10 ombudsman is going to fill up quickly.

From Hadoopsie: “Re: unsolicited vendor email. This one wins the award for the silliest buzzwords!”

From Halen Hardy: “Re: NextGen. Little birdy within the company told me they just laid off 19 Austin-based employees.” Unverified. I think that’s the Hospital Solutions office that was formerly Opus Healthcare Solutions until QSI/NextGen acquired that company in 2010.

From Lemmy: “Re: John Halamka of BIDMC. Is having a town hall meeting with all IT staff today (September 17). This is his first one in three years.”

From BKG: “Re: readmissions. Dignity hospitals reduced 30-day readmissions by 25 percent by implementing AHRQ’s RED Toolkit.”

From Grammar Nazi: “Re: health system branding efforts. I’m sick of all the permutations of the word ‘healthcare,’ such as HealthCare and Health Care. It’s about time they got creative – aNytown hEalthcAre!” As a Grammar Nazi sympathizer, I don’t like fusing two words together into one while leaving the second portion capitalized, which passes for innovating thinking among creatively bankrupt marketing people. You see that a lot these days (Partners HealthCare, CommonWell, MedAssets, UnitedHealth Group) as all the good, trademarkable words have been taken, leaving companies to create gibberish. The name HIStalk isn’t far from those examples, so maybe I shouldn’t complain.

HIStalk Announcements and Requests

Deborah Kohn donated $100 to my DonorsChoose project, which I put to work immediately using matching funds from my anonymous vendor executive and from Smarties Candy Company’s “Smarties Think” classroom project. We provided six tablets for Ms. Long’s alternative high school ninth-grade class in West Point, MS. She reports that all of her students come from poor families (some of them get their only meal of the day at school) and they need stimulation to engage in science material. Two-student teams will use the tablets to quiz each other, create flash cards, and play related games. Ms. Long concludes, “I believe that someone taking an interest in them and their education could change their whole attitude about school.” Someone did – DK and her matching donors. Update: Ms. Long emailed to say, “OH MY GOSH! Thank you so much for your donation! You are going to help students know just how much someone cares about their education! You are amazing for doing this and I am sooooo fortunate that you have done this for me! I really appreciate it!”

We bought an iPad Mini for Mrs. Frazier of Memphis, TN, who teaches elementary classes, runs the after-school program, and just earned her library certification. She emailed to say that she is using the tablet to participate in technology webinars and offers it to students in their daily “academic choice” activity, where she says it’s popular because of the apps she has installed and the digital books that are available.

Also checking in was Mr. Schmook from Herminie, PA, whose elementary school class received a large bundle of STEM materials that we donated.

A note to non-experts trying to create hysteria over so-called vendor “gag clauses.” Those customer-signed terms that prohibit disclosing intellectual property such as source code, documentation, prices, and screen shots are not gag clauses – they don’t bar users from going public with patient-endangering problems, they only restrict them from exposing proprietary information that would be of little interest to anyone other than competitors. I don’t agree with including screenshots in that contractual definition since that prohibits sharing even user-designed screens with each other or in presentations (a clause that Epic is adamant about enforcing, which is what stirs up people the most), but none of that precludes going public with software problems. That limitation would be covered in a different part of the contract. I would also be interested at how often vendors actually threaten or undertake legal action against their customer, which would seem to send the wrong message to those who might want to become customers. It’s probably an indication of the three-vendor EHR market that customers sign those agreements without a peep, apparently happy to be allowed to fork over millions under whatever terms their vendor among limited choices demands.

Listening: Wolflight, new progressive music from former Genesis guitarist Steve Hackett. Since his former bandmates don’t seem interested in a reunion, I’m thankful he skillfully covered some of their songs on Genesis Revisited, including my favorite, Supper’s Ready. It’s not quite as good as the original Genesis (watch the previously omnipresent Phil Collins if you think he was only good for crooning lame pop tunes), but it’s the only live option other than cover bands like The Musical Box.

This week on HIStalk Practice: Ian Crozier, MD tells a riveting tale of post-Ebola complications. Vermont physicians agree that administration and documentation burdens are taking away from patient care. ProEx Physical Therapy gets into the consulting business. Brad Boyd evaluates the financial return of clinical alignment tactics. HHS releases $500 million for primary care expansion. Boson Health goes with paging and answering service tech from TelmedIQ. Teladoc gets the green light to move forward with its case against American Well. Google moves into the fake body parts business to sell more wearables (no joke!).

Webinars

Acquisitions, Funding, Business, and Stock

Kyruus raises $25 million in funding to expand adoption of its ProviderMatch health system patient scheduling and referral management system. Investors include one of its customers, Providence Health & Services, as well as McKesson Ventures.

HIMSS Media buys the oddly named MobiHealthNews. I don’t read it, but HIMSS claims it’s the “leading source of digital health news and analysis” and says “our sales team is looking forward to driving growth.” It covers topics that don’t interest me as an average health system reader (fitness trackers and uncritical digital health cheerleading). Still, I would rather have seen it remain independent than to be absorbed into the vendor-friendly, sales-focused HIMSS fold. HIMSS already publishes mHealth News, which it describes as “the only news publication completely focused on mobile innovation within healthcare,” which seems to have intentionally marginalized MobiHealthNews before the acquisition. Both sites are edited by people with zero health or IT experience other than writing about it, which to me is OK when they’re wordsmithing or quoting an expert, but not OK when they try to editorialize or analyze for an expert audience.

American Messaging Services will offer its 1,400 hospital customers real-time care coordination and communication from Cureatr.

HP will lay off up to 30,000 employees when it splits the company later this year into HP Enterprise (enterprise services) and HP Inc. (hardware), with the personnel cuts coming from the Enterprise business. HP had already laid off 55,000 people since Meg Whitman took the CEO job following disastrous decisions that followed no obvious strategy except to get bigger – overpaying for acquisitions, hiring and then firing Leo Apotheker as CEO, and dumping its PC business with hopes of making more money selling data center hardware and services. Its aspirations to be IBM were admirable except IBM had long since abandoned that same strategy by the time HP put its own into place.

The Nashville business paper digs up an SEC filing in which Emdeon says it will spend $126 million to “rebrand” itself to Change Healthcare.

Sales

Wellness Council of America chooses Validic to power its “On the Move” employee wellness challenge. Companies that sign up by February 2016 receive behavior programming, outcomes reporting, device integration, coordinator training, personalized assessments and coaching, and educational material.

Announcements and Implementations

Aprima expands its “Rescue Plan” that offers licensing discounts of up to 65 percent to users of an expanded list of EHRS that originally included only Allscripts MyWay.

McKesson wins the 2015 C. Everett Koop National Health Award for its employee health and wellness program that is powered by the Vitality, a South Africa-owned wellness program whose hallmarks are Know, Improve, Reward, and Support.

Imprivata integrates its Cortext secure communications platform with Forward Advantage’s Communication Director, allowing Meditech customers to automatically deliver patient alerts (transitions of care, consult requests, and critical test results) to mobile devices and desktops.

Government and Politics

The health services of Scotland and Wales form the Health Informatics Service Alliance to collaborate on digital services, with Northern Ireland possibly becoming a third member down the road.

ONC fixes its Health IT Complaint Form, or as Modern Healthcare describes in an absurdly attention-seeking headline, “ONC wants to know what health IT issues grind your gears.” Now that the form is visible, I noticed that it offers submitters an option to remain anonymous. It doesn’t say if it will publish the issues it receives.

Privacy and Security

The Tampa VA hospital gets hit with ransomware, taking down the employee shared drive for five days.

Innovation and Research

A report by IMS Institute for Healthcare Informatics finds that the rapidly increasing number of apps that might be considered “mHealth” is at 165,000, but most simply provide advice related to wellness, diet, and exercise. A fourth of them focus on chronic disease. Only one in 10 connects to a device or sensor and just 2 percent exchange information with provider systems, but two-thirds have social media connections. Nearly half of all downloads are represented by just 36 apps. The authors suggest that providers prescribe health apps to increase adoption and ongoing use, but those providers hesitate because EHR connectivity is uncommon, technologies are ever-changing, providers are paid for volume and not quality, and studies that prove app effectiveness are lacking.

Technology

An interesting perspective on the addition of ad-blocking to iOS9 says Apple is threatening Google’s main source of revenue (advertising) as more users use mobile devices and Apple develops search capabilities that bypass Google. It says web content will suffer as small publishers lose advertising revenue, summarizing,

What you want is the content, hot sticky content … Unfortunately, the ads pay for all that content, an uneasy compromise between the real cost of media production and the prices consumers are willing to pay that has existed since the first human scratched the first antelope on a wall somewhere. Media has always compromised user experience for advertising: that’s why magazine stories are abruptly continued on page 96, and why 30-minute sitcoms are really just 22 minutes long. Media companies put advertising in the path of your attention, and those interruptions are a valuable product. Your attention is a valuable product.

Other

A Harvard Business Review article written by the dean of Boston University’s School of Public Health says it’s hard to measure population health success, but it’s tempting for organizations to cherry-pick the most cooperative of their patients and ignore the rest, which will leave marginalized communities (by race, income, and ethnicity) behind. He uses as an example apps that help people quit smoking, which even if they work, still leave out patients who lack the technology and the discipline to use them. The US smoking rate is stuck at 20 percent because it’s harder and more expensive to get poorer patients into cessation programs, which might redirect resources such that the overall smoking rate might increase even as equity is reached. It’s always fascinating to see the dramatic contrast between the beliefs of health system people and those whose world view is based on public health. I’d trust the latter far more than the former in reducing costs and providing the most good for the most people.

Weird News Andy says this article reads like a Medtronic advertisement, but is still pretty cool. Intervention neurologists use a stent retrieval device to fish out the blood clot that is blocking a woman’s carotid artery, reversing her early stroke symptoms within three hours, allowing her to recover entirely in just a few days. Most impressive to me is the quick action of the hospital: the patient arrived in the ED at 10:29 a.m., the CT was finished at 10:44, thrombolytics were given at 10:47, a groin puncture was made at 11:10, and reperfusion occurred at 11:40, barely more than an hour after she arrived.

Sponsor Updates

Stella Technology co-founder and CEO Lin Wan will participate in the Nationwide Interoperability Pursuit panel at the Central Pennsylvania HIMSS conference on September 18 in Grantville, PA. She has a PhD in physics from Princeton and has held key technology roles at Axolotl and OptumInsight.
Forward Health Group posts a video interview with HealthLink CEO Beth Wrobel (I interviewed her this week) and CIO Melissa Mitchell.
Health Catalyst wins the 2015 Utah Ethical Leadership Award.
ShareCor names Fortified Health Solutions, a Santa Rosa Consulting company, as an endorsed security services vendor.
Experian Health is ranked #1 in Modern Healthcare’s 2015 list of largest revenue cycle management firms.
MedData will exhibit at the UCAOA Fall Conference September 24-26 in New Orleans.
Medicomp Systems releases a new video, “Doctors see 30% More Patients.”
Navicure will exhibit at the VMGMA 2015 Fall Conference September 20-22 in Norfolk, VA.
NTT Data will exhibit at the BCBS Information Management Symposium September 20-23 in Fernandina Beach, FL.
Oneview Healthcare will exhibit at The Beryl Institute Regional Roundtable September 24 in San Francisco.
PerfectServe will exhibit at the Maryland MGMA State Conference September 25 in Maryland.

Blog Posts

The Financial Impact of Care Management Programs and Population Health Analytics (Medicity)
Population Health Management – I’m having déjà vu (Medecision)
Patient Engagement: Your Patient, Your Consumer (Nordic)
SayIt & Public Hospitals: A Perfect Fit (NVoq)
Smart Mobile Solutions Facilitate Safer Patient Transports (PatientSafe Solutions)
A Physician’s Take on ICD-10 (PatientKeeper)
Inside Secure Texting: Group & Picture Messaging in Action (Practice Unite)
Innovation Friday: Prostate Cancer Awareness Month (Lexmark)
Medical Staff Credentialing Departments Manage only about 20% of a Hospital’s Provider Base (Phynd Technologies)
Always Listening: A Consultative Approach (PMD)
EHR Blamed for Ebola Death. REALLY? (Point-of-Care Partners)
Happier Clinicians = Happier Patients (Qpid Health)
Sagacious Cares: The River Food Pantry Fights Hunger (Sagacious Consultants)
The Changing Landscape of Healthcare Provider Marketing (Optimum Healthcare IT).

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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Morning Headlines 9/17/15

September 16, 2015 Headlines 1 Comment

HELP Committee chairman calls for flexibility in implementation of Stage 3 EHR rules

Senator Lamar Alexander (R-TN), chairman of the Senate Health, Education, Labor and Pensions Committee, calls for a phased in approach to the creation and implementation of MU3.

Hilo Medical Center Selected as 2015 HIMSS Enterprise Davies Award Recipient

Hilo Medical Center (HI) receives the HIMSS Davies Award, being recognized for using its EHR (Meditech) to drive $35 million in cost reductions and a $4 million overall ROI while reducing hospital acquired infections and the mortality rates of patients admitted with pneumonia.

Mayo Clinic and AVIA Announce Finalists Competing for $100,000 THINK BIG Challenge

Mayo Clinic announces the finalists of its Think Big Challenge, a design competition challenging engineers to build tools that promote health lifestyles or help people living with chronic diseases.

1 Comment

Morning Headlines 9/16/15

September 15, 2015 Headlines Comments Off

Cambridge chief exec resigns

The CEO and finance director of Cambridge University Hospitals NHS Foundation Trust, Epic’s first UK customer, resigns following a growing financial deficit and “significant performance and quality concerns” related to IT.

CMS Did Not Always Manage and Oversee Contractor Performance for the Federal Marketplace as Required by Federal Requirements and Contract Terms

An HHS OIG report on the rollout of Healthcare.gov finds that CMS failed to “provide adequate contract management and oversight for Federal marketplace contracts,” which resulted in delays, performance issues, and unauthorized costs.

Google Bets on Insurance Startup Oscar Health

Two-year old tech-savvy insurance startup Oscar Health raises a $32.5 million funding round from Google Capital, bringing its total raised to $325 million and its valuation to $1.75 billion.

Identifying preventable readmissions: an achievable goal or waiting for Godot?

Researchers question the accuracy of readmission risk metrics, arguing that future research efforts should be shifted away from hospital care and toward “developing quality care measures of complex disease management across a patient’s continuum of care.”

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News 9/16/15

September 15, 2015 News 16 Comments

Top News

Qualcomm acquires France-based medical device integration technology vendor Capsule Technologie, confirming the rumor from Boisterous Lad that I reported here on September 2 (he said it actually happened awhile back but wasn’t announced). Qualcomm will run Capsule as a wholly owned subsidiary under Qualcomm Life, which will extend its wireless connectivity into hospitals to create an ecosystem the company calls “the Internet of Medical Things.”

Reader Comments

From Zaphod Beeblebrox: “Re: Cambridge University Hospitals Foundation Trust. So much for the accepted wisdom that nobody loses their job for selecting Epic.” The CEO and finance director of the Cambridge hospitals resign following big financial losses after their Epic rollout. The resignations may also be related to a quality report that will be published on September 22. Regulation Monitor announced on July 31 that it was investigating the trust’s financial problems, including its $300 million Epic project that went live last October amidst physician complaints and a 20 percent drop in ED performance. The now-resigned CEO admitted a few weeks ago that the trust experienced “more than teething problems” with unanticipated issues that included lab problems, while the medical staff council stated that the hospital is “less safe than before the introduction of Epic.”

From Tony D’Antonio: “Re: HealthLeaders Media. Being a health leader apparently doesn’t require knowing how to spell Epic.” They already show an affinity for misspelling in making up “HealthLeaders.” It’s a mistake no matter how you look at it – not only is “EPIC” flat-out wrong, they spell it correctly as “Epic” in other articles. At least be consistently incorrect.

Speaking of magazines, this one for pharmacists uncovers the well-kept secret that Epic is actually owned by HIMSS Analytics.

From Lance Link, SC: “Re: EHR survey. Epic is #1 again.” Maybe. The HIMSS-owned magazine’s much-hyped satisfaction survey (complete with cute “report cards” and the obligatory infographic that tries to milk as much mileage from the skimpy results as possible) used questionable methodology, polling an unspecified number of its self-selected reader “users” to gather just 400 responses from a wild variety of job titles in both inpatient and outpatient settings to score nine EHRs (that’s maybe 30-40 responses per company). They also dumped all products together under each vendor, so you have no idea which McKesson, Meditech, or Allscripts products each respondent was reviewing. I suppose it’s commendable that they tried to create some faux news instead of just passing off reworded press releases as insightful journalism. It doesn’t surprise me that Epic is first and GE Healthcare, McKesson, and the former Siemens are last, but basically everybody else tied with scores separated by just 0.4 points on a 10-point scale, meaning that if you believe the survey’s validity, users of all products are equally unsatisfied and an EHR selection committee should therefore just throw a dart at the list. KLAS has obvious flaws in its methodology, but I’d still trust it a lot more than anything put out by a magazine or Black Book. The challenge is that it’s time-consuming and expensive to conduct surveys that are statistically defensible — it’s easier to shout the results while mumbling the methodology.

Since examples of well-conducted surveys are rare, here’s what I want to know before I’m willing believe that a survey’s results reflect broad beliefs (which is why you do a survey in the first place):

How did you choose your pool of potential survey respondents? Was random sampling of a known population used?
How did you invite participation?
What was your survey’s sample size and response rate?
What were the characteristics of your survey’s non-respondents?
What is the motivation of those who responded? (unsatisfied people are more likely to respond in most cases).
What were the demographics of your respondents?
How did you prevent ballot box stuffing?
What did your survey instrument look like? Were your questions clear, unbiased, and appropriate for those surveyed? Did the sponsoring organization create bias (unintentional or otherwise) in the choice and wording of questions?
Does your survey report include raw data that prove its conclusions? What type of statistical methods did you apply in analyzing the responses?
Do your conclusions overreach the underlying data in trying to gain publicity with catchy headlines and graphics that aren’t supported? Do your published results state the limitations of the survey?

From NotMe: “Re: Healthcare Tech Outlook. My company was also approached to be short-listed for some ranking and they tried to sell us a sponsorship. If you look up SiliconIndia’s profile on Glassdoor.com, you’ll see that many of their employees don’t have good things to say about them, including comments about ‘fake rankings.’ Yikes.”

HIStalk Announcements and Requests

A couple of generous readers have contributed to my DonorsChoose.org project, using a method devised by the DonorsChoose folks that provides them with a tax-deductible receipt. I put their donations to work immediately.

Reluctant Epic User donated $200, which was matched by my anonymous vendor executive to provide Ms. A’s Miami third grade class with five Android tablets, cases, and an electronic flash card app for her STEM and reading centers. Ms. A emailed to say, “The tools that you have funded will enable my students the opportunity to get their hands on technology and get in an even playing field with their higher income peers. In addition, students will be able to better their math and reading skills by having a tablet center where they get on helpful online math and reading programs that will enable them to become proficient readers and mathematicians. The children will LOVE this!”

Lady Pharmacist’s $100 donation was matched by both the anonymous executive and the doubled amount was matched again by The Arthur M. Blank Family Foundation to provide an iPad Mini, case, and headphones for a first grade class in Atlanta.

Meanwhile, Ms. O from Fort Walton Beach, FL sent photos of her second graders using the math card centers we bought them, saying they work in small groups to work through math questions and to identify the strategies they used.

I dreamed last night that in an irreverent gesture similar to that of Howard Stern fans who scream “Baba Booey” during competing live broadcasts, HIStalk readers would post a comment simply saying “ONHART” (Old News, HIStalk Already Ran This) when news sites run less-current items or ideas that they may or may not have found by reading here.

Webinars

The Breakaway Group created a cool intro to their September 22 webinar above. They mention HIStalk at 1:12, which always catches me off guard. The acting is pretty good, especially the guy playing the CMO.

Acquisitions, Funding, Business, and Stock

Two India-based technology executives create a $500 million fund that will acquire US digital health companies priced from $50 to $200 million. One of the founders explains, “The US healthcare industry is undergoing radical transformation with the Affordable Care Act. Evolving thought and business models have little semblance to present mechanisms. Over the next five years, SNSK aspires to be an engine of accelerating digital solutions that would make patient care more accountable, efficient, predictable, and effective.”

Persivia, formerly known as Alere Analytics until Alere sold the company back to its founders, acquires Burlington, MA-based quality reporting and analytics vendor IHM Services Company. Persivia, whose headcount increases to 50 with the acquisition, will release its first post-acquisition product next month.

Lightshed Healthcare Technologies, which offers Clockwise.MD, closes a $1 million investment round.

Sales

Baptist Health System (AL) chooses Merge Hemo.

Middlesex Hospital (CT) chooses Access electronic patient forms.

People

Insurer and technology vendor Cambia Health Solutions hires Laurent Rotival (GE Healthcare) as SVP of strategic technology and corporate information officer.

Announcements and Implementations

The HealthLinc FQHC (IN) goes live with Forward Health Group’s PopulationManager and The Guideline Advantage.

PeriGen, UCSF, and Kaiser Permanente North California launch a research project that will look at preventable birth-related brain injuries in newborns by studying the occurrence of neonatal encephalopathy as it relates to unusual uterine contractions and fetal heart rate.

In the Netherlands, Philips, Radboud University Medical Center, and Salesforce introduce a prototype mobile patient app and online community for type 1 diabetics. The app is based on the HealthSuite digital platform that was announced by Philips and Salesforce in June 2014.

Government and Politics

The New York Times highlights the rollout of ICD-10, noting that coders have become a hot commodity and hospitals and practices are getting lines of credit with expectations of insurance company payment delays. One hospital HIM director says ICD-10 coding will take 35 percent longer.

A jury convicts a Houston psychiatrist of defrauding Medicare of $158 million over six years by submitting false claims through Riverside General Hospital’s partial hospitalization program, whose patients not only weren’t hospitalized, they often received no treatment at all. The psychiatrist was also charged with falsifying medical records. Twelve people have already received prison sentences or are awaiting sentencing. I’m always encouraged that Medicare scammers get caught, but discouraged at how long it takes to sentence them and the fact that the majority of the fraud iceberg remains invisible.

An HHS OIG report of how CMS managed the rollout of Healthcare.gov finds that CMS didn’t follow federal requirements for managing its contractors, which allowed the companies to miss dates, bill for additional costs, and earn contracts despite poor past performance. Terremark Federal Group was supposed to provide a system security plan by early July 2011 but didn’t submit it until July 2013. Unauthorized CMS employees also tacked on additional work without the approval or knowledge of the contracting officer. The report examined only the 20 most critical Healthcare.gov contracts that were worth a combined $605 million. CMS did not dispute any of the OIG’s findings or recommendations.

Privacy and Security

A first-half 2015 breach report finds that the world’s largest was the nearly 80-million record Anthem cyberattack, which by itself accounted for a third of the total records exposed in the first half of the year. Medical Informatics Engineering was #8 on the list with 3.9 million records exposed.

The Los Angeles Fire Department finds itself in the middle of a privacy debate when its officers mistakenly tell accident bystanders that they can’t take photos or videos because that would be a HIPAA violation. The department clarifies to its officers that anyone can photograph or record fire department personnel at work as long as they are on public property or their own private property, reminding them that citizens and journalists aren’t bound by HIPAA. The fire department tells its employees to ask people not to interfere with its work and to protect the patient’s privacy by holding up sheets or other visual barriers when possible. I’m all for not claiming HIPAA applies when it really doesn’t, but the fact that idiots with cell phones or “if it bleeds, it leads” TV cameras will obstruct rescue work to take pictures of the victim is a sad state of affairs reminiscent of the movie “Nightcrawler,” with the worst part being that the aforementioned idiots are merely providing the gore supply for the even bigger idiots who demand it.

Innovation and Research

A small study of pneumonia patients questions whether hospital readmissions are usually caused by quality issues and casts doubt that commercial software such as 3M’s can accurately determine the preventable ones that trigger financial penalties. The authors say health systems are spending a lot of time questionably in trying to create “readmission risk” measures instead of focusing on broader health system quality care measures.

Other

The local TV station covers the switch of 25-bed critical access hospital Aspirus Iron River Hospital and Clinics (MI) from Healthland to Epic. Eight-hospital Aspirus acquired the former Northstar Health System last year.

The BBC covers Beth Israel Deaconess Medical Center’s use of an unnamed patient assessment “super computer” that BBC unfortunately concludes makes it “an especially frightening application” in that it can “predict death.” Brits seem to obsess with the idea that both computers and clinicians can fairly accurately determine the odds of survival given clinical information, so BBC couldn’t resist taking a potentially interesting story into tabloid territory.

Granted the name North Shore-Long Island Jewish Health System was unwieldy, but its upcoming new name, Northwell Health, seems a bit trendy and generic. I expect more of the marketing-driven name changes, which have followed predictable cycles over the years — “Yourtown Hospital” became “Yourtown Medical Center,” then “Yourtown Regional Medical Center,” then “Yourtown Health System,” and finally “Yourtown Health” in a quest to change perception while leaving reality untouched. Now we’re in the “meaningless marketing names that just sound cool” phase as the mishmash of hospitals, practices, clinics, and related businesses defies an all-encompassing nomenclature that has any basis in reality.

Speaking of marketing people run amok with made-up words that require lame explanations, Kryptiq “rebrands” itself as Enli Health Intelligence. The CEO says the old name didn’t capture the direction of the company (unlike IBM, Microsoft, Apple, Exxon, General Electric, and a zillion other companies who let their deeds rather than their obviously dated names do the talking for them) and it spent a lot of energy on market research and “ethnographic field work” to make up the name Enli (short for “enlightened,” so they say). The marketing hired guns convinced the company that after “getting to know their purpose and values,” the Kryptiq name “was limiting their ability to connect more with their constituency.” I automatically assume that a company willing to spend a fortune to change its name (or to use the word “rebrand” in any official communication) must be trying to distance itself from the stench of past failure. “HIStalk” is an outdated name since the term Hospital Information Systems (the “HIS” in “HIStalk”) was appropriate in 2003 when I started writing it but isn’t used much these days, but I think I would be ill advised to let New Coke-type marketing geniuses convince me that I should “rebrand” it to something trendy to “connect more with my constituency” (who would, I suspect, react with eye-rolling annoyance rather than enthusiasm).

I criticized the text-heavy, endlessly scroll Meditech website last time I looked. The company let me know they’ve redesigned it and I have to say it’s very nicely done, with high-quality graphics, obvious and logical links, video, and a footer that contains links to all the less-mainstream content such as the executive team page and events list. Companies probably don’t think their website is all that important, but here’s what I look for when I’m deciding to either use or ignore a company’s press release:

Can I tell quickly what the company’s business involves without having to decipher buzzwords?
Is a list of available products easily accessible and plainly stated so I can tell what the products actually do and who might use them?
Can I easily find the address of the headquarters location and regional offices?
Is the executive page clearly marked so I can find out who runs the company?
Is company news regularly and quickly updated so that any press release that might go out on the national wires is also on the company’s site immediately, preferably linked from the home page?
Does the front page give me an easy way to see the most recently added information?
Is a search box provided so I find information without having to navigate?
Are contacts listed for sales, media, and customer support, preferably with a more accessible method than an on-screen contact form that goes to some undisclosed recipient’s inbox?
Are links provided to the company’s Facebook, LinkedIn, Twitter, and YouTube pages?

Thank goodness Uber used its mammoth war chest to squelch the protectionist Las Vegas cab driver union and their high-powered lobbyists well ahead of the HIMSS conference – Uber restarts operations in Las Vegas, giving tourists an option that they will likely exercise in great numbers. Nothing annoys me more than previously smug, now-outdated people and organizations who try to survive via intimidation and political maneuvering instead of letting the market choose what it wants. On the other hand, Uber calls the city “Vegas,” which drives me crazy (they don’t say “Angeles” or “Cruces” just to save one syllable).

Dignity Health announces plans for a year-long, $220 million “facelift” that includes refurbished patient rooms, elevator artwork, mobile device charging stations, improved signage with a wayfinding app, free WiFi, and family seating with communal spaces. I don’t know about you, but my #1 criterion for choosing a healthcare provider to keep me alive is tasteful elevator artwork.

GetWellNetwork and its “Get Involved Now” non-profit that addresses the needs of pediatric, high-risk pregnancy, and leukemia and lymphoma patients and families sponsored a “2015 Day at the Beach Special Surfers” event at La Jolla Shores in San Diego, CA. Employees provided surfing lessons for special needs kids and families and staffed a cookout for all.

Sponsor Updates

Aventura publishes a white paper, “Strategies for Driving the Use of Speech Recognition in Healthcare,” that describes its Aventura for Speech Recognition workflow optimization solution.
AirWatch will host AirWatch Connect Atlanta September 21-24.
Bernoulli/Cardiopulmonary Corp. is listed as a leader in the KLAS Alarm Management 2014 report.
Billian’s HealthDATA will host “Update: The Road to Health Data Equity” September 22 in Boston.
CitiusTech will exhibit at the BCBS Information Management Symposium September 20-23 in Amelia Island, FL.
Inc. features CoverMyMeds in a profile of productive cities for innovative entrepreneurs.
Direct Consulting Associates will exhibit at the Ohio MGMA Fall Conference September 18 in Akron.
Wellcentive will exhibit at NAACOS Fall Conference October 8-9 in Washington, DC.
Elsevier will resell HCPro’s HIPAA and corporate compliance libraries.
Impact Advisors is named one of Consulting Magazine’s “Best Small Firms to Work For.”
EClinicalWorks will exhibit at the 2015 APHCA Annual Conference & Tradeshow September 22-24 in Orange Beach, AL.
FormFast showcases workflow automation for McKesson hospitals at InSight Conference 2015.
HealthMedx will exhibit at the North Carolina Association Long-Term Care Facilities Convention & Trade Show through September 16 in Greensboro.
Healthwise will exhibit at the World Congress Patient Engagement Summit September 17-18 in Boston.
Iatric Systems will exhibit at the CIOhealth event September 24 in Boston.
Ingenious Med will exhibit at Spark! Healthcare Innovation and Technology Showcase September 23 in Austin.
Liaison Technologies will exhibit at the CIO Visions Leadership Summit September 20-22 in Baltimore.
LiveProcess will exhibit at the Indiana Healthcare Emergency Preparedness Symposium September 17-18 in Indianapolis.

Blog Posts

Increase Front Desk Revenue, step 5 of 5 (AdvancedMD)
FDA Direction on Biosimilar Naming Poses More Questions than Answers (First Databank)
CEO Shares News: Capsule is Now a Qualcomm Company (CapsuleTech)
Information Management #1 – Digital Empathy (Clinical Architecture)
Patient Portals – Placing Patients in the Driver’s Seat (Culbert Healthcare Solutions)
Smart Mobile Solutions Facilitate Safer Patient Transports (PatientSafe Solutions)
How to Get Your EHR & Practice Through the ICD-10 Transition (E-MDs)
Impressions and Lessons Learned from the 2015 Health Analytics Summit powered by Health Catalyst (Galen Healthcare Solutions)
ICD-10 Survival: The Right Partners Will Help You Prepare (Greenway Health)
Epic Implementation: Evaluate & Sustain Support Plans (The HCI Group)
Pre-visit planning will help you shift from reactive to proactive care (Healthfinch)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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16 Comments

Morning Headlines 9/15/15

September 14, 2015 Headlines 1 Comment

Qualcomm buys Capsule Technology to connect home and hospital care

Qualcomm’s healthcare arm acquires Capsule Tech, a data integration firm that helps hospitals capture and analyze data from medical devices. Qualcomm will use the technology to advance its connected home health efforts. Financial terms were undisclosed.

Breach Level Index: 2015 First Half Review

An analysis of data breaches reported during the first half of 2015 finds that the healthcare industry is the most vulnerable to breaches, accounting for 21.1 percent of total reported breaches. Healthcare was also responsible for the largest consumer impacting breach, a cyberattack on Anthem that exposed 80 million patient records.

What do we know about developing patient portals? a systematic literature review

A systematic review published in JAMIA finds that there is no evidence base for developing patient portals that increase patient engagement. Authors conclude the review by recommending future research topics that would address these gaps.

How Data-Wranglers Are Building the Great Library of Genetic Variation

Researchers from Harvard and MIT studying links between genetic variations and diseases have analyzed the genetic data from thousands of patients and have identified around 10 million genetic variants scattered throughout the genome, most of which have never been described before.

1 Comment

Curbside Consult with Dr. Jayne 9/14/15

September 14, 2015 Dr. Jayne Comments Off

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We hear a lot of chatter about big data and the ability to conduct analysis and draw conclusions from enormous volumes of information. I know I’ve written previously about attempts to determine whether Agatha Christie was developing dementia through analysis of her writings. I’d love to do analysis right now on some of the physicians I’m connected with through social media. Based on some of their posts, one might extrapolate a far-reaching conspiracy, mass paranoia, psychosis, or all three.

What has them so excited? It’s ICD-10, of course. Apparently quite a few hospitals are just beginning their ICD-10 preparations. For physicians who are on staff at multiple facilities, the training requirements are converging to form a perfect storm of regulatory madness. One of my friends from medical school reports being required to complete training programs at all three hospitals where he has medical staff privileges.

Despite having completed two previous programs, the third hospital is requiring him to complete more than 20 online training modules. Even though he’s a particularly specialized surgeon that deals with a part of the human body smaller than an elementary school milk carton, he had to sit through courses on coding for OB/GYN, neonatal diseases, and specialties he’s never going to use.

Since this was his third go-round, he timed the modules. They took more than 15 hours. He also reports that the narration was done by someone “with no idea how to pronounce medical terms.” I hope he was multitasking during the non-relevant portions or at least enjoying a cocktail because I know I would have gone crazy if faced with the same scenario.

It’s been entertaining to watch the back-and-forth as other physicians respond to posts complaining about ICD-10. One friend asked, “Is it just me or is ICD-10 going to make the practice of medicine more inefficient? Does it seem like it was created by bureaucrats who are trying to assert a rationale for their existence?” Another responded that the second question provides the answer to the first.

A third friend answered that without required ICD-10 courses, new regulations, and more hassles, “the woman who doesn’t know how to pronounce medical terms and lots of other people like her wouldn’t have a job, so they come up with new rules to keep themselves busy to justify their jobs.”

Indeed, that sounds a lot like some of the bodies that have been making an increasing number of healthcare regulations over the last several decades. There was a comment that ICD-10 is a conspiracy “to force physicians into the arms of hospital networks.” Certainly one might be inclined to only be on staff at one or two facilities rather than three or four if one has to take redundant training. I sympathize with what he’s going through – I once went live on the same EHR at two different hospitals and had to complete the entire training curriculum for both, even the parts of the system that are not client-configurable.

Another friend suggested just blowing through the slides and taking the end of module test since “doctors are some of the best test-takers in the country.” One physician chimed in that she has so many emails in her inbox about ICD-10 that it would take days to go through them. She plans to take a course at a local medical school and hopes it will be “helpful rather than soul-sucking.” Unfortunately, many of the ICD-10 courses I’ve heard about represent the latter.

One of the best follow-up comments I read was from a friend of a friend of a friend (funny how social media works that way) who said his hospital offered an animated course with a cowboy and a talking horse/donkey character. I certainly haven’t heard of that one, but would love to see it if anyone can point me in the right direction. Just thinking it reminds me of my own hospital’s HIPAA videos, which had a questionably-executed gangster/flapper theme.

It’s all too easy to get sucked into social media and I didn’t want to waste much more time than I had already spent. Before I closed my browser, though, I did come across this video of a woman surfing in stilettos. I thought it was pretty impressive, but one of my shoe diva friends commented it was a way to ruin a good pair of shoes for sure.

What’s the best ICD-10 training you’ve seen? Email me.

Email Dr. Jayne.

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HIStalk Interviews Beth Wrobel, CEO, HealthLinc

September 14, 2015 Interviews Comments Off

Beth Wrobel is CEO of HealthLinc of Valparaiso, IN.

Describe what HealthLinc does.

We are a Federally Qualified Health Center. The federal government realized that there was a need to build a national infrastructure for the underserved, which up until now was the uninsured, Medicaid, and Medicare, although that’s changing.

HealthLinc was one of those free clinics back in the 1990s. In early 2000, we applied to become a Federally Qualified Health Center. We get a little bit of state funding and some federal funding, but most of our funding comes from patient fees — Medicaid, Medicare, or a sliding fee basis.

We treat the whole body. We have medical, dental, and behavioral health on site. At one of our sites, we have optometry. We have on-site pharmacies. Truly we’re a one-stop shop for those who are underserved.

We’ve seen a huge change as people get $5,000 or $10,000 deductibles. In my mind, those are becoming our underserved. At least in Indiana, we’ve been able to get a lot of the uninsured to get services through what they call the Healthy Indiana plan. We’re not supposed to call it Medicaid expansion, but it really is our Medicaid expansion. We’re a healthcare provider that treats the whole body.

What lessons have you learned in managing health and not just healthcare episodes?

It goes down to data. A lot of times the healthcare system sees bits and pieces of that body and they don’t communicate. The number one thing that we have learned even internally is to see that person as a whole body.

I like to tease when we talk about optometry, behavioral health, and dental that we put the neck back on the body. The human body is intertwined. If you treat one part of it but don’t look at the other, you could be hurting that person’s outcome. At HealthLinc and with Federally Qualified Health Centers, we look at every part of that and help them.

The other part that is different for us is we never start with, "The patient will…" You can say until you’re blue in the face, "The patient will go get their meds. They’ll exercise." We have people that help them set goals and help them understand that. Treating the whole body and communication are the two things we do best.

What technology do you use?

We have a practice management system that talks to our electronic health record. That’s from Greenway. They have three platforms, but the one we use is called Intergy. We use it for optometry. We use it for behavioral health. It’s very flexible. We just switched to a new dental program, MediaDent, so that it talks to it.

Our medical providers can see what’s happened over on the dental side, optometry side, or behavioral health side and vice versa. It’s very common during flu shot season, which we’re just starting in, for dentists to say because it pops up in their side, "You haven’t had your flu shot. I can call someone if you want to get your flu shot right now." That’s just not heard of. It takes the IT infrastructure to be able to leverage that and to be able to do what we do.

How are you using your technology to reach out to patients?

About a year ago we got a call from The Guideline Advantage, which is a consortium of the American Cancer Society, the American Heart Association, and the American Diabetes Association. They had received a grant from the GE Foundation to work with Forward Health Group, a software company, to do population health.

That patient can look great in our electronic health record, but you can’t see what that population is going through. What are you doing? Are there things that we could be doing on a population-wide basis through this Guideline Advantage and Forward Health Group software that would improve not only that patient, but all the diabetics or all the hypertensive patients? That’s our next step in improving our patients’ health.

We’ve also found — I like to joke about this — that once we put in the PopulationManager of Forward Health Group, we were able to see data that wasn’t put in correctly. When we started looking at the population of a site and the BMI of patients in that site, we saw someone that had a 30,000 BMI, which is pretty much impossible [laughs]. It wasn’t me — that was the good news, there’s somebody worse than I am. We were able to start to clean up our data. We’re starting to do a lot more interfaces that go right in to the system and see that the medical assistant typed in the number wrong. Instead of maybe a weight of 130, they might have done 13,000. That doesn’t always come through, but it did in PopulationManager.

Our providers want to give the best care. but sometimes they don’t know what they don’t know. By looking at PopulationManager and seeing that maybe Dr. Smith — we don’t have a Dr. Smith, so I’m going to use that name — his hypertensives are not under control. We can go in there and see why. Is it the population? Is there some additional training? Something that he didn’t know? Is he using the wrong drugs?

We code everything green, yellow, and red. Green is the good — meeting your goals. Yellow is kind of, “You’re almost there.” And red. They all want to be green. When you start to show them a population, it motivates them. It gives them a better picture than what they have when they look at just each patient. That’s making a huge difference, having the TGA people working with us with Forward Health Group.

How would you describe your relationship with traditional health systems and how does the technology fit?

I used to always say we were their safety net, because the Medicaid and Medicare population and the uninsured weren’t the patients that they really wanted. We still have great partnerships. At HealthLinc, we’re pretty well spread across about 100 miles of northern Indiana, across the top of the state, and probably another 80 miles down.

We work with five hospital systems. With some FQHCs I’ve heard of competition, but we work with them more. But I could see as we start seeing these more of these commercial insurances come to us, there is the potential of that.

I have heard stories – again, I’ve never been able to document it — that the primary care aspect of a hospital system is the loss leader. They make money on everything else. My dream someday is to get a hospital system that says, "You guys are really, really good at primary care. You’re a patient-centered medical home. You have the infrastructure and everything. We’ll let you be that primary care infrastructure. You’re going to send labs and things like that to us."

From a community financial standpoint, that makes more sense to me. Of course, that’s me talking and not a hospital CEO. But looking at those relationships and what we can do to improve the health of the community, because we have been doing this infrastructure where we treat the whole body for a while now, it’s hard to catch up with that, but we’re there. So far, so good. We aren’t seen as a competition, but I could see where that could happen down the line.

FQHCs are required to have strong patient representation on their boards, which isn’t common with health systems. How does the patient perspective influence how your operation is conducted?

Patients of the clinic are 51 percent of our board. That makes a huge difference. I’ll give you an example. Before we had optometry, we had an eye doctor who would see our patients. It was in another town. There were transportation issues and things got in the way. Every time they had a no-show, they would call up. For $35, you got an eye exam and glasses. She would fund-raise on her own to pay for the glasses.

I brought that up to the board. I said, "I’m really struggling. I’m afraid we’re going to lose this doctor. Any ideas?" One of the patients on our board said, "Why don’t you charge them the $35 up front and make them sign and if they didn’t go, they lose it?" Not that $35 is much money for someone with means, but for them, it meant a lot. Once we implemented that, the no-show rate dropped drastically. We got our own optometrist. We were able to keep that eye doctor.

Social determinants of health are becoming very prevalent now. Are you close to a grocery store? Do you have transportation? Do you have babysitting services? You can’t come to your appointment because you have to drag six kids, but Medicaid only pays for you to bring one kid in transportation? Those kind of things. They can really help us with that, too. It’s a win-win because we understand more of what it is for our patients. But everybody has those social determinants sometimes, whether you have money or not. That’s an aspect that isn’t there in primary care.

We’re open until 8:00 four nights a week, 6:00 on Friday, and open on Saturday. A lot of primary care hospital-run systems are not open that late. They want you to go to urgent care. Urgent care can take care of your urgent needs, but they’re not going to take care of your diabetes or hypertension and do your well checks.

In one of our sites that we were able to build about two years ago, we started seeing more commercial insurance patients. They’re at work and they can’t get to the doctor, but we’re open until 8:00, so they can come to us. Again, they have money. They could go anywhere. They have insurance. But because of our hours, they like to come to us. It’s bringing in what that patient needs.

Do patients who could go anywhere consider your services to be at least equivalent?

When they get through the door and they see the one-stop shop, they are like, "Oh my gosh, this is great." A newspaper editor came and we went, "Wow, I’ve never seen something this nice." We treat them with respect. We treat everybody with respect. That comes through very quickly to people.

It’s been a journey. At one time, we wouldn’t take commercial insurance. We started before the marketplace, but a lot of our patients were over 200 percent of poverty, which is $24,000 a year, approximately. When the marketplace came, they were able to get some insurance, but they stayed with us because they liked it. They felt like they were getting good care. Our hours were convenient. We treated them well. That’s important. If you feel comfortable where you’re going to your doctor, that helps with keeping you in good health, or if you’re sick, improving your health.

Where do you see the healthcare system in 10 years?

My crystal ball is broken, but I guess what I can say is that we’ve got to do something. We cannot continue for these costs to go out of control.

What I’d like to see is that every system has population health, that patients can get the healthcare wherever they want, whether it’s going to the doctor or doing telehealth. Until we get to the point where we can control the cost and use these population health programs like Forward Health Group and through the TGA, we’re not going to do that. My dream is that we will see the costs go down and that our health improves.

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Morning Headlines 9/14/15

September 14, 2015 Headlines 1 Comment

Do you have a complaint? ONC has a new tool that might help

ONC launches a new EHR complaint form that it will use to “better triage, track, route, and respond to your health IT concerns or challenges.” Users can file complaints concerning EHR usability, interoperability, safety, and more.

When Family Members Run Foundations, Scrutiny Never Ends

The New York Times profiles the philanthropic organization established by Meditech co-founder Mort Ruderman, and the role his grandson plays managing it.

Health IT Policy Committee

During last week’s Health IT Policy Committee, team members from the Interoperability Task Force presented its report on the barriers facing EHR interoperability, concluding that the market is slowly moving in the right direction, but at an unacceptably slow pace that is being caused by unclear financial incentives for embracing interoperability.

Medical Innovation Bill Passed the House With 344 Votes; Now It’s On Life Support

The 21st Century Cures Act, which passed in the House 344-77 this past July, is facing a tougher time gaining traction in the Senate due to funding issues and its $8.75 billion price tag.

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Monday Morning Update 9/14/15

September 13, 2015 News 3 Comments

Top News

ONC launches a health IT complaints webpage for providers to report health IT concerns or challenges that they can’t resolve through other channels, including information blocking, EHR usability issues, or certified EHR products that aren’t performing as expected. ONC says it will triage, track, route, and respond to submissions, although it adds that “we may not always have the ability to step in and fix the problem.” Meanwhile, to whom should I complain about the error message I receive when trying to access the alleged complaints page?

Reader Comments

From Reluctant Epic User: “Re: DonorsChoose project. I’m inspire by the anonymous vendor executive’s matching contribution pot, but I don’t have an anonymous vendor executive’s paycheck. Can you set up a way for your provider readers to kick in small amounts to keep the pot alive?” DonorsChoose helped me figure out how to do it:

Purchase a gift card in the amount you’d like to donate.
Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
I’ll be notified of your donation and you can print your own receipt for tax purposes.
I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.

The reason I set a $1,000 vendor minimum initially was because I was offering them an HIStalk plug for their donation and that seems worth a fair donation amount to a vendor. For companies or individuals who don’t need that exposure, you can donate whatever amount you like using the process above and I’ll take it from there.

Speaking of DonorsChoose, Mrs. W reports from Las Vegas, “I cannot begin to explain what an impact the iPad case, iPad adapter, and Chromecast have made in my classroom! Since the day I received the package in the mail, the materials have been in the hands of students. The students love using apps to extend learning, we love watching academic content using the adapters on our projector, and we know our iPad is safe. These are such special tools that I will continue to use every day in my classroom. Thank you for making a difference and improving my classroom environment. I work so hard to provide the best education for my students, and this donation helps to make their classroom a fun and exciting place to learn!”

From The PACS Designer: “Re: Apple’s iPad Pro. Medical capabilities were demonstrated at Apple’s launch event. The iPad Pro has double the resolution of previous devices and also 3D.” Video of the announcement is here. I wouldn’t be a prospect for a “tablet” that weights 1.57 pounds and has a screen nearly as big as a laptop’s, especially when it costs $799 for just 32GB of storage. I could get two laptops for that price and have a terabyte hard drive, nice keyboard, and 8GB of memory (my Toshiba Satellite cost less than $400). Still, I’m sure the Apple fanboys will be waving their giant new toy conspicuously around at every opportunity. It’s fascinating to me that phones are now as big as tablets and tablets are now as big as laptops even thought portability was the genesis of all three. It will be interesting to see how the iPad Pro competes with Microsoft’s Surface Pro running Windows 10, especially since neither device seems to solve any particular problem or market deficiency except for people who desperately need an expensive, heavy, electronic version of a pencil and paper.

HIStalk Announcements and Requests

Seventy percent of poll respondents have designed or written clinical software, which I find commendable (since I’m one of the majority). New poll to your right or here: how much success will Salesforce have in healthcare?

An anonymous reader reported last week that Portland Adventist has experienced significant revenue cycle problems following their June go-live on Cerner. That’s not true, according to folks on site. Bills are processing, claims are being submitted, and nothing unusual is happening considering where they are in their conversion.

I filed an Office for Civil Rights complaint in early July after my hospital refused to give me an electronic copy of my medical record. I still haven’t heard anything from OCR or the hospital other than the auto-generated “we have received your submission” OCR message.

I’m not honored to be speaking at a conference, not thrilled to have been nominated for an award, not exhausted from a vacation to Bora Bora, and not grateful that some journal has published my article. We get it, Mr. Social Media humblebragger – you are way more wonderful than the rest of us. Meanwhile, I’m having fun unfollowing Twits who litter my feed with sports-related tweets, possibly unaware that I could just go to ESPN.com rather than follow healthcare IT people if I cared about tennis or college football updates.

Last Week’s Most Interesting News

Excellus BlueCross BlueShield discovers that hackers have had access to the information of 10 million people since December 2013.
GetWellNetwork acquires Skylight Health Systems, combining the #1 and #2 KLAS-ranked interactive patient systems vendors.
3M announces that it may sell or spin off 3M Health Information Systems.
IBM Watson Health announces a population health application and brings on former Philips Healthcare CEO Deborah DiSanzo as GM.
An independent assessment of the death of Ebola patient Thomas Duncan commissioned by Texas Health Resources finds that its employees were overly reliant on Epic to convey critical information, the placement of travel history information separate from the patient assessment in Epic was ill advised, and employees either didn’t understand or ignored an on-screen infection warning in discharging the patient when he had a fever.
The New York Times profiles hospital cost analytics work done by University of Utah Health Care.

Webinars

Sales

WellCare Health Plans will use analytics from Inovalon.

People

Altru Health Systems (ND) promotes Mark Waind to CIO.

Privacy and Security

A study finds that longer, more complex passwords may actually be less secure than easier ones because users are likely to put them on sticky notes left lying around. It gives as an example a recent Super Bowl live TV camera shot that displayed the press-only Wi-Fi network credentials as jotted down by someone worried about forgetting them, allowing thousands of fans to jump on.

Other

A New York Times article about family philanthropic foundations profiles the grandson of Meditech co-founder Morton Ruderman, who earns $225,000 per year to give away $10 million per year of the foundation’s $185 million in assets to recipients in the US and Israel while making sure not to run afoul of the IRS while disbursing the money to organizations that can have the desired social impact. Morton Ruderman (above), who died in 2011, was also involved in real estate development.

A federal judge declines to send a Chinese citizen and former NYU professor to prison for accepting a $4 million NIH grant that he used to patent his research findings on behalf of the China-based imaging company for which he was secretly working.

The Portland business paper profiles Michael Blum, MD, cardiologist and CMIO at UCSF Medical Center and his thoughts on the future of healthcare. He likes ever-shrinking sensors, analytics, treatment of addiction behaviors (including food), and DNA sequencing.

Weird News Andy will be sorry he didn’t get to the bottom of this gem of a story. A woman arrested on jewelry theft charges after surveillance video showed her swapping a fake diamond for the real one she then secretively swallowed produces the evidence when the six-carat, $278,000 diamond is removed via colonoscopy.

Sponsor Updates

Huron Consulting Group will present at the Deutsche Bank Technology Conference September 16 in Las Vegas.
Streamline Health will exhibit at Medhost’s The Nashville Experience September 16.
Summit Healthcare and Zynx Health will exhibit at McKesson Insight September 15-17 in Nashville.
Sunquest Information Systems Finance Director Ryan Hintz is appointed to the Tucson Metro Chamber’s Emerging Leaders Council.
TriZetto will host its Fall Customer Conference September 14-16 in San Diego.
Valence Health will exhibit at the ASHHRA Annual Conference & Exposition September 19-22 in Orlando.
Versus Technology will exhibit at MiMGMA’s Fall Conference September 16-18 in Mount Pleasant.
Qpid Health President and CEO Mike Doyle stars in a Donald Trump satire video for Athenahealth’s More Disruption Please conference.
VitalHealth Software will exhibit at the Delivery Science Summit September 16-18 in Rochester, MN
Vital Images will exhibit at the PICS: Pediatric and Adult Interventional Cardiac Symposium September 18-21 in Las Vegas.

Blog Posts

The Ever Evolving Role of the Chief Information Security Officer (Surescripts)
Technology’s Role in Improved ED Performance (TeleTracking)
Five Reasons Not to Miss VHC2015 (Verisk Health)
Tearing Down the Walls (Voalte)
Value-based reimbursement and key denial management tips ahead of ICD-10 (ZirMed)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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3 Comments

Morning Headlines 9/11/15

September 10, 2015 Headlines Comments Off

Essentials Brief: Telemedicine Study

HIMSS Analytics releases its 2015 Telemedicine Study which surveys health IT executives on current telemedicine projects. The survey measured an uptick in both adoption and awareness of telemedicine products and services and finds that two-way video conferencing systems are the most popular communications systems being used.

Partners Healthcare, Health Catalyst Announce Strategic Collaboration To Improve Patient Care

Partners Healthcare signs a $30 million agreement with Health Catalyst to co-develop and deploy a population health management platform.

IBM Watson Health Announces New Partnerships, New Cloud Services and Global HQ in Cambridge, MA

IBM opens its new Watson Health headquarters in Cambridge, MA while simultaneously announcing a new population health solution that integrates its data analytics tools with Apple’s HealthKit and ResearchKit.

3M to Explore Strategic Alternatives for Its Health Information Systems Business

3M is shopping around its health information systems business, which offers coding software, services, and analytics tools, and expects to make a decision on whether or not to sell by Q2 2016. The business unit booked $730 million in revenue in 2014 and has delivered “greater than 10-percent compounded annual growth over the past three, five and 10 years.”

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News 9/11/15

September 10, 2015 News 3 Comments

Top News

New York insurer Excellus BlueCross BlueShield announces that the information of 10 million members has been exposed in a previously undetected cyberattack that started in December 2013.

Reader Comments

From DejaVuAllOverAgain: “Re: Portland Adventist in Oregon. Word is they’re having revenue cycle problems after going live on Cerner in June, with no claims sent since. Patients are filing complaints that they know they owe something, but don’t know what amount.” Unverified.

HIStalk Announcements and Requests

Mrs. S says she was “honestly blown away” by our DonorsChoose grant that provided two Amazon Fire tablets for STEM time in her Oklahoma elementary school class. She adds, “My favorite part about getting this project funded was explaining to my students that people we don’t even know bought these Kindle Fires for us to use in our classroom so that we can access all the technology we need. They couldn’t believe that people cared that much about their education that they would buy those for them.” I still have matching funds from an anonymous vendor executive for companies or individuals who would like to donate $1,000 or more to DonorsChoose – it’s a really easy process and I’ll give you credit on HIStalk unless you would rather remain anonymous. Contact me.

Also checking in was SC second grade teacher Mrs. J, for whom we covered lodging expenses so she could attend a national educator’s conference (with matching funds from the Bill & Melinda Gates Foundation). She’s using techniques she learned every day, such as playing boom box music for a quick class dance when they answer hard questions.

Listening: new from LA skate punkers FIDLAR, an acronym that is, like most of their music, exuberant but far from family friendly. Also, new from David Gilmour, who just started his first tour (including some Pink Floyd songs and a tribute to deceased Floyd keyboardist Richard Wright) since 2006 to support his upcoming new album.

I use Upflix to sort Netflix offerings by category and by IMDB and Rotten Tomatoes scores, which led me to find The Babadook, an excellent Australian horror film that avoids cheap jump scares and instead focuses on the psychology of the characters. It’s annoying that Netflix’s star system is a history-driven recommendation rather than a summary of actual reviews, but that’s where Upflix comes in.

My latest grammar and usage peeve: people doing product demos who refer to an unnamed doctor as “he” or an unnamed nurse as “she,” perpetuating gender stereotyping (“they” is probably incorrect although I like it, but otherwise “he or she” will do or just “Dr. Smith”). Even more annoying are those who hiply overcompensate by referring to the doctor as “she.”

This week on HIStalk Practice: ICD-10 optimism overshadows lack of provider prep. The Pennsylvania eHealth Partnership Authority offers $10 million in grants to connect practices to its P3N HIE. Medical actors give new meaning to self-exams. VillageMD co-founder outlines the role primary care will play in population health management. New Jersey and Tennessee rank at the bottom for EHR utilization by office-based physicians. Med students take advantage of farm-to-table culinary medicine courses.

This week on HIStalk Connect: Researchers working in organ engineering achieve "single-cell resolution" that will allow them to construct biologically accurate organ structures. Fitbit sues Jawbone for patent infringement in response to the three lawsuits Jawbone filed against Fitbit earlier this year. Scanadu recruits 4,000 clinical trial participants from its list of Indiegogo campaign backers. Digital health accelerator programs begin targeting international markets.

Webinars

Acquisitions, Funding, Business, and Stock

GetWellNetwork acquires Skylight Healthcare Systems, combining the top-rated interactive patient systems vendors.

Streamline Health Solutions announces Q2 results: revenue up 19 percent, EPS –$0.05 vs. –$0.14. Above is the one-year price chart of STRM (blue, down 27 percent) vs. the Nasdaq (red, up 5 percent). The company said in the earnings call that it is talking to leading healthcare IT vendors about reselling its Looking Glass solutions. It has also implemented a message bus that will tie its solutions together using RESTful APIs, allowing it to create value around existing client EMRs. Streamline says working with NantHealth on genomics is fun for its engineers and good for the company as it adds life sciences customers.

3M is exploring the sale or spinoff of 3M Health Information Systems, expecting to reach a decision by early next year. The business generates $730 million in annual revenue in sales of technology for coding, population health management, clinical documentation improvement, transcription, and revenue cycle management.

Roper Industries acquires RF Ideas (card readers and proximity-based workstation security) and Atlantic Health Partners (a healthcare group purchasing organization) for a combined purchase price of $277 million. Some of Roper’s other healthcare companies include Sunquest, Strata Decision Technology, Data Innovations, IPA, Managed Health Care Associates, Verathon, SoftWriters, and SHP. ROP shares are up 8.5 percent in the past year, valuing the company at $16 billion.

Sales

St. Joseph Health (CA) chooses Meditech’s Business and Clinical Analytics solution.

Value Care Alliance (CT) will deploy analytics from Arcadia Healthcare Solutions to its five member hospitals to compare cost, quality, and efficiency metrics.

People

Leidos Health promotes Tom Aikens to deputy group president.

PeraHealth hires Elizabeth Pruett (Innovative Healthcare Solutions) as VP of clinical services.

Deborah DiSanzo (Philips Healthcare) joins IBM Watson Health as general manager.

ONC names Rebecca Freeman, RN, PhD (HCA) as chief nursing officer.

Richard Taylor, national sales director for ScImage, died Monday at 63.

Announcements and Implementations

HIMSS Analytics releases its ”2015 Telemedicine Study,” which points out that while telemedicine adoption increased only modestly in the past year, providers are using a “hub and spoke” model to spread services over their locations. The study adds that the term “telemedicine” is loosely defined and no single solution or service dominates, but that situation is changing as providers get serious about expanding their services, most often by using two-way video.

Mobile charge capture and physician communication technology vendor PMD announces release of a mobile ICD-10 conversion tool.

Partners HealthCare and Health Catalyst will create the Partners HealthCare Center for Population Health, which will train employees of both organizations on care management and population health. Health Catalyst will license Partners intellectual property, while Partners has signed an enterprise-wide Health Catalyst subscription. Partners has been a Health Catalyst investor since 2013 and will increase its equity stake.

IBM Watson Health announces a population health solution that integrates Watson Health with Apple’s HealthKit and ResearchKit. The company also announced collaboration with Boston Children’s Hospital and Columbia University.

Merge Healthcare will collaborate with the non-profit Rad-Aid International, offering charitable contributions of software and expertise to medically underserved and poor regions of the world.

Israel-based Archimedicx launches an “intelligent and objective global hospital search engine” that allows consumers to find hospitals based on condition or procedure. The company’s methodology is certified by HIMSS Europe, although the data sources and algorithms are not stated. It covers only 300 hospitals. The company’s terms of use indicate that it makes money when someone outside the US contracts for services from a US hospital – the hospital pays Archimedicx a fee ranging from $2,000 to $15,000. I’m surprised at how prominently the company includes the HIMSS logo on its materials – I assume money changed hands to make that happen.

Government and Politics

The biggest IT project in Rhode Island’s history, a Medicaid and food stamp management system being developed by Deloitte, will cost at least triple the original estimates. Federal taxpayers will cover all but $77 million of the project’s estimated $364 million completion cost. A state executive says the new estimate isn’t due to cost overruns, but rather that changes made to get more federal money, saying, “With another administration in Washington, it is unclear as to whether this kind of opportunity to get federal support and federal funds to build a system like this would be possible. Then it would fall on Rhode Island taxpayers.” A limited government advocacy group calls the project a “dependency portal” that encourages residents to go on the dole.

A fourth rural Tennessee closes following the state’s decision to opt out of Medicaid expansion, although low volumes made them unprofitable anyway. People seem to want to do something about the closures despite lack of market demand, although I don’t know why the hospitals couldn’t just run a free-standing ED instead of staffing empty beds that nobody wants to be in. Every small town hates to lose the local hospital, but in most cases they would receive better routine and elective care at a bigger and busier facility (I say that having worked in small, rural hospitals for years).

Innovation and Research

A UK company a 3D barcode that can be imprinted as tiny pinpricks on tablets to detect counterfeit drugs. The challenge would seem to be in getting hospitals and pharmacies to perform the scan, especially since the drug supply chain is better protected in the US than in many other countries.

Otsuka Pharmaceutical Co. and Proteus Digital Health announce that the FDA has accepted their New Drug Application for the first “digital medicine,” an aripiprazole tablet (for psychiatric problems) embedded with a digital sensor that reports back to the prescriber whether the patient is taking their medication correctly. The drug-device combination requires FDA approval for each component, the tablet itself and the ingestible sensor that sends information via a patient-worn patch.

Technology

AirStrip announces on stage at Apple’s event this week that it will allow users to authenticate simply by wearing an Apple Watch running the AirStrip app. Video from the Apple event shows how pregnant women at home can be being monitored via AirStrip’s Sense4Baby (which it acquired last year) while wearing a sensor and Apple Watch, which can distinguish the mother’s heartbeat from that of the baby.

Other

The Miami paper lists the highest-paid employees of tax-funded Jackson Health System, with the CEO topping the list (of course) at $1 million. The CIO was #69 at $282K and the CMIO #85 at $256K. I’m surprised that several nurse anesthetists topped $250K in annual compensation, but then again I haven’t paid attention to CRNA salaries.

England’s NHS asks the government to include nurses on its list of positions with official shortages, saying it needs at least 1,000 RNs from India and the Philippines in the next six months.

Philadelphia’s fire department is investigating a video showing an ambulance driver checking Facebook and texting while transporting a woman and her toddler to the ED.

Sponsor Updates

ZeOmega is named to the Inc. 5000.
EClinicalWorks will exhibit at the International Vision Expo & Conference September 17-19 in Las Vegas.
FormFast will exhibit at the InSight 2015 Annual Conference September 15-18 in Nashville.
Healthcare Data Solutions will exhibit at the H-E-B Pharmacy Conference September 15 in San Antonio.
Health Catalyst announces that its Healthcare Analytics Summit 2015 drew 1,000 attendees to Salt Lake City this week.
Healthfinch, Iatric Systems, and Liaison Technologies will exhibit at the North Carolina Healthcare Information & Communications Alliance Annual Conference September 13-16 in Pinehurst, NC.
Ingenious Med will exhibit at the 13th Annual Canadian Society of Hospital Medicine Conference September 17-24 in Ontario.
Leidos Health will exhibit at InSight 2015 Annual Conference September 15-18 in Nashville.
LiveProcess will exhibit at the Vermont Association of Hospitals and Health Systems 2015 Annual Meeting September 16-18 in Jay.
AirStrip will exhibit at the Leerink Partners Healthcare Summit September 16-18 in St. Helena, CA.
Impact Advisors is named to Modern Healthcare’s “Largest Revenue Cycle Management Firms.”
Aprima will exhibit at the Ohio American Academy of Pediatrics Annual Meeting September 11-12 in Dublin.
Bottomline Technologies will host its annual Race for a Cause September 12 at its headquarters in Portsmouth, NH. Proceeds from the event will benefit Families First Health & Support Center.
Capsule Tech will exhibit at the Medhost Mpact Summit September 15-18 in Nashville.
CoverMyMeds will exhibit at the Minnesota Pharmacists Association Annual Conference September 11-13 in St. Paul.
Quest Diagnostics SVP and CFO Mark Guinan presents at the 10^th Annual Wells Fargo Healthcare Conference in New York City.
Navicure will exhibit at the Oregon MGMA Fall Conference September 16-18 in Eugene.
Netsmart will exhibit at the Kansas Public Health Association Conference September 17 in Manhattan.
Park Place International Systems Engineer Erick Marshall is recognized as a #vExpert for contributions and engagement with the VMware community.
Experian Health will exhibit at the 2015 Alabama HFMA Fall Institute September 13-16 in Sandestin, FL.
Patientco will host an Arkansas kick-off event September 17 in Little Rock.

Blog Posts

Demonstrating the Power of Analytics in Population Health (Medicity)
Nursing-Centric Design and Clinical Communication (PatientSafe Solutions)
No Interoperability Without Integration (Extension Healthcare)
Confusing Meds and Care Coordination (Galen Healthcare Solutions)
An “Ideal” Arrangement for Radiologists: Proving Innovation and Low Cost Can Come As a Pair (GE Healthcare)
Coming Soon: Meaningful Use Final Rule … Will You Be Ready? (Greenway Health)
Outsourcing Your Billing Office Operations: Benefits vs Risks (Hayes Management Consulting)
Epic Implementation: Project Management & Marketing (The HCI Group)
September is Sepsis Awareness Month – What are You Doing to Mitigate Sepsis Risk? (Health Data Specialists)
Infusing Health Content Into an Integrated Member Engagement Strategy, Part 2 (Healthwise)
How Access to External Imaging Improves Patient Care and Referral Expansion (LifeImage)
Increase Front Desk Revenue, Step 4 of 5 (AdvancedMD)
Overcoming 3 Obstacles to Speech Recognition in Healthcare (Aventura)
Overview of CMS Admission Penalties for 2016 (Besler Consulting)
Volunteering can be a Path to a New Job or Career (Direct Consulting Associates
)It’s Oh So Quiet … (MedAptus)
Quippe Increases Nursing Satisfaction at Bumrungrad International Hospital (Medicomp Systems)
Workflow Tech in Hospitals (Oneview Healthcare)
The Evolving Relationship Between Payers and Providers (Orion Health)
“Humanizing Technology” for Physicians (PatientKeeper)
Embracing Change: Four Steps to an “A-Ha!” Moment (PerfectServe)
Dan Barchi at Yale Sets the Record Straight on Data Blocking by Health Systems (Phynd Technologies)
PMD’s First HIE: Interfacing as a Service (PMD)
Taming the Complexity of Medi-Cal (Relay Health)
Targeting Value in a Revenue Cycle IT Department (Sagacious Consultants)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

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3 Comments

EPtalk by Dr. Jayne 9/10/15

September 10, 2015 Dr. Jayne Comments Off

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I was pleased to see that Vermont finally legalized electronic prescribing of controlled substances, making the process now legal in all 50 states. According to Surescripts, only 2 percent of physicians are electronically prescribing controlled substances. Early on, even if it was legal in your state, it was still a challenge due to lack of pharmacy participation. Now nearly 80 percent of pharmacies can accept controlled substance prescriptions and I’m guessing that the cumbersome workflows involved are contributing to the low numbers.

The two-factor authentication options offered by my primary vendor include a key fob token or a soft token installed on a cell phone. We have a strict “no cell phones” policy (even for physicians) so that option is out and my partners weren’t too wild about having to carry a token. We dispense most of our controlled substances in-house, so our practice hasn’t adopted yet. Since we dispense, we’re not afraid of being able to meet the controlled substances requirements, but I have several friends who are nervous about the auditing and reporting requirements.

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This week, CMS is urging practice to contact their software vendors, clearinghouses, and billing services to “ask about testing and training opportunities.” We’re three weeks out and I think it’s a little late in the game if practices are just starting this process. I continue to be amazed by the number of practices that are way behind on their preparations. A solo physician contacted me today, finally realizing that we’re not going to get a reprieve. He forwarded a 26-page “checklist” of to-do items from his software vendor. It was more like a novella than a checklist and had cross-references to more than a dozen other documents, each with other check lists.

Although the document was overwhelming, I can’t fault the vendor too much because their checklist outlined a timeline that was to have begun six months ago. Had the work been done on the vendor’s suggested timeline, the steps would have been relatively small and manageable by any practice. Trying to tackle it at the last minute though is like standing at the bottom of a cliff and hoping a flying elephant can help you get to the top. I’m going to do some ICD-10 coding training for him, but had to refer him out for the technical pieces. I haven’t adjusted my fee schedule for the last-minute rush, but I bet clients will be paying a premium for technical services as we get closer to the deadline.

CMS also released webcasts for Dental, Lab, Pharmacy, and Radiology clinical concepts. In addition to new documentation requirements, the presentations cover physician perspective. I’m sure the physician perspectives they present are pretty far from what many of my colleagues are thinking, which ranges from, “Why did I go into medicine again?” to, “I should have gone to a cash-only practice when I could.”

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Last week, Mr. H mentioned a study that looked at episodes of “Grey’s Anatomy” and “House” and how on-screen patients fared with CPR. They survived at twice the rate of real patients. Thanks to Netflix and some quality time on the treadmill, I’m finally caught up on “Grey’s” and was happy to see Dr. Miranda Bailey discuss her end-of-life preferences with her husband even if he didn’t agree.

HIMSS recently sent me a “Connected Health” survey that asked about my organization’s plans to expand technologies in the next year. Most of the organizations I’m working with are delaying any strategic planning sessions until after the Meaningful Use final rule is released. Between the uncertainty of the requirements and the strain of ICD-10 and related upgrades, everyone just seems to be running out of gas.

A reader made my day with this piece in The Onion: “Health Experts Recommend Standing Up at Desk, Leaving Office, Never Coming Back.” I’ve definitely had days when I feel like taking their advice to use my lunch break “to walk until nothing looks familiar any more.” I sent back an email of thanks and was rewarded with this gem from Gomer Blog detailing an EHR upgrade gone wrong.

Have you ever had a week when you feel like you’re going to have to send your IT team to a safe house? Email me.

Email Dr. Jayne.

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Morning Headlines 9/10/15

September 9, 2015 Headlines Comments Off

New York health insurer hacked, over 10 mln members possibly affected

Excellus BlueCross BlueShield and its affiliate Lifetime Healthcare Companies reports that a cyberattack executed in December 2013 has exposed the demographic and medical claims data of 10.5 million of its customers.

Electronic Health Record Vendor Adherence to Usability Certification Requirements and Testing Standards

A JAMA study evaluates EHR vendor compliance with ONC’s usability and user centered design requirements, finding that many certified vendors are out of compliance but continue to hold their certifications.

GOP scores early win in ObamaCare lawsuit

A federal district judge has approved a House GOP lawsuit against the ACA to move forward. The suit alleges that the White House is using unauthorized funds to pay for components of the healthcare law.

2015 HIMSS Congressional Asks

HIMSS publishes its annual list of congressional asks, including: bolstering support of EHR interoperability, helping organizations combat cyber threats, and approving broad telehealth reimbursement for Medicare beneficiaries.

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HIStalk Interviews Sean Carroll, CEO, Arcadia Healthcare Solutions

September 9, 2015 Interviews 1 Comment

Sean Carroll is CEO of Arcadia Healthcare Solutions of Burlington, MA.

Tell me about yourself and the company.

Arcadia is an EHR data harmonization and analytics company. We focus on building high quality, highly usable data assets for risk-sharing entities such as health plans, IDNs, and IPAs. The scope of the business has us covering 20 million patients, 40,000 providers, and 4,000 practices, both owned and affiliated.

As for myself, I am a lifer in health IT. I’ve been at it for almost 30 years across six companies. All of those companies have had some principal focus on data and some form of disruptive technology or business model component. I’ve been here at Arcadia for two and a half years.

Your solutions connect to the back end of EHRs. Interoperability seems to have settled on two sides of the equation, one being real-time integration that requires vendor participation and the other being to extract information in some other way as needed. Do you see that perhaps the market forgets that external applications can sometimes access EHR databases directly?

Yes. That’s been our focus, certainly for the last decade — working quite deliberately on the back end of the top 30-plus electronic health record systems in the market. I think right now the standard is less about two-way operability, especially between EHRs. That’s very rare if not non-existent. But more so the kind of deep integration that is needed to execute against the kinds of measures that are emerging in the marketplace largely driven by value-based care.

Do you need the EHR vendor’s help to understand their data catalog and metadata or can you discover that on your own?

We don’t need their help, necessarily. We certainly need a customer who has invested in electronic health records to work with us to make all parties helpful to the process, because in the end, it’s the patient we’re trying to help, and it’s the customer who has made that investment who needs to drive how to get at that data to provide quality care and lower cost.

You connect to 30-plus data sources. How much information outside the EHR is needed to give you a complete picture of a patient or of quality?

Right now I would say it’s very helpful fringe-level data. Most of the market is still reconciling to the notion that deep clinical data from electronic health records is paramount to creating a high quality, highly usable data asset. We do have clients who are already well into that path, of course, and have asked us to pull in data from practice management systems or other systems that have bits and pieces of information that might not exist elsewhere.

What insights are customers discovering that they wouldn’t have been able to figure out just by looking at the EHR?

A simple example would be if you are looking at claims data — which is principally how people begin to think about analytics around healthcare data that’s been the standard for so long — you would be able to see from a claims component that someone had a cancer screening test done. But without the integrated EHR data in that analysis, you wouldn’t know necessarily whether they have cancer. If you think about where healthcare is trying to move to in terms of closing gaps in care and being efficient, the combination of those two things is what’s really needed to be more timely and efficient in how you handle the patients. That’s a very basic but I think a very important and high-profile example.

Providers often don’t know what questions to ask until they see a report that, by definition as a canned report, reflects the collective best practices of the vendor’s other customers. Are your off-the-shelf reports a surprise to providers who wouldn’t have thought about looking at specific information on their own?

Absolutely. Some of that is driven by the breadth of the information that results from that combined data set. But oftentimes with electronic health record data in the mix, you’re seeing things much more real time than you would from claims-based analysis only. They’re in a position to react to situation much more quickly through deeper and broader information that is much more timely, as most of our data refreshes every 24 hours.

EHRs focus on transaction management and data completion. They don’t do a lot on the front end with patient engagement and then on the back end some of them don’t have robust analytics. Do you see the post-EHR era being three legs of a stool with the EHR vendor providing just one?

Absolutely. The future would suggest that it’s the next generation of systems that have the capability to harmonize data from a variety of systems and draw insights from that aggregated data set. That was the original thesis for the electronic health record. Given how adoption has been less and it has taken the time that it has and the business model of value-based care and global payment is now in the driver’s seat in the marketplace, I see the electronic health record systems as a source of information among many. Albeit a very very important one and with a great deal of the necessary information, but still just a source.

EHRs were supposed to be different from EMRs because they would collect and present health information from many systems in many encounter locations outside a given provider, such as dental offices, drugstores, and long-term care facilities. That EHR concept was sidetracked when ONC decided to certify the same old EMR products and call them EHRs. Would you agree that no provider has deployed what might truly be called an EHR under that original definition?

There are unique deployments of electronic health records with unique organizations that have gotten close to the original promise of what they were intended for, but the vast majority of the market has not realized the original dream. Based on the slow march towards value-based care, we’re going to see a reset where next-generation technology is going to drop on that substantial footprint of EHRs that exist, but it won’t be the single answer. It will have to be compiled with clinical, business, and claims data from other systems to affect and support the change that’s required in the healthcare model.

Is it common now to incorporate claims data?

It’s more common. Certainly the payer marketplace is recognizing that their data coupled with clinical data is a great asset in the marketplace. About half of our clients are payers and some of the more advanced ones — like a large Blue Cross organization in New England that we work with — use aggregated claims and electronic health record data to support the administration of a very creative pay-per-performance program. That’s been very successful in bringing together providers and in the plan on the premise that if we share information carefully and appropriately, we can in fact provide incentives, control costs, and affect quality in the way that we want.

There are certainly real things happening out there with data when it comes together with the provider side of market and the payer side of the market. It works the other way, too. We have direct clients who are large provider organizations or large ACOs who are doing the same thing for similar reasons. But the concept is very much the same – the datasets together provide the lens into what’s happening across principally their ambulatory networks and they can see and manage at the population level.

Are providers are getting into the payer side of the business?

Sure. We talk to provider organizations all the time who are contemplating moving toward building a plan.

We see this in both directions, but the trend we’re seeing more is a much stronger willingness to come to the table, provided that the technology exists and there is the presence of some form of trusted third party — which is a role that we typically play — to help aggregate and arbitrage the right data to the right people in a very trusted and appropriate way. We’re seeing that trend more than providers standing up plans or plans somehow getting closer to providers.

What factors should a provider consider when choosing an analytics vendor?

It’s a very needed competency. It truly is all about the data when it comes to being effective in a value-based model. I would make sure that a supplier can connect you up with clients who’ve really put the technology to use and have seen tangible outcomes. Many organizations in the market are still early stage in the development of their technology. Secondly is the question of the source. The source in our mind is electronic health record data.

It’s very customary for us to engage in a dialog with even a medium-sized IDN who might have 50 different EHRs across their network. When you think about extracting the right data from 50 different systems just at the EHR level and getting that harmonized appropriately, it’s very heavy lifting. I would make sure that who you’re talking to can demonstrate that capability in a real way and with references.

The last piece goes back to the provider themselves. Do they have a clear strategy? Because what we’ve found is that many organizations know that they need to move in this direction and they know that data and technology in particular is important or perhaps even a backbone, but they haven’t fleshed out their full plan yet. Therefore, they’re not quite ready for the technology. That’s one of the reasons we acquired the Sage business — to help those organizations who are just a little more early stage to move closer to value-based or risk-sharing before making the investment in a solid data asset on which to drive the strategy.

How did the Sage Technologies acquisition change what you offer?

It added a deep tenure in managed care through this Midwest-based business that provides end-to-end services to provider networks that are engaged in risk-based contracts with managed care payers and ACOs. They provide everything from claims processing, network administration, utilization management including case management, customer service, data management, reporting, and critical care management. Really a full suite of supporting services that are required for an IPA or some form of other provider network to execute when they’re engaged in risk and to be good at it.

A large part of the market is still in that state, thinking about more aggressive moves and deeper risk arrangements where technology starts to become more critical. We wanted to have an ability to serve those clients now and also to make sure that we had the resident services to offer some of our technology clients in support of their activities. It has helped us with a little bit more of an end-to-end capability serving a larger portion of the market, which is very much in transition with a variety of different maturity levels amongst the organizations as it relates to risk-based contracting.

How would you like the company to change over the next five years?

We’re very dedicated to the notion that clinical data in particular — for the next five years and perhaps beyond — aggregated from electronic health record, is fundamental to an effective data strategy. A data strategy is fundamental to being successful in value-based care. We’re focused on that.

We certainly understand the necessity to deliver on the full outcome, but our focus will remain on solving this important and fundamental challenge that organizations have, which is, "I’ve made huge investments in my electronic health record strategy. I need the information out of all of them. I need it timely. I need to be able to then process it right it away in much broader ways, including looking at the full population that I serve. That’s the only way that I will be effective in executing in any sort of risk model."

Our focus will stay there. We hope to be the recognized leader in that particular competency. We’ve been at it for 10 years. We have quite a bit of intellectual property in and around that process. Beyond that, our mission is to help patients and help the system evolve in a high quality way and to deliver to providers a useful tool that will be efficient in the way they provide medicine as these models evolve.

Do you have any final thoughts?

We’re very enthused that the market is signaling clearly that value and value-based models are the landing spot. We see that through multiple things happening with CMS, including recent announcements about supporting value-based characteristics and Medicare Advantage. That’s just another signal. We’re very curious about that. We think that that is where healthcare should be. We think we can play a significant role in assisting in that journey.

Clinical data from EHRs is a difference-maker. We’ve seen it over and over again with our 40 clients. The speed, the depth, and the comprehensiveness of that data, coupled with payer data and other sources, is critical. We believe plans and providers can and will — and in fact, must — come together to share the kind of information that will make all this possible. We’re seeing that happen more and more in the marketplace. We’re looking forward to being a part of this tremendously positive momentum that’s occurring.

1 Comment

It is contained in the same Forbes article. Google “paywall remover” to find the same webpage I used to read…

The link in the Seema Verma story (paragraph?) goes to the Forbes article about Judy Faulkner. Since it is behind…

Seema Verma - that’s quite a spin of “facts” good luck.

LOL Seema Verma. she ranks at the top of the list of absolute grifter frauds.

Re: US Rep. Matt Rosendale's comments on MASS in the VA Ummm. I have to express some difference with Rep.…

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