In Ireland, Cork University Maternity Hospital goes live with Cerner as the first hospital in a plan to deliver a single, shared maternity EHR across the nation.
Sreedhar Potarazu, an ophthalmogist and political commentator on cable news outlets, pleads guilty to criminal investment fraud charges after lying to investors about his health technology startup’s finances to secure $30 million in investments.
IBM’s Watson business unit has launched a pilot program aimed at developing cybersecurity monitoring tools for healthcare and several other industries.
Harvard University professor and cybersecurity scholar Bruce Schneier discusses the recent IoT-based denial-of-service attack on Dyn servers and the risk that such attacks pose to hospitals and public safety.
Ireland goes live on a nationwide maternal and newborn clinical management system at Cork University Maternity Hospital, making newborns like Emily, above (dubbed the country’s “first digital baby”), initial recipients of a digital patient chart. The Cerner-developed MN-CMS will roll out across the country’s 19 maternity units over the next three years, with near-term go lives planned for University Hospital Kerry, Rotunda Hospital, and National Maternity Hospital in Dublin. The new technology is the first of its kind in the world, and marks the Irish healthcare system’s first interoperable EHR.
Webinars
December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.
December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.
Acquisitions, Funding, Business, and Stock
Potomac, MD-based ophthalmologist Sreedhar Potarazu pleads guilty to charges related to a $30 million investment fraud scheme tied to VitalSpring Technologies, his now-defunct healthcare business intelligence company. Potarazu admitted to defrauding over 150 shareholders by lying about the company’s finances, failing to pay payroll taxes, hiding tax liabilities, and even going so far as to concoct a charade around a fake prospective buyer. He faces 15 years in jail.
Theranos will dissolve its Board of Counselors, including two former secretaries of state, the former director of the CDC, and a former secretary of defense. James Mattis, a retired Marine general who has gained notoriety as President-elect Donald Trump’s pick for secretary of defense, will remain on the company’s Board of Directors.
Grail, a spinoff of DNA-sequencing company Illumina, looks to raise $1.7 billion to fund large-scale clinical trials in the UK to test early-stage cancer detection tools. The company was initially funded early this year via a $100 million Series A round led by Illumina.
Boston-based PatientPing raises $31.6 million in a Series B financing round led by Leerink Transformation Partners and Andreessen Horowitz. The company plans to double its workforce and expand beyond the six states it currently serves. Vermont announced statewide adoption of the care alert technology in April. The company raised $9.6 million in venture funding last year.
Germany-based CompuGroup Medical walks away from Agfa acquisition talks for undisclosed reasons. It began discussions with the Belgian company in late October.
People
Shafiq Rab (Hackensack University Health Network) will join Rush University Medical Center as CIO and SVP effective January 9.
Joe Driscoll (PC Connection) joins Verscend as CFO.
The American Society of Clinical Oncology hires George Komatsoulis (NIH) as its first chief of bio-informatics.
Announcements and Implementations
ColumbiaDoctors (NY) will roll out mobile patient engagement technology from HealthGrid across its 95 locations.
Dayton Children’s Hospital (OH) begins a two-phase implementation of GetWellNetwork’s bedside Interactive Patient Care software. Phase two will take place next Summer with the opening of a new hospital tower.
Athenahealth adds ADP’s workforce payroll and time and attendance software to its AthenaOne offering for hospitals and health systems.
Rochester RHIO adopts the Connect Image Exchange Transfer-to-PACS workflow from EHealth Technologies.
Sales
Lurie Children’s Hospital of Chicago chooses MerlinOne’s digital asset management system.
The Oklahoma Dept. of Human Services opts for case management technology from Mediware to help it better care for aging and/or disabled residents.
Rusk County Memorial Healthcare (WI) selects Harris Healthcare’s Affinity ERP solution for automation and integration of accounting and financial tasks.
Pharmacy procurement and utilization management company Sentry Data Systems signs on with NTT Data Services for data security and hosting.
Technology
Baxter launches the Sigma Spectrum Safety Management system, including infusion data analysis and reporting and technical support.
Premier develops performance benchmarking technology that sheds light on potential reimbursements and prioritizes areas of improvement.
Meditech releases a fall risk-management tool kit.
Government and Politics
HHS releases the latest round of healthcare spending figures, which show a 5.8-percent growth in 2015 – the fastest rate since 2008. That puts the average annual healthcare spend for one person at close to $10,000. The increase coincided with 9.7 million people gaining insurance coverage under the ACA, and 10.3 million more enrolling in Medicaid.
Research and Innovation
Tenable publishes a cross-industry analysis of cybersecurity preparedness, noting that readiness scores dropped an average of six percent from last year. It gave the healthcare industry a “D” in overall preparedness, a grade lower than its score of the previous year.
Sponsor Updates
Agfa Healthcare will present several sessions at the European Summit on Digital Innovation for Active & Healthy Ageing this week in Brussels.
Audacious Inquiry wins The Baltimore Sun’s 2016 Top Workplaces Award.
Arcadia Healthcare Solutions will exhibit at the CCO Oregon Cost of Care Conference December 13 in Salem.
Besler Consulting releases a new podcast, “Key takeaways from the 2017 OPPS Final Rule.”
B2B Marketing features Bottomline Technologies CMO Christine Nurnberger.
E-MDs offers early bird pricing for its user conference and symposium June 18-20 in Grapevine, TX.
EClinicalWorks will exhibit at the 2016 Connected Health Continuum December 11-14 in National Harbor, MD.
HCI Group releases a new podcast, “EHR Training: Developing Your Curriculum, Using Your LMS, and Organizing Your CTs ft. Stephen Tokarz.”
An Aprima survey of 312 physicians and practice staff finds that 52 percent believe a Trump presidency will improve healthcare, while 48 percent seem confident in a positive financial impact.
Meditech customer Farrer Park Hospital (Singapore) receives numerous health IT accolades.
PokitDok publishes, “5 Healthcare IT Trends to Watch in 2017.”
EClinicalWorks issues reminders about patient safety and the use of its EHR software.
Theranos announces that its Board of Counselors, including two former secretaries of state, the former director of the CDC, and a former secretary of defense, will retire in 2017.
Tenable publishes a cross-industry analysis of cybersecurity preparedness, noting that readiness scores dropped an average of six percent from last year, and giving the healthcare industry a “D” in overall preparedness.
Grail, a spinoff of DNA-sequencing company Illumina, is in the process of raising $1.7 billion to fund large-scale clinical trials in the UK to test early-stage cancer detection tools.
Many organizations are starting to get ready for their Meaningful Use attestations early next year. Those that prepared well in advance and monitored their performance as the year rolled along are simply dotting the proverbial “i” and crossing the “t” before the year closes out. Others are in panic mode, realizing that they waited too long to get serious about it, or failed to follow up. I was contacted recently by a couple of clients that fell into the latter category, and was sorry to have to tell them that there isn’t a lot that I can do to help them.
One group started the year strong, using their EHR’s quality measures dashboard to make sure providers were posting solid metrics for their identified measures. They provided retraining for the end users as needed, making sure documentation was done using as much discrete data as possible. They were headed strong into May, and then had some changes in their office dynamics that resulted in the loss of some key staffers. The new office manager was tasked with picking up the Meaningful Use readiness work, and there is some debate about whether she simply didn’t do it or whether she told one of the partners that she was too overwhelmed to take it on.
Practice leadership realized about a month ago that they hadn’t been seeing any reports, and hired a new resource to start managing things. It took her several weeks to get up to speed, and even then it seems that it was too little, too late. Many of the providers have slipped back into documenting their visits using free text and dictation, and based on how the system reports, they aren’t getting credit for their documentation. The managing partner reached out to me asking for my firm to completely take things over for the rest of the year. I was willing to give it a go, until he demanded that I assure him that his providers would meet certain numbers on the metrics. Without a magic wand or a time machine, it would be pretty impossible to correct that much missed documentation, so I elected to take a pass.
Another client had a supposedly savvy IT person who was modifying patient visit data on the backside of the system. He would take the providers’ visits, and if there was free text documentation that kept the visit from qualifying for certain metrics, he would perform database inserts to trigger the discrete data points. That might be a valid approach as long as there is solid documentation on what is being done and clear boundaries around it, but they failed to document the plan or the authorization. Now the physicians are in a battle about having people modify their charge without approval of the individual visits, and it’s probably going to tear the practice apart. They wanted me to come in and audit the database and see how widespread the modifications are, but given the state of the practice, there isn’t enough money on the table for me to get into the middle of something like that.
These examples illustrate, in part, a major issue that we’re still seeing in healthcare IT. Far too many providers and organizations still think that these types of projects are technology projects. I hear a lot of nebulous references to “the IT department” owning such initiatives when really they are clinical/operational initiatives with IT support. There’s also a lot of blame on the EHR vendors. Although I’ve definitely seen my share of flawed workflows, strange workarounds, and oddly calculating measures, clients have to realize that unless they’re willing to switch systems, they have to work with what they have in front of them. Of course, they should also open tickets or support cases or use whatever complaint mechanism their vendor provides, but at some level the customer is responsible for selecting or staying with a particular vendor.
When physicians push back against my assertion that they need to own these projects along with their practice operational leaders, I ask them if they would assume that the company that manufactured the fax machine or the person who dialed it is responsible for the information written in the letter they’re sending to their consulting or referring physician. (Don’t get me started on the fax machine analogy. It’s sad that I have to use it, but so many offices are still faxing letters back and forth that it’s an effective way to make the point.)
It’s now December, and there are somewhere around 17 or 20 work days left in the year for most practices, depending on how you handle your holidays. If you’ve been asleep at the quality measures wheel for most of the year, there is virtually no way to make it up before the attestation window closes, unless you’re willing to engage in database shenanigans or know someone who will on your behalf. You’re not going to be able to retrain providers to fix their workflows for this year, but you can start educating them on what they need to do differently for 2017. And hopefully those organizations who are in a bind at the moment have realized what they too need to do differently for next year, if they want to be successful.
Whether you look at it as succeeding in a world of changing payment structures or avoiding penalties or complying with the requirements of your employer, staying ahead of quality reporting requires a lot of work. Providers have to be constantly monitored for compliance with recommended workflows. End users have to be educated on ways to support the providers so they don’t become data entry clerks. Practice managers and administrators need to be running reports regularly and taking action to mitigate issues as soon as they identify them.
Leadership should be careful on how often they run reports though and what results they expect – I had one client who was running them twice a week, and complaining that they weren’t improving. We had to have a lengthy conversation about interventions and how long they take to bear fruit, since it’s nearly impossible to change provider or end user behavior overnight. That’s also assuming that you actually reached the providers with the intervention, and that half of them weren’t in the operating room or missing it because they were rounding or not reading their email. Even with significant incentives or penalties, it’s still going to take several weeks (if not months) for new workflows to become part of daily routines.
Managing quality metrics is definitely more of a marathon than a sprint. How is your group doing with MU attestation preparation? Email me.
Allscripts acquires Australian EHR vendor Core Medical Solutions. adding both localized software and employees with deep knowledge of Australian healthcare workflows to Allscripts.
Harris acquires iMDSoft, expanding its footprint in healthcare. The company will be run as an independent business within Harris and will be run by iMDSoft EVP Shahar Sery. Financial terms were not disclosed.
Epic quality assurance employees file a class-action lawsuit against the company arguing that they were misclassified by Epic as exempt from overtime rules.
Cerner sues iCapital founder Ahmed Saeed Mahmoud Al Badi after his company subcontracted Cerner to help develop a national EHR for the United Arab Emirates but stopped paying once work was complete. Cerner has filed complaints in Washington and Oregon, where it is seeking $60 million in real estate assets owned by Mahmoud Al Badi.
December 4, 2016NewsComments Off on Monday Morning Update 12/5/16
Top News
Allscripts acquires Australia-based Core Medical Solutions for an undisclosed sum. The company’s BOSSnet clinical information system seems to be its best known product, with numerous implementations across the Western part of the country. CMS will operate as an Allscripts subsidiary out of its South Australian headquarters in Adelaide. Allscripts has had a strong foothold in South Australia since 2010, when the government enlisted the company to develop and roll out an Enterprise Patient Administration System across its 80 hospitals to the initial tune of $225 million – a figure that has since escalated to $317 million over 10 years.
Last Week’s Most Interesting News
The House passes the 21st Century Cures act in a rare, bipartisan 392-26 vote and sends it off for the Senate to review.
A CDC report finds that the number of people struggling to pay their medical bills has fallen sharply in the last five years. Researchers cite reduced unemployment and the implementation of ACA as the primary reasons.
The Senate unanimously passes a bill requiring HHS and GAO to analyze the University of New Mexico’s Project ECHO pilot program and report on opportunities to expand the program nationally.
President-elect Donald Trump selects Rep. Tom Price, MD to replace Sylvia Burwell as the next HHS secretary, and health policy consulting firm CEO Seema Verma to succeed Andy Slavitt as the next CMS administrator.
Rupert Murdoch will likely lose $200 million in Theranos investments after his own newspaper, the Wall Street Journal, exposed the company for misleading investors.
Webinars
December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.
December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.
December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.
Acquisitions, Funding, Business, and Stock
Apex Technology and related investors wrap up their acquisition of Lexmark, originally announced in April. Lexmark’s Enterprise Software Group will separate from the investor-led company and rebrand to Kofax. Former Vice President and CFO David Reeder will take over as president and CEO, and appears intent on selling off the software business as quickly as possible to focus on its imaging assets. The sale includes the assets of Perceptive Software, which Lexmark acquired in 2010.
Dallas-based civil and criminal justice technology company Securus Technologies acquires Quebec-based PHD Medical’s telemedicine assets. Securus has been intent on broadening its healthcare offerings for correctional facilities, having acquired EHR vendor Cara Clinicals last year, and healthcare management systems business Archonix in 2013.
Cerner finds itself in the real estate market thanks to legal battles with Ahmed Saeed Mahmoud Al Badia, a property developer with ties to the United Arab Emirates Ministry of Health, which hired Cerner in 2008 via a subcontractor agreement with Al Badia’s company, ICapital, to develop a national EHR system. Cerner contends it hasn’t been paid the full amount due, despite finishing the project. It is suing Al Badia and trying to seize a $30 million mixed-use development and other assets to recoup $63 million it claims to have lost on the project.
Epic faces another class-action lawsuit pertaining to its overtime pay policies. This particular suit contends that quality assurance workers were illegally denied overtime pay despite the fact that they mainly tested Epic’s software products by simulating user experiences and documenting problems – work that required little training or education in computer programming or engineering. (Higher-level employees like analysts, programmers, and software engineers are typically exempt from overtime pay rules.) The company faces two other overtime-related lawsuits filed early last year on behalf of technical writers who believe Epic illegally classified them as exempt from overtime wages and then paid them a fixed salary irrespective of the number of hours worked.
People
James Aita (Idea Couture) joins Medicomp Systems as director of strategy and business development, North America.
Decisions
Sleepy Eye Municipal Hospital (MN) will switch clinical and physician documentation software from Healthland to Meditech on December 1.
UConn John Dempsey Hospital (CT) will go live on Epic in June 2018.
These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.
Announcements and Implementations
The New Hampshire Health Information Organization can now share data with NH providers who care for veterans inside and outside of the VA.
Gillette Children’s Specialty Healthcare expands its telemedicine program to facilities in Central Minnesota. The state passed legislation last year requiring payers to cover virtual consults to the same degree they would in-person appointments.
Tampa General Hospital (FL) settles a class-action lawsuit related to a non-hospital employee’s unauthorized access of patient information and the hospital’s failure to adequately protect that information. The hospital maintains it is not responsible for the misdeeds of former employees related to the access.
Glendale Adventist Medical Center (CA) fires a nurse after the employee accessed the records of 528 patients without permission.
NIST’s National Cybersecurity Center of Excellence seeks help with designing simple and secure mobile login methods for first responders. Organizations interested in supporting the single sign-on effort can submit a letter of interest to NIST, which hopes to begin developing use cases in January.
University of Iowa Hospitals and Clinics recovers from a six-hour Epic downtime caused by an electrical problem in one of its main server rooms. The health system shifted to standard downtime procedures and transferred critical services from its data center to a redundant data center off site.
Innovation and Research
A HealthLoop health literacy study of 2,226 diagnostic imaging patients finds that those offered educational materials via digital means were more likely to correctly identify what ionizing radiation was than those that received paper materials. The digital engagement group was also “significantly” more at ease with undergoing examinations using such radiation compared to their paper-based counterparts.
Sponsor Updates
Experian Health will present at the VA AAHAM meeting December 9 in Williamsburg, VA.
PokitDok will present at Health 2.0 Asia-Japan December 6-7 in Tokyo.
Surescripts and ZeOmega will exhibit at the AHIP Consumer Experience & Digital Health Forum December 6-9 in Chicago.
TierPoint will host the Nebraska Security Summit December 8 in Omaha.
Zynx Health will exhibit at the National Forum on Quality Improvement in Healthcare December 4-7 in Orlando.
Sutherland Healthcare Solutions publishes “Meaningful Use Stage 3 and its Impact on the Healthcare Industry.”
A CDC report finds that the number of people struggling to pay their medical bills has fallen sharply in the last five years. Researchers cite reduced unemployment and the implementation of ACA as the primary reasons.
California will create an electronic registry to store end of life orders of residents which will be accessible by local emergency and social service providers.
Omnicell will acquire Raleigh, NC-based Ateb, Inc. for $41 million in cash. Ateb develops pharmacy-based medication adherence and chronic disease management solutions and has a customer base of 15,000 pharmacies across the US and Canada.
The House passes the 21st Century Cures act in a rare, bipartisan 392-26 vote and sends it off for the Senate to review next week.
Provisions include a less-thorough FDA drug approval process, $5 billion in NIH research funding, $1 billion to address the opioid epidemic, and mandatory EHR interoperability requirements that prohibit information blocking with potential fines of $1 million. The bill would also combine ONC’s HIT Policy and HIT Standards committees
A controversial measure that would have reduced requirements for drug companies to continue publicly reporting their payments to providers was removed.
The bill would be funded by taking money away from preventive health projects.
Reader Comments
From Luna Immortal: “Re: [vendor 1 name omitted]. I’m hearing that they have an upcoming merger and wonder if it might be [vendor 2 name omitted] since there’s a lot of people who worked at both companies and Vendor 2’s home health software vendor stake would help Vendor 1, whose product isn’t robust.” Unverified. Sorry about all the Vendor 1/Vendor 2 stuff, but I don’t usually list the names of publicly traded companies when I run rumors even when it’s not hard to figure out who’s who.
From Byte Bard: “Re: upcoming webinar. Your speaker’s bio says his prior company went public. That’s not accurate – it was an SEC Regulation D investment.” I see a good bit of accomplishment inflation in this industry, like the executive’s LinkedIn profile I was reviewing this morning that, in the absence of actual graduate education, listed one of those super high-priced, days-long visit to the campus of a big-name school that offers programs for those who are flush with cash but who don’t find it convenient to earn an actual graduate degree like many of their underlings managed to do. I’ll trust your resume forensics in this case. I recall that I got all kinds of nasty and threatening emails years ago when I wrote about unaccredited schools and linked to the bios of healthcare people who were throwing around their fake MBAs and PhDs. If the credential can’t withstand any sort of inspection, then it has no place on a resume or LinkedIn.
DonorsChoose Updates
Donations from (a) the anonymous vendor executive who asked me to do a reader cybersecurity survey; (b) long-time reader Marty; and (c) our own @JennHIStalk funded these DonorsChoose classroom projects:
A library of books and a storage cart for Mrs. L’s first grade class in Cedar Hill, TX.
30 calculators for Mrs. S’s sixth grade math class in Union, SC.
Math games for Mrs. S’s first grade class in Independence, MO.
Learning center headphones for Ms. M’s elementary school class in Chicago, IL.
Programmable robots for the library’s makerspace of Mrs. E’s elementary school in Greenwood, SC.
Science teaching items for the sixth grade class of Mrs. S in Union, SC.
Hands-on learning stations for the learning disabled students of Mrs. P’s kindergarten class in Oklahoma City, OK
Mrs. S from SC, who says she was “thrown in” to teaching science after school had already started and therefore had no materials to work with, checked in:
You do not know how much this means to me and to my students. This has been a difficult year trying to teach my students with limited supplies. I can’t wait to tell my students tomorrow morning. I’m sure they will be just as excited as I am. Thank you for your generosity.
Industry long-timer Tom sent a very generous personal donation with a note saying that it’s sad that charity has to provide classrooms with essential learning tools, but he’s still happy to donate for “our future adult citizens.” The matching money really added up in funding these teacher grant requests with Tom’s donation:
A listening center for Mrs. H’s first grade class in Battle Creek, MI.
Additional books for the library of Mrs. L’s first grade class (the first donation to her class was above).
A mobile organizer and spelling games for Mrs. S’s elementary school class in Gaffney, SC.
Three sets of building blocks for Mrs. K’s elementary school class in Rome, NY.
An iPad Mini for read-along lessons for Ms. N’s elementary school class in Brooklyn, NY.
A social emotional library of 33 books for the International Baccalaureate class of Mrs. M in Nashville, TN.
Non-fiction books and subscriptions for Ms. S’s elementary school class in Chula Vista, CA.
Robotics and engineering kits for Mrs. G’s elementary school class in Springfield, NY.
STEM learning project kits for Ms. L’s elementary school class in Independence, MO.
Music and band supplies for Mrs. R’s elementary school class in Wasco, CA.
HIStalk Announcements and Requests
My fatigue is growing with lazy health IT reporters who craft “news” stories consisting mostly of loosely woven together tweets or quotes extracted from them. They should be practicing journalism that they promote via Twitter, not using Twitter as a news source. Every time I think that journalists (if you care to call them that) can’t possibly get lazier or less informed, they prove me wrong. The “eyeballs at any cost” movement among sites that don’t charge a subscription fee (and thus trade in titillation rather than education) has made us collectively dumber than we already were and that’s saying a lot.
I’m also tired of people repeating the well-intentioned but dead wrong trite assertion that “Your ZIP code determines your health more than anything.” If that were true, people would be miraculously cured just by moving. Health status is certainly related to socioeconomic factors that are prevalent in a given ZIP code, but you and I won’t fall apart medically just because we move to East St. Louis. It’s a cute phrase that ironically confuses cause with effect and applies broad group characteristics to every individual in the group. Healthcare people should know better.
This week on HIStalk Practice: AbleTo adds care coordination capabilities to behavioral telehealth service. PCPs found extremely lacking in willingness to fess up to medical errors. Topline MD practices roll out telemedicine capabilities. Orb Health raises $3.2M for CCM-focused care coordination tech. Culbert Healthcare Solutions CMO Nancy Gagliano, MD shares four reasons why telemedicine hasn’t taken off more quickly. Excellus BCBS preps for MDLive roll out. CompuGroup Medical adds rehabilitation module. WebPT CEO Nancy Ham shares her thoughts on the importance of workplace culture in attracting top talent.
Listening: new from Seattle-based lo-fi rockers Dude York, which to my untrained ear can sound like the Pixies one minute and the Thermals the next. Their drummer nails it. I’m also kind of enjoying their former neighbors from their Walla Walla days, the riot grrrlish Chastity Belt, who bristle at being called a “girl band” in saying that all the members “just happen to be female” and that nobody would call Led Zeppelin a “boy band.” We get great recorded performances of both courtesy of the U-Dub affiliated KEXP in Seattle, which offers live streaming of its radio programming (I’m listening to it now).
Webinars
December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.
December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.
December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.
Acquisitions, Funding, Business, and Stock
Document Storage Systems will acquire Streamline Health’s patient engagement suite that includes patient scheduling and surgery management. Those are the former systems developed by Unibased Systems Architecture, which Streamline acquired in 2014 and then renamed from ForSite2020 to Looking Glass Patient Engagement. I ran a reader rumor from Twice Bitten on October 5, 2016 saying that Streamline had laid off half of the team involved. DSS offers products and services to government and commercial clients based on the VA’s VistA, so I’m not sure what they’re planning to do with the former USA products.
Omnicell will acquire Raleigh, NC-based Ateb, which offers pharmacy-enabled care and population health management solutions, for $41 million in cash. CEO Frank Sheppard left his IBM developer job in 1992 to form the company.
Lifestyle telehealth software vendor Fruit Street raises $3 million from physician investors in a Series A funding round.
I messed up my New Zealand dollars currency conversion conversion in summarizing Orion Health’s just-announced results. Here’s the corrected version:
Orion Health announces first-half 2017 interim results: revenue up 9 percent, operating loss $12 million vs. $19 million in the first half of 2016. Shares dropped 18 percent to a record low on the news and are down 64 percent since the company’s 2014 IPO. While revenue is up, losses are down, and the company projects profitability in 2018, Orion’s cash position has dropped to $17 million after a net cash outflow of $23 million in the first six months of the fiscal year. The company has also expressed some concern that its predominantly US customer base might defer decisions following the presidential election, but it believes healthcare IT initiatives have bipartisan support.
Sales
Allied Physicians Group (NY) chooses Dimensional Insight’s Diver Platform for analytics.
People
Greg White (Allscripts) joins PerfectServe as COO.
Announcements and Implementations
Spok announces the T52 two-way pager that allows encrypting messages.
Health Catalyst launches Healthcare.ai, an online repository of open source machine learning algorithms.
National Decision Support Company expands its CareSelect clinical guidelines to include the Choosing Wisely campaign,medications, labs, and blood management.
NTT Data Services (the former Dell Services) announces analytics partnerships with Imbio (lung analytics) and AnatomyWorks (brain mapping analytics).
DrFirst will integrate pharmacogenetics-based point-of-care electronic prescribing from Translational Software into its Rcopia medication management system.
Northwell Health and Siemens Healthineers form research partnership to address imaging effectiveness and outcomes.
Government and Politics
A CDC study finds that the number of people whose families are struggling to pay their medical bills has dropped 22 percent in the past five years due to an improving economy and the large number of people who gained insurance through the Affordable Care Act.
In Australia, SA Health fires two more employees for inappropriately accessing medical records, raising its total to seven after a February crackdown.
A research team hacks 10 types of implantable medical devices, claiming that a hacker could kill pacemaker and defibrillator patients within 15 feet.
In Canada, Carleton University temporarily bans Windows-using students from its network after ransomware takes down its internal systems.
Innovation and Research
A group of cadets in an Israel Defense Force officer training course creates a digital bracelet and associated sensors that can be attached to wounded soldiers to record information about their treatment. The bracelet is powered by near-field communication technology that connects to the smartphones of medics. Medical teams are testing it for potential general army rollout.
Other
California is testing an electronic registry for POLST (Physician Orders for Life-Sustaining Treatment) forms that would allow first responders and clinicians to look up their wishes for emergency treatments. POLST forms, intended for use by people near the end of their lives, contain actual provider orders and thus are more stringent than advance directives. Advocates fear that the barrier to widespread electronic registry use will be that hospitals won’t share their data.
This is sobering: gunshot detection system vendor Shooter Detection Systems gets its first (unnamed) health system customer.
Sponsor Updates
Agfa Healthcare, GE Healthcare, and Lexmark Healthcare complete the RSNA Image Share Validation program.
Xerox develops a printer for ambulatory providers capable of sharing patient information via the cloud.
EClinicalWorks will exhibit at the Orthopaedic Summit December 7-10 in Las Vegas.
Deloitte includes Evariant in its list of fastest growing technology companies in North America.
Iatric Systems will exhibit at the Privacy & Security Forum 2016 December 5-7 in Boston.
Imprivata will exhibit at IHI’s National Forum on Quality Improvement in Healthcare December 4-7 in Orlando.
Deloitte includes Ingenious Med on its list of fastest growing technology companies.
InterSystems will exhibit at the NYeC Digital Health Conference December 6-7 in New York City.
CompuGroup Medical adds a rehab module to its WebEHR.
EHR integrations drive nationwide adoption of CareSelect Imaging.
Navicure will exhibit at the HIMSS Revenue Cycle Solutions Summit December 6-7 in Boston.
December 1, 2016Dr. JayneComments Off on EPtalk by Dr. Jayne 12/1/16
Breaking Up is Hard to Do, or Caveat Emptor
I’ve been doing change management work for longer than I care to admit, so I’ve seen firsthand that change is never easy. It’s human nature to be risk-averse to some degree, and many people have deep-seated feelings that change is risky. I’ve enjoyed my work helping physicians and their staff members through the challenges of implementing EHRs and expanding their use of technology, moving them from the “no way” group to the “I can’t manage without it.”
I’ve watched some physician friends move through that transition and it’s been gratifying even though I haven’t been involved in their projects. As an EHR proponent, I’ve been on the receiving end of a lot of complaints about technology, and seeing people reach the point where it enables their work instead of causing heartburn keeps me going. Relying on EHRs has its own challenges, though, particularly when a practice breaks up.
One of my closest friends has spent the better part of the last three years going through such a breakup. Her group of three surgical subspecialists had been stable and productive for years when one of the partners became disabled and could no longer perform surgeries. They held it together while they recruited a replacement physician, taking on extra work to cover the portion of the overhead no longer funded by the departing partner. Unfortunately, the new physician didn’t work out and debts mounted. The remaining partner simply decided to stop working, forcing my friend to terminate the partnership rather than take on debt trying to keep the doors open.
The stress has been significant, but she was starting to see light at the end of the tunnel as she agreed to join another group in town. Since they were on the same EHR vendor, her hosting team promised her an easy conversion. She ran the pricing past me and I thought it looked low. Digging into the agreement, I noticed that it was only a demographic conversion and no clinical data was to be converted. Instead, the clinical data was going to be converted to PDF and added to the imaging portion of her new practice’s EHR. We talked through the ramifications of that, and whether she would rather have the data converted or abstracted. Due to the episodic nature of most of her patient relationships, she was willing to risk it.
I expected her to call after a week or two in the new practice, asking for an abstraction vendor. It wasn’t two hours into her new practice before she was inundating me with text messages and emails. The conversion wasn’t the problem – the EHR was the problem, along with the practice staff.
In a small practice, there may be only one or two super users. In this case, both of them had quit since the last time a new physician joined the practice. No one in the office knew how to add her to the provider master file, so they simply added her as a user since that’s all they knew how to do. As a physician, she didn’t know that was an issue until she started trying to issue prescriptions and apply her electronic signature to office notes. No one in the office knew how to contact the help desk, so she called me, knowing that I’ve worked with her vendor before.
I gave her the help desk number and some pointers on what to ask for and hoped for the best. I felt so bad for her. The average physician looking for a new practice situation is more focused on questions about the call schedule and how expenses are shared than he or she might be on asking about the number and availability of super users or system admins. Especially if we’ve come from a highly functional EHR support framework, it might never cross our minds. We take it for granted that things just work, not remembering all the hard work and setup that it took to get the system to the place where we could see patients.
We may also take it for granted that every installation of a given vendor’s system is the same. Although there may be core modules that are the same, practices and hospitals often customize and configure many portions of their system, unknown to the average end user. Additionally, not every installation is on the same version of a given piece of software. In my friend’s situation, her new practice was on an older version of the system. The visit documentation templates were nearly unrecognizable to her, as they pre-dated her previous system by several major releases. I’m sure asking for their release version and the number of their most recent content patch wasn’t part of her interview questions, either.
Fortunately, I was able to call in a couple of favors and get her some immediate help, although we haven’t been able to get her set up with electronic prescribing or updated letterhead for her patient plan documents. She’s not yet present in the patient portal and can’t order labs, but at least she can print prescriptions, document her visits, and bill out her charges.
Although the old adage about “buyer beware” certainly applies, these are uncharted waters for most physicians. Most physicians that are making moves are consolidating into larger groups or are being acquired by hospitals and health systems. It’s not as common for them to move from one small practice to another, but even in that situation, groups may be on a hospital’s community EHR offering or on a fully hosted solution. It’s rare to see a small practice trying to maintain their own client-server system and I think many physicians would fail to deduce that arrangement if they were in her shoes.
Back in the day when EHRs were just coming on the scene, I started my “on the side” consulting business by helping small practices with system selection and implementation. I’m thinking I may need to consider a new business line helping physicians on the move who need help teasing out potential EHR pitfalls during the practice selection process. It would definitely be a niche offering given the number of new grads joining hospital-owned practices, but for those physicians faced with a situation like hers, it would be worth it. Once the match was made, it would lend itself nicely to conversion and/or abstraction services.
My friend has given me permission to use her experiences to create checklists and questionnaires to help prevent other physicians from going through similar circumstances. I’m sorry she had to go through it, but I’m going to be ready for the next physician who needs help evaluating a practice opportunity.
The 21st Century Cures Act passed a House vote and will now move to the Senate for consideration. The bill includes provisions calling for the reduction of documentation requirements associated with EHRs, a change that would allow scribes to document in lieu of providers, and a simplification of meaningful use requirements.
The Senate unanimously passes a bill requiring HHS and GAO to analyze the University of New Mexico’s Project ECHO pilot program and report on opportunities to expand the program nationally. Project ECHO uses telehealth to expand access to specialists to patients in rural areas.
CVS Pharmacy partners with OptumRx, a free-standing UnitedHealth Group pharmacy care services business. The partnership will bring OptumRx’s patient engagement solutions to CVS patients and will create a single platform where the two businesses will co-develop new solutions.
Fred Powers is president, CEO, and co-founder of Dimensional Insight of Burlington, MA.
Tell me about yourself and the company.
The company was founded back in 1989. There are two founders. We have built the company organically. We have no outside investors.
We tend to focus in industries which have complex data. Our very first customer, in fact, was a dental implants company. Back in 1990, we showed them where their product was being bought and where a competitor was taking away market share.
From that very beginning, we have expanded. About 15 years ago, we entered healthcare, which is now a major focus for us. We are focused on rules and measurements so that we can bring integrity to measures so that they are accurately displayed so that decisions can be made.
What is healthcare’s maturity in using data to make decisions as compared to other industries?
In any industry, you have some that are the leaders and you have some that are bringing up the rear. The sense is that healthcare lags behind industries as a whole. I don’t think that that’s really true.
I think that the difference here is that the data itself is more complex. If you go into a distribution company, you’re basically looking at all of finance and then you’re looking at product going into the warehouse and product leaving the warehouse.That’s one data domain, and in a typical manufacturing or distribution operation, it’s a finite number of domains.
When you move over into the area of healthcare, it becomes much more complex. Each domain by itself is relatively easy to understand, but when all of a sudden you have 50 of them, you have different stakeholders, and the data crosses these domains — that’s where the complexity comes in.
Healthcare is complex. People have been looking at this problem for a number of years. It’s just taking healthcare a little bit longer to solve some of these complexity issues that don’t exist in other industries. Certainly electronic health records have helped because we’re gathering this data. That would be a change. But if you look even at the electronic records, there are hospitals that have had that for 15 years and some that came on board only a couple of years ago.
Healthcare is getting a bad rap when people are saying that they’re way behind times. It’s just that their data is complex, in terms of all of these different domains and all of the different stakeholders that they have that they have to satisfy. If you’re going into a distribution center or manufacturing, you might only have one or two plants. If you take a look at healthcare, you might have 20 different facilities, maybe more, and all that has to be consolidated, and yet it has to be broken apart as well. There’s a challenge.
What lessons were learned from early healthcare data warehouse projects?
The short answer is that they don’t work, but that’s because you’re attempting to solve a complex problem. Quite often, you’re better off if you chip away at the problem with a collection of data marts. The concept of bringing all of this data together has been around for well over 40 years and it’s always been a problem when you attempt to bring it all together into one place.
I do believe that what’s happening with the data warehouse is it’s going to move more towards a columnar database over a relational database. The reason for that is that you have more flexibility with the columnar database than the relational. It also handles higher volumes of data. Right now, as this data is collected, you have to ensure that you have integrity throughout the process, and the more data that you bring together and attempt to digest, the harder it is for that integrity to take place. You really need to decompose the problem.
Here at Dimensional Insight, we’re using a columnar database for our storage vehicle. If you do research between a relational and a columnar, most of your research is going to come back and say that for a data warehouse-type approach, this is actually a better approach. There is a tremendous amount of momentum in terms of what was done in the past and then bringing that forward.
Just having proper data is really not the issue. You can ensure that you have integrity of data. Your bigger question is, do you have integrity in terms of your rule management? If you’re looking at, let’s say, an admission or a readmit, what are the rules for that? Are they consistent across the hospital? How do the underlying rules relate to the measures that ultimately you’re scoring yourself on? Because something like an admit is used across a whole collection of additional measures. Does your measure equal what CMS says or is your measure slightly different, your rules slightly different?
This is now an area that the hospitals are going to be looking at, where before, they were just saying, “I just have to get some data into my data warehouse.” Then what do you do with that data? How do you measure? That’s where your measures come to bear. We use the term “measures.” Some might use “KPIs.”
The underlying rules are very complex. We could probably spend another half hour just talking about rules management. I can honestly say that these rules are more complex than what we see in industry as a whole. This is going to be the big issue in the future.
It kind of fits under “data governance,” but the word here is “data.” I think it’s probably better if you were to call it “measure governance.” I’s more focused, because if you don’t have these proper measures, how can you manage? This is going to be a real issue as we move forward.
Then they have to be centralized. Hospitals today are buying a lot of what I call point solutions. Each one of these point solutions has some BI in it, some dashboards, and of course this is based on a collection of rules and measures. What happens if those rules and measures in Point Solution A don’t agree with Point Solution B? Which one is right? Do you have a central location for controlling these rules and measures? How does that affect the point solutions?
Over the next two or three years, we’re going to start to see the industry look at this and say, “I’ve really got a management issue here that I didn’t realize I had, because I was pulling the data out of my data warehouse.” Let’s assume they have a data warehouse. The rules were not in there, or if they were in there, it was just piece parts, and now all of a sudden, I don’t have integrity when it comes to those rules. This is going to be some interesting times for these hospitals. In my opinion, they really haven’t given enough thought to that.
How much help do hospitals need in understanding their available data elements and then finding low-hanging fruit to give them a faster payback?
Each hospital is in a different position. Larger systems will no doubt have some form of a data warehouse. They’re wondering how they can maintain it and how they know it has integrity. You move into a smaller hospital, they might have no data warehouse. They have no governance. Depending upon the environment you’re in, it’s going to have a difference in terms of how you approach the problem.
We have some customers that are small hospitals and they’re trying to see their data for the very first time. They’re really not interesting in doing anything that’s fancy. You know, “Just give the numbers. I’ve been blind. Show me the numbers over time so that I can at least see trends.” Then you move into a large entity and they’re interested in doing more because they’ve already crossed that threshold.
That’s another challenge that we have from healthcare. When you go over to industry as a whole, they’re all pretty much kind of at the same level, where when you move into healthcare, that’s just not the case.
Obviously, whether it’s a large entity or a small entity, the goal is to pick some problem that they have and then solve that problem. Then solve the next problem and the next problem. It’s kind of like eating one grape at a time. If you attempt to eat too many grapes at once, if you’ve got a young child, you know that that’s not a good thing. We try to avoid that.
Let’s focus on something that’s important, something that you need today, and then what data sources you need for that. Let’s ensure those data sources have integrity. What rules are required? What measures are required to support that need? Let’s make sure that’s in place.
Let’s ensure that you have the necessary support staff, which I might add, is not necessarily IT. A lot of it will be a nurse practitioner, as an example, or a doctor who has left the fold and now they’re into the analytics and they understand what’s necessary. They understand the data. Quite often an IT professional might not understand that. They’re more a technologist. You need that business manager. This is a real issue because a lot of hospitals don’t have those people.
Is the key to analytics adoption providing pre-built applications or perhaps finding a data-curious department expert or that rare technologist who wants to work with users to answer their questions?
It gets down to where are they on the adoption curve. Let’s assume that this hospital is just starting out. You want to give them a package containing a collection of measures, predominantly CMS, so that they can track where they are. Now, if it turns out that they have history — which they should have, depending upon when they converted, because quite often when you convert, you leave your history behind with the older system — they can go back and look at how those metrics have performed over the last two or three years and which way are the curves going.
Executives obviously like this a lot because they can see the trends. You’ve got to get something in front of the executive quickly, because he or she has to buy into it. They have to see value in it. At the executive level, they’re interested in a certain amount of information and they want the ability dive into the underlying detail. Then your detailed analyst obviously might want even more information, and they become what we call a diver. In other words, they can just go in and they can swim in this data however they choose to understand what they have. But without question, you need the executive.
The other thing that’s happening is herd mentality. We’ve been doing this since 1989 in a multitude of industries. Let’s say that you’ve got an early adopter and they’re doing their thing. Then you’ve got another early adopter and then you’ve got three and four and five. Pretty soon, you start to get this herd mentality, like everybody’s got to do this. That’s what’s happening in healthcare. If you went back 10 years, you still had the problem. People just didn’t recognize that they had to solve the problem.
Now you have a certain amount of herd mentality. “Oh, they’re doing this at this hospital. That’s pretty cool. I think I have to go do that.” You can’t leave the emotion of the decision-maker out of the equation. There’s a lot of emotions in these decisions. Hospitals tend to be very political.
November 30, 2016NewsComments Off on Value-based Care Prompts Glass to Grow Up
HIStalk looks at the ways in which smart glasses – once thought to be an over-hyped novelty – are turning into a not-to-be ignored market force aimed at helping healthcare transition to value-based care. By @JennHIStalk
The name “Google Glass” once evoked guffaws aimed at the early consumer adopters (Glass Explorers) who were seen sporting them in everyday settings. “OK Glass” – the command used to jumpstart the wearable’s software – was not, contrary to initial manufacturer expectations, uttered at a rate that demanded further mass consumerization.
Healthcare, however, did express interest, and at least a few headset-wearing folks walked the halls of the HIMSS conference in 2013 and 2014 The Glass hype in healthcare was understandably strong, given the industry’s propensity to create high-tech cures for low-tech problems.
Though privacy and security concerns caused Google to take a step back from the consumer market for Glass, its prospects in the world of business quietly flourished (despite the fact that HIStalk readers voted Glass “the most overrated technology” in the 2014 and 2015 HISsies). Even Apple has taken notice, with rumors resurfacing of its intent to develop an iPhone-compatible pair of smart glasses. Healthcare providers and vendors have also shown increasing interest in the devices, which in turn has helped a number of startups flourish in the face of almost gleeful naysaying.
From Pipe Dream to Readmissions Reducer
San Francisco-based Augmedix has made a name for itself in the smart glasses space, becoming one of the first companies in healthcare to recognize the value this type of technology can bring to physician workflows. Founded in late 2012 by Ian Shakil and Pelu Tran, the company — which offers remote scribing capabilities via smart glasses — has grown from two to over 700 employees.
“In the beginning, people viewed us as a novel hype play,” Shakil admits. “Now that the hype has bled away, people are starting to view us a real, substantive, hard-nosed solver of big problems in healthcare. The problem we’re going after is the sad fact that doctors spend two to three hours a day charting, typing, and clicking. They hate it and the patients hate it. We’ve thrived in the world of volume and paper; doctors are busy and burdened, and so saving them a third of their day with our remote scribing capabilities is very valuable. Those same factors are still true in the emerging world of value-based care. Doctors are scarce, they’re expensive, and their overhead is expensive. Reclaiming those lost hours enables them to focus their energies on spending more time with patients or population health endeavors. Either way, the value translates in both worlds and it’s really starting to be tallied and received by the market, which is feeling a lot of growth.”
Augmedix’s J-shaped growth curve over the last four years is indeed indicative of healthcare market interest, which has helped spawn a number of other competitors. Mountain View, CA-based Drchrono jumped onto the Glass bandwagon in 2014, developing the first EHR-compatible “wearable health record” in partnership with Google and Box.
Founded in 2004, Advanced Medical Applications got into the smart glasses game in 2014 with the first live broadcast of a surgery using Google Glass between two continents. The company, which specializes in mobile technology development for a number of verticals, has managed to find its niche in smart glasses-enabled telemedicine and emergency services.
Austin-based Pristine plays in a similar space. The three year-old startup has focused on creating a telemedicine solution that enables doctors to provide their expertise visually from anywhere at any time.
“The ‘See What I See, Hear What I Hear’ collaboration solution was initially adopted by teaching hospitals, ambulance organizations, healthcare systems that provide care for remote patients, assisted living facilities, and anywhere access to expertise was limited,” explains Pristine CEO Peter Evans. “In the past year, we’ve seen two changes that are accelerating that adoption. First, there has been a shift in approach from Explorers and those kicking the tires on the concept, often funded by grant money, to organizations that have specific pain points and realize that the traditional approaches to providing care are not scalable.”
“Second, we are seeing a rise in adoption by manufacturers of healthcare products,” Evans adds. “Companies that make complex healthcare technologies, produce pharmaceuticals, and provide other third-party solutions are enhancing their support models to healthcare providers through adoption of augmented reality and smart glass solutions. As an example, we are seeing the implementation of the rep-less model, where sales reps who normally provide in-person, in-theater support for a surgeon or doctor can now provide the same or significantly better support and expertise without having to physically be there. This improves efficiencies and reduces operational costs for both the hospital and vendor, while enabling reps to scale and support multiple clients.”
That accelerated adoption has helped Pristine’s provider customers begin to realize significant operational efficiencies. “Studies by our customers are showing that the ability to get the right skilled knowledge in the right place at the right time in an efficient manner is improving patient care and outcomes. Some of our customers using our solution for telemedicine applications have reduced readmissions by over 17 percent and reduced recovery time by almost 30 percent. We believe that we can be one piece of a complex puzzle that enables providers to be rewarded based on quality on value, not just quantity.”
Following in the Smartphone’s Footsteps
Evans believes that the maturity of the market for smart glasses will grow in lockstep with related hardware. “The hardware is trying to catch up to the applications that users envision,” he says. “While many may be familiar with Google Glass, there is very good technology that has been introduced by companies like ODG, Vuzix, Epson, and Intel with its acquisition of the Recon Jet product.
“The state of smart glass hardware reminds me of the evolution of the smartphone,” Evans continues. “Early versions of the iPhone 2, for example, had hardware shortcomings. It didn’t have a camera, long battery life, GPS, or 3G. However, it had value with initial applications – sending texts, surfing the Web, and core apps that had immediate value. Over time, the hardware became more robust. Richer applications were developed and the incremental value grew. We are witnessing the same maturity of smart glasses and augmented reality solutions for business. The hardware has some limitations, but they are being addressed rapidly.”
Shakil also believes there are lessons to be learned from the world of smartphones. “It’s a vibrant space out there, with more smart glass offerings coming by the day,” he says. “Think back to when the first PalmPilots came out, and then compare that with the iPhone 7 – it’s like night and day. I think we’re going to see a similar progression in smart glass technology. They’re going to become more like normal-looking glasses – lighter, with a better battery life, more comfortable, and more resilient.”
Opening Up Use Cases
Today’s hardware limitations don’t seem to be holding providers back when it comes to reaping the benefits of smart glass technology. Shakil says that Augmedix customers anecdotally report more satisfied and engaged patients. “We’re beginning to see that showing up in the data,” he adds, “but it’s still early days. With our solution, the doctor feels more enabled to go deeper and get more investigative. The whole process becomes more hands-on for provider and patient.”
Customers participating in the OpenNotes initiative are also realizing new use cases for smart glass capabilities. “Sutter is one of our most progressive health system partners,” Shakil explains, “and while they’re very engaged with OpenNotes, they’ve struggled to deploy it operationally because it takes a lot of time and effort to write a beautiful note in rich, comprehensible English, get it into Epic, and then make it available to the patient by the time they get home. The Sutter team has found that, by using Augmedix, the note is almost always done in plain English by the time the visit is over, and is immediately available to the patient. They love being able to offer that. It engages the patient in their own care, helps them identify things they may have initially missed, and improves compliance in all the usual things. We’re really excited about the ways in which we can enable OpenNotes and all the downstream benefits that entails.”
Shakil is quick to add that some of the company’s more progressive end users – particularly those on the forefront of technology-enabled patient engagement efforts – have already expressed interest in taking smart glass capabilities even further. “Some of our health systems have an interest in going one step beyond OpenNotes to open up the visit from Glass itself for later retrieval on the patient portal,” he says. “We’re not doing that anywhere yet. We want to make sure that we have all the secure storage capabilities, opt-ins, and opt-outs from the patient side. Personally, as a patient, I think it would be amazing to go home and relive the appointment with my family – how to use the asthma inhaler, when to come in for refills, instructions on follow-up care. I think it will improve care and engagement in a big way.”
With Scale Comes Management Concerns
The need for complementary solutions is also a strong indicator that smart glass technology is here to stay. VMware AirWatch has added smart glasses management to its line of enterprise mobility management technologies and services, a move the company attributes to increasingly larger pilot programs and the resultant need for assistance with device management.
“We are seeing research being carried out in healthcare to identify use cases from training to documentation to data visualization during surgery,” says VMware Vice-President of Product Marketing Blake Brannon. “Pioneering customers are starting to pilot smart glasses and report gains in productivity and reduction in costs. We have started to see pilots move from less than five devices to a few hundred, or in some cases, a few thousand. When the scope of pilots increases to that extent, that’s typically when IT gets involved and needs a game plan to secure, configure, and deploy them at scale.”
The Cybersecurity Question
Though patients seem to have become more comfortable with smart glasses from a privacy point of view, enterprise adoption comes with its own set of adoption challenges. “Privacy and data protection will definitely come up as potential issues,” says Brannon, “resulting from any local storage of information and transmission of data. I’m not sure cybersecurity concerns will be addressed. They’re more likely to be amplified. We saw issues with Google Glass – not knowing if you were being filmed or having pictures taken of you. There will also be the same concerns as with other mobile devices. What if it gets stolen? Does it have patient information on it? Images? Can they be remotely wiped? Is the software or firmware up to date? Questions like these from our customers prompted us to develop an answer.”
The Future
Though smart glasses seem here to stay, albeit in a very niche capacity, Brannon believes the market still has to do its fair share of growing up. “The market is fragmented right now,” he notes. “There are many manufacturers with different devices that run different versions of Android. Some devices are also running proprietary operating systems. In the short term, we could see certain manufacturers create specific enterprise policies to differentiate their hardware, but, long term, we expect to see more consistency as the core hardware vendors emerge and build to a specific standard.”
Evans takes a more long-term view with the expectation that smart glass technology will become part of a person’s daily routine for work and play. “Some pundits are predicting that in 10 years we will see the demise of the smartphone, as it will be replaced by smart glasses. Anything that can be done on a smartphone or tablet can be done on the same Android operating system on smart glass.”
“Once the hardware becomes lighter,” he emphasizes, “then people will engage others by looking up rather than down at a small screen. Voice-recognition technology, which we’re already seeing with Siri and Alexa, will become a key enabler. We can all speak commands faster than we can type them, after all. Individuals will prompt their smart glasses with voice commands and other external beacons like barcodes and object recognition and will be immediately able to call up any information needed, to be displayed while we continue to interact with the world around us. The days of smartphone-induced disengagement will become a thing of the past.”
Comments Off on Value-based Care Prompts Glass to Grow Up
Seema Verma, a health policy consulting firm CEO with ties to VP-elect Mike Pence, has been chosen to replace Andy Slavitt as the next CMS administrator.
The VA will work with artificial intelligence software vendor Flow Health to comb through the medical records of 22 million veterans and use the clinical data to help create software capable of offering meaningful clinical decision support and generating personalized care plans.
Rupert Murdock will likely lose $200 million in Theranos investments after his own newspaper, the Wall Street Journal, exposed the company for misleading investors.
President-elect Trump nominates former orthopedic surgeon and Affordable Care Act critic Rep. Tom Price (R-GA) as secretary of the 78,000-employee HHS. He would replace Sylvia Burwell.
Price’s Empowering Patients First Act calls for age-adjusted tax credits for those buying health coverage on their own; a one-time credit for starting a health savings account; state-administered high-risk pools for people with pre-existing conditions; tort reform; and allowing insurers to sell policies across state lines. It would also allow individuals to opt out of government plans such as Medicare, Medicaid, and the VA programs and take the tax credit instead to buy their own insurance and would allow small businesses to create their own national insurance buying groups. It would also prohibit HHS from using comparative effectiveness or patient-centered outcomes research to deny federal insurance coverage of specific treatments. However, Price says he’s open to compromise and the only line he draws in the sand is the one opposing the ACA.
Here’s what I quoted Price as saying about the HITECH act back in 2011:
Instead, what does the federal government do and think it’s getting high tech? It is defining every little thing, every box that the physician or nurse has to check every time you see a patient, in order to get an extra 1.5 percent of reimbursement from the government. Or, not getting dinged for an extra 1.5 or 2 percent. These are the Meaningful Use things. Washington always has these great lines, right, these wonderful Meaningful Use standards. They’re neither meaningful nor useful and they’re so ridiculous that they actually incentivize pathologists to have to ask on every single patient that they care for how old they are, how many allergies they have, what medications they’re on, when was the last time they saw their primary care physician, on and on and on, including of a slide of a patient … the pathologist never actually sees that patient … or a corpse for an autopsy. This is no lie. The federal government wants the pathologist to determine whether or not a corpse has any allergies. How you feeling today, right? This is nonsense.
So what do you do with technology to make it so it actually works for healthcare? I think the proper role of government in the area of technology in healthcare is to say, OK, this is the platform we will use. This is the highway upon which we will ride. Everybody needs to have a system that allows it to speak to another system within these parameters. And not dictate what the docs are doing on a day-to-day basis for a given patient, because it doesn’t make any sense. It’s a waste of time. They can never, ever put in place the right standards for a bureaucrat to determine whether or not the doctor’s doing the right thing.
President-elect Trump also nominates Seema Verma, MPH to serve as CMS administrator, replacing Andy Slavitt. The health policy consulting firm owner is mostly known for her work on Medicaid expansion and her Indiana ties to VP-elect Mike Pence.
Reader Comments
From Dillon Darkbird: “Re: Epic. NYCHHC does business with Epic, which doesn’t even pay its own state taxes.” DD provided a screen shot of New York’s tax warrant system showing that Epic owes the state $626,000, but I repeated the search and turned up nothing, which I assume means that Epic has since paid its tab.
From EHR Nomad: “Re: EHR migration. I’m looking for information moving from one system to another. Conversion is probably not a good option, as indicated by a number of sources that led me to that thought. What other options are there?” This is a hospital-based reader, so I’m thinking this refers to inpatient systems. You’ll probably want at minimum an application retirement system that will allow you to look up previously generated information as needed. It’s probably also both unnecessary and unwise to start with a blank EHR slate, converting at least the basic patient, provider, and clinical information to avoid frustrating users of the new system. However, it’s a good time to start over (at least technically) on order sets and system defaults. Readers with expertise in this area are welcome to respond. EHR Nomad didn’t specify the EHRs involved, but let’s assume they’re moving to Meditech 6.1. UPDATE: EHR Nomad clarifies that the conversion involves a practice the hospital is buying that runs MEDENT and they want to convert them to Allscripts. He’s wondering whether to just take possession of the practice’s server and keep it running or whether there’s a way to extract the information and store it in a logical way in case it’s needed. I think he’s given up on the idea of importing the information into Allscripts.
HIStalk Announcements and Requests
Nordic donated $500 to my DonorsChoose fund, which with the addition of matching money fully funded these teacher grant requests:
Three sets of non-fiction books for the first grade classroom of Mrs. G in Saint Paul, MN.
Makerspace supplies for the school library of Mrs. G in Middleton, WI.
Three Chromebooks for Mrs. J’s first grade class in Lugoff, SC.
STEM modeling materials for Mrs. M’s elementary school class in De Soto, KS.
Headphones for students with profound disabilities in Mr. P’s middle school class in Oklahoma City, OK.
STEM materials for Mrs. W’s first grade class in Easley, SC.
Mrs. J was quick to respond, referring to her class — as teachers often do — as “us,” which gets me every time:
I am absolutely blown away by the generosity of others at this time of year and all year round with DonorsChoose. My students are going to be so surprised when these Chromebooks arrive! My students love technology and your donations and kindness will really make a difference in their learning. Thank you so much for your gift. Words can’t begin to tell you how much your gift means to us.
I don’t intentionally solicit funds for DonorsChoose because I don’t like being strong-armed for donations myself, but readers often send money voluntarily and I’ll always put it to good classroom use. I’ll have another round of funded projects to describe next time thanks to some new donations that came in on Giving Tuesday.
Webinars
December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.
December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.
Acquisitions, Funding, Business, and Stock
Canada-based Constellation Software’s subsidiary Harris continues its acquisition spree by buying iMDsoft. Its previous acquisitions include Picis, QuadraMed, MediSolution, DigiChart, and NextGen’s hospital systems business.
In Australia, the builder of the unfinished Royal Adelaide Hospital is preparing to sue the state government, claiming it has delayed the hospital’s scheduled April 2016 opening to cover up problems with its overdue and over-budget Allscripts-powered EPAS system. The health minister says an independent auditor previously dismissed those same claims.
Austin, TX-based doctor-patient texting app vendor Medici raises $24 million. It pitches itself to doctors with, “Get paid to text with your patients on your schedule.” The 13-employee company tries to create buzz by calling itself the “Uber of healthcare” and “WhatsApp with your doctor.” Hopefully the example screenshot above isn’t representative of the degree of clinical thoroughness involved with those convenient, billable text exchanges.
Orion Health announces first-half 2017 interim results: revenue up 9 percent, operating loss $12 million vs. $19 million in the first half of 2016. Shares dropped 18 percent to a record low on the news and are down 64 percent since the company’s 2014 IPO. While revenue is up, losses are down, and the company projects profitability in 2018, Orion’s cash position has dropped to $17 million after a net cash outflow of $23 million in the first six months of the fiscal year. The company has also expressed some concern that its predominantly US customer base might defer decisions following the presidential election, but it believes healthcare IT initiatives have bipartisan support.
Wall Street Journal owner Rupert Murdoch is likely to lose most of his $200 million investment in Theranos, whose downfall was ironically triggered by investigative articles published by his own paper. Many big, later-stage Theranos investors were individuals and families with little connection to the usual VC vetting process who watched the company’s $9 billion valuation drop to nearly zero. Meanwhile, two more investors file lawsuits against the company claiming they were misled, one of them seeking class action status.
Sales
NorthShore University Health System (IL) and Valley Children’s Healthcare (CA) choose Phynd’s provider management system.
New York-Presbyterian Hospital (NY) chooses Mobile Heartbeat’s clinical communications system.
People
Teleradiology services vendor Virtual Radiologic promotes Shannon Werb to president/COO, replacing departing CEO Jim Burke.
Announcements and Implementations
Community Health Network (IN) expands its use of Kyruus ProviderMatch to its new consumer website.
Boston Children’s Hospital (MA) and GE Healthcare will work together to develop brain scan interpretation software that will be available via GE’s Health Cloud.
Phynd releases version 2.0 of its Unified Provider Management system.
Philips, following GE Healthcare’s lead, will develop medical software for its imaging systems, with its CEO telling investors, “The world does not need much more capacity in scanners, but is especially in need of better interpretation of data” for improving diagnosis.
The VA will partner with artificial intelligence vendor Flow Health to analyze the VA’s 20-year database to identify disease markers, suggest treatments, and discover the influence of genetics on risk, diagnosis, and treatment.
Nationwide Children’s Hospital (OH) and SeizureTracker.com release a seizure diary app for the Apple Watch that allows people to record their seizure data and video, share it with their doctors, and contribute it to a research database.
Marketing and customer service software vendor Pegasystems offers FHIR-powered APIs to connect with its healthcare applications.
Clinical Architecture adds Advanced Clinical Awareness Suite to its new Symedical terminology management platform release, which normalizes patient data from multiple EHRs or virtual medical record formats and applies inference rules to suggest diagnoses, recommend orders, or provide advice or alerts.
Government and Politics
A pending Medicare rule change would require hospitals to discuss nursing home quality data with inpatients who are about to be discharged to one of those facilities. Current Medicare patient choice requirements prohibit hospitals from doing anything more than just handing over a list of nearby facilities that have space available. Hospitals like the idea because they can be penalized for readmissions caused by poor nursing home care.
Kaiser Health News reports that a record 1,455 lobbyists representing 400 companies are trying to convince members of Congress to either pass or reject the 21st Century Cures Act in voting this week, which would increase NIH funding, devote funds to address the opioid crisis, and change the FDA’s drug and device approval standards. Even the US Oil and Gas Association is involved since the Cures Act would be paid for by selling oil from the government’s Strategic Petroleum Reserve. The drug company trade association PhRMA has spent $25 million to support the bill, which would get their expensive drugs to market faster and would also reduce their requirement to publicly report payments made to doctors via the OpenPayments database. The Cures Act still falls far short of the ACA’s record-setting lobbyist activity, when 1,200 companies mobilized their ear-whispering firepower seeking favorable treatment .
Privacy and Security
HHS OCR warns providers that phishing emails are being sent to HIPAA covered entities that include the HHS letterhead and the signature of OCR Director Jocelyn Samuels. The email includes a link that appears to direct readers to a document involving their inclusion in HIPAA audit, but it actually sends them to a cybersecurity firm’s website. HHS OCR says it takes “unauthorized use of this material by this firm very seriously.” I’m not sure in the absence of details whether HHS’s use of the term “phishing” in describing a disguised link is correct since it’s not clear whether the user is asked for confidential information, but obviously they aren’t happy about it.
Trend Micro reports that 35 healthcare organizations, 17 of them in the US, have been scammed in the past two weeks by cybercriminals who spoofed the CEO’s email account and ordered employees who manage wire transfers to send money to their bank accounts.
Innovation and Research
In Australia, Metro North Hospital and Health Service and Queensland University of Technology are building a dedicated 3D tissue-printing facility for the hospital’s OR, predicting that biofabrication can create personalized implants, help with robotic-assisted surgery, and improve surgical training.
Technology
The Gates Foundation funds the work of low-cost, rapid-result portable molecular diagnostics vendor QuantuMDx, which is fine-tuning its field tuberculosis testing system.
Other
NPR’s “All Things Considered” finds that biomedical research information is proliferating due to EHR rollouts and well-funded projects like the Cancer Moonshot, but nobody’s actually looking at all that big data. Reasons: the information is not all that robust and reliable due to variations in EHR database usage and much of the good stuff is recorded as free text. FDA Commissioner Rob Califf says the only way to validate the datasets is to get people to participate in studies that try them out, with increased study participation being the #1 FDA big data issue.
Stat profiles Myriad Genetics, which made $2 billion in the 17 years of patent exclusivity it enjoyed for its BRCA breast cancer genetic testing. With competitors offering similar tests for a few hundred dollars instead of the $4,000 that Myriad charges following their successful patent litigation, Myriad has instructed its salespeople to disparage those competitors that it labels as a “public health crisis.” An interesting review by members of the Free the Data consortium compared the results with those of its competitors and found little difference, although patient recommendations from all of them change over time as they gain more real-world data. The group was formed because Myriad refused to share its database with physicians and researchers, so Free the Data gathers the reports downstream directly from participating providers.
Patients at C.S. Mott Children’s Hospital (MI) will receive a custom cardboard virtual reality viewer that can run apps from their own smartphones, including a University of Michigan game day app, courtesy of a $50,000 grant from the Jim Harbaugh Foundation.
A radiologist’s JAMA opinion piece written with Eric Topol, MD suggests that radiologists should emulate pathologists in embracing technologies that can replace much of their work, often more accurately and always more efficiently, and retool their practices as “information specialists” whose job would change from extracting information to managing the information created by those technologies. The authors even suggests that perhaps the pathology and radiology specialties should be merged.
Sponsor Updates
Catalyze releases a new podcast, “Why Healthcare Should Expand its View of FHIR.”
Black Book announces the top ranked, end-to-end crisis management PR agencies.
Forward Health Group is sponsoring the December 7-9 annual conference of the California Association of Public Hospitals and Health Systems in Pasadena.
Besler Consulting releases a new podcast, “What healthcare policy might look like under the Trump administration.”
Black Book lists the top 20 issues faced by healthcare PR and crisis management firms.
CapsuleTech will exhibit at the National Forum on Quality Improvement in Healthcare December 4-7 in Orlando.
CoverMyMeds sponsors the Healthcare Association of New York State’s Back to Basics Bootcamp November 29-30 in Tarrytown, NY.
Cumberland Consulting Group will sponsor the Health Plan Alliance’s Informatics and Analytics Value Visit December 6-8 in San Antonio.
The House will vote Wednesday on a final version of the 21st Century Cures Act, a $6.3 billion piece of legislation that will target opioid addiction, fund Obama administration research programs for the next 10 years, and speed federal approval of new drugs and devices.
A new JAMA study finds that a hospital’s CMS star rating is “heavily influenced by its location’s socio-economic conditions,” reinforcing longstanding concerns voiced by industry stakeholders.
Lawsuits continue to pile up for Theranos, with investment firm Robertson Stephens & Co founder Robert Colman accusing the company of making false and misleading claims about operations and technology during its investment talks.
Former conman and world renown authority on forgery and fraud, Frank Abagnale, will speak at HIMSS17 at a session called Stealing Your Life that will address data breaches and identify theft within the healthcare industry.
It was a busy holiday weekend for me, with several days of patient care. I saw several extended families with a “stomach bug” that was more likely to be food-borne illness. It’s never fun to suggest that Aunt Tillie’s cooking make everyone sick, but it does happen. At one point, we had so many patients receiving IV fluids that we had to call for more supplies to be sent from another location.
Although I think I won the prize for fluid administration, several other locations broke records for the number of patients seen in a single day. Not every patient was in need of such urgent attention, though. Dozens had conditions that could have waited or didn’t need to be seen at all. I’ll have fun analyzing the statistics once we complete our month-end close, but the potential root causes are interesting.
Over the last several years, we’ve seen greater patient empowerment, which is generally a good thing, especially when you’re talking about shared decision-making and improved health through greater patient involvement. But it’s less of a good thing when patient empowerment loses the “patient” piece and becomes more of an exercise in instant gratification.
To be clear, I’m not talking about patients with urgent medical needs, such as shortness of breath, chest pain, lacerations needing stitches, strep throat, etc. I’m talking about the folks who have had a cough for one day, who haven’t tried any over-the-counter remedies, and who expect the physician to work magic and get mad when we don’t have much to offer.
We had one patient come in as we were closing on Friday who stated that she was “miserable” with her symptoms, yet she came in at closing time because she was too busy with her Black Friday shopping to be seen earlier. Even her $50 co-pay wasn’t a deterrent. She could have called the after-hours line at her primary care office and received the same advice that I gave her, which was to treat the symptoms using over- the-counter remedies since it was most likely a viral infection. She ended up being upset with my treatment plan and demanded an antibiotic, which I refused to give her. I’m sure she’s going to call our administrators and complain.
I used to become more aggravated at situations like that, but they’ve unfortunately become par for the course. When my administrators look at the overtime that was paid out handling her care, I’m sure they’ll be a bit less sympathetic to her complaints.
I also had several patients who were there because they were worried about symptoms they did not yet have. One was a college student planning worried about getting sick before finals, because she had been having a runny nose for a few hours. Her mother was more concerned about “what could possibly be causing those dark circles under her eyes?” than listening to my discussion of needing plenty of rest, plenty of fluids, and some over-the-counter medication from Target. I recommended that she obtain a flu vaccine when she gets back to school on Monday (we have already exhausted our supply) and she stated that she refuses to go to the student health service because they didn’t have “real doctors” there. Her mother heartily agreed. I knew at that point there was no reasoning with them.
Some of these situations are the unforeseen consequences of shifting healthcare policy. My practice is big on price transparency. That’s part of our marketing since we’re significantly more affordable than the local hospital emergency departments. We’re not cheap, though – self-pay physician visits are right around $100 with testing and treatment on top of that.
Patients paying out of pocket tend to have better judgment when deciding to come in, and most of them have conditions that legitimately need a prescription treatment or other intervention. The majority of patients who don’t really need to be there have insurance and are somewhat insulated from the real cost of care. Even those with high-deductible plans tend to come to care a little more frequently than I’d expect, knowing that the charges will be billed through to insurance first so there isn’t a direct correlation between care and payment.
My dad recently found some old physician office fee tickets from the 1970s that made for interesting reading. I remember going to those physician offices. They didn’t have big billing staffs or revenue cycle management agreements or contracts experts or any of that overhead. They had a physician, a nurse or assistant, and a receptionist who also collected the payments at the time of service. Even adjusting for the wages of the day, the charges were reasonable.
I look at my practice (which is right at MGMA benchmarks) and see how many people are supporting me from a revenue cycle standpoint compared to how many are actually helping me deliver patient care and it’s disheartening. We have so many layers between the patient and the payment that are contributing to costs, and yet no one seems intent on reforming the insurance industry or their extreme profits. Back when I ran my own practice, I once calculated that the costs of managing the payer-related workflows in my practice (charge entry, payment posting, working denials, collections, office management functions related to those workflows, etc.) were nearly 30 percent of my overhead.
People are working hard in the realm of healthcare technology to streamline those processes and make them efficient as possible. The practice management system I use now leaves the one I had in 2005 in the dust and it’s significantly easier to use as well. We’re automating ways to get the most out of the healthcare system, but the underlying problems aren’t getting much better. In some ways they’re becoming more complex, as we now have to manage prospective payments, capitated payments, fee-for-service, increased patient-pay amounts, and other arrangements.
I recently watched a practice spend nearly $100,000 in staff and consulting hours on a project to address write-offs and refunds largely related to inefficiencies in payer processes. I guarantee that practice had more patient-centric priorities they could have spent that money on, but they were hemorrhaging money with their previous process and needed to fix things so they could move forward.
Even with our major shifts in healthcare policy, it often doesn’t deal with some areas of urgent need. I saw one patient who was actively delusional, yet had nothing to offer her because she wasn’t a danger to herself or others. Mental health services are so strapped in our community that unless you meet the latter criteria, it may take months to see someone. I spent nearly an hour trying to come up with a plan for her, which ended up being pretty pathetic compared to the care she really needed. But at least I was able to refer her electronically and with an associated C-CDA so when she does finally have an appointment, the receiving care team will have my data.
My next few patient care shifts are in non-holiday, non-weekend time blocks, so maybe I’ll see more typical urgent care cases that will help reset my psychology around the work I do and how it plays into the grand scheme of things from a healthcare reform standpoint. In the mean time, I’ve got some last minute HIPAA-related security risk assessments to work through for consulting clients that like to wait until the last minute to get things done. After that, I’ll start helping clients get ready for end-of-year data gathering and preparing their attestations for various payer programs as 2016 winds to a close. The end of the year used to be a slow time, but no more.
November 28, 2016Readers WriteComments Off on Readers Write: 5 Common Clinical Information Blind Spots
5 Common Clinical Information Blind Spots By Sandra Lillie
The growth rate of data moving into VNAs is exploding – expected to reach 1.4 billion objects by 2017 – and approximately 75 percent of these objects will be non-DICOM assets. To date, many hospitals don’t have a formal strategy addressing how to identify, import, and manage non-DICOM images and video as part of core image management and security efforts. This puts the organization at risk of exposing PHI (protected health information).
Moreover, these assets often aren’t included in or accessible from the EHR (electronic health record). These holes in the health record provide clinicians with an incomplete picture of the patient that can negatively impact diagnoses, treatment plans, and ultimately, outcomes.
With increased scrutiny being placed on the healthcare organizations to tighten up security efforts to protect patient data, and an industry-wide movement toward greater interoperability and patient-centered care, the need to establish centralized insight and control of non-DICOM assets has never been more important. However, this can be a significant challenge because of all the systems, devices, and media throughout an HDO (healthcare delivery organization) on which these images reside.
The departmental nature of care delivery in the past has created a plethora of locked and blocked silos that contain critical clinical images an organization may be unaware even exist. Identifying and consolidating these assets as part of an enterprise imaging strategy allows for the deployment of a more complete EHR while reducing costs locked in departmental system solutions. The key is to identify areas throughout the HDO where the largest numbers of unconnected and potentially valuable non-DICOM images are likely to reside. Bringing these images into the fold first can address some the biggest risk areas while adding the most clinically relevant patient information to the health record.
The following are five of the biggest sources of non-DICOM blind spots in hospitals and health systems.
1. Visible light images and video. This source is fairly convoluted because of all the areas of the hospital where visible light images and video are captured and stored. However, they are all important, whether they’re endoscopy or colonoscopy images from gastroenterology; ureteroscopy or cystoscopy images from urology; or laparoscopy images from OR/surgery. It’s vital to identify all of the producers of visible light images and video throughout the hospital and implement technology solutions that allow those assets to be captured and imported in their native formats from a wide range of video scope systems and processors.
2. Dermatology and plastic surgery. Many dermatology and plastic surgery departments have specialized imaging systems that capture high-definition (and sometimes 3D-rendered images) of everything from routine skin conditions to complex reconstructive surgery. These images are important pieces of the clinical narrative that are often missing from a patient’s electronic health record because of the isolated and proprietary nature of many of these systems.
3. Ophthalmology. Ophthalmology departments also routinely leverage specialty systems that capture images of the retina, cornea, and other features of the eye. A complete picture of a patient’s eye health can only be obtained by including images from these specialty systems in an overall enterprise imaging strategy.
4. Mobile devices. The healthcare industry today is increasingly mobile. Clinicians at the point of care (especially in emergency rooms) routinely capture images of wounds, allergic reactions, skin anomalies, and more in the exam room on their smartphones and tablet devices. Capturing, consolidating, and managing these photos as part of an enterprise imaging strategy can be challenging, particularly in healthcare environments that have adopted a BYOD (bring your own device) mobile policy. A technology that can be installed on mobile devices to encrypt and route medical images from these devices to a central PACS, VNA, or EHR while ensuring no image data is saved to the device camera roll is essential.
5. CD/DVD media. This is another convoluted source of non-DICOM (and potentially even DICOM) images and video. Practically any medical department that leverages imaging in some way, shape, or form has (at one point or another) stored old patient images on CDs or DVDs. These images are likely rarely, if ever, accessed by clinicians and are completely disconnected from the EHR. It is important that the pertinent historical imaging data contained on this media is imported into an enterprise imaging platform and reintroduced to the patient record.
These five sources of medical imaging clinical blind spots are just a sample of the areas to keep in mind in pursuing an end-to-end enterprise imaging strategy. As the industry moves further down the path toward delivering true personalized medicine, other emerging areas – such as pathology and genomics – will be important to consider in an effort to produce and maintain a comprehensive patient record for clinical use.
Furthermore, HDOs also sometimes forget that additional unstructured information (such as documents) exist within other departmental systems and provide another source of important clinical information. A well-articulated and focused enterprise imaging and healthcare content management (HCM) strategy with a reputable partner capable of delivering the necessary interoperability requirements can put an HDO on the path for delivering a truly comprehensive EHR.
Sandra Lillie is industry manager for enterprise imaging for Lexmark Healthcare.
Comments Off on Readers Write: 5 Common Clinical Information Blind Spots
Re: Dr Z. Great story, but whatever happened to professional courtesy???