HIStalk Interviews Mari Poledna, Telehealth ICU Nurse, Banner Health

Mari Poledna, RN is a telehealth ICU nurse with Banner Health of Phoenix, AZ.

Tell me about yourself and what you do.

I’m a telehealth ICU nurse. I work for Banner. I have been in this position for seven years. I have 18 years of ICU experience. I monitor ICU patients throughout the Banner healthcare system, following the model and the protocols that we’ve developed throughout the years for providing bedside monitoring and services for our sickest patient populations.

What’s it like to be working on the tele-ICU side of the house after being a bedside nurse?

In my heart of hearts, I am, I think, a bedside nurse. I still do some bedside nursing to keep my skills as clinically accurate and up to date as I can. I find that the challenges for me are to keep myself focused on how I can best support the bedside nurse and the patients in their hospital stay. I’m always trying to think like the bedside nurse.

Nurses glean a lot from their familiarity with the patient and how they are behaving. Can you do that as a telehealth nurse?

I have found that at this point in my career, with having the experience I’ve had — 18 years of seeing patients with all acuity levels — that with a video camera, honestly, I can video camera, look at a patient, and within a minute in many instances, I can tell that patient’s in trouble and that patient’s not going to last very long in terms of how they’re doing and what their physiological status is.

I feel in that sense that I can definitely get a good sense of how patients are doing. I don’t have to focus on the minutiae and the tasks of getting the things done. My viewpoint is different than what they see at the bedside, but it’s sometimes a really, really important vantage point. If you’re looking at something really up close versus stepping a few feet away, you’re still looking at the object, but you may see things that you didn’t see before.

A bedside nurse has to worry about the minutiae. They have to worry about the tasks, managing their time, other patients that they’re responsible for. Sometimes you’re just so busy and the patients are so much more ill now than they were when I started in ICU 18 years ago. Half the patients I see now in ICU would probably be dead, in all honesty. They’re very, very sick. So yes, I can look at a patient and a lot of times be able to see there’s going to be a big problem here.

The bedside nursing model seems to fluctuate every few years, with nurses first doing only clinical tasks at the top of their license, but then being made responsible for everything down to emptying patient room trash cans and sweeping floors. Now that you’re isolated from those non-clinical tasks and can concentrate purely on the intellectual activity of being a nurse, does it seem that the model is wrong?

I still do some bedside. I am emptying my trash and I’m doing certain things that other non-licensed people could do. Once again, it’s a budgetary focus, and a lot of times, the things that get cut are the things that they figure, hey, nursing can do that. We’ll just have nursing do that.

The trickle-down effect is that they’re not having the time to sit and look through trends, values, and labs. I can do that. If I see a patient and I’m worried about them, I can spend as much time as I want, 15 or 20 minutes, and look through the chart, look through results, and pull up strips. I have time to come up with a picture and a situation.

When I’m at the bedside, a lot of times I’m in this frantic mode of doing. I’m doing, I’m doing, I’m doing. Sometimes I have to stop myself and go, wait a minute, let’s think for a minute. What’s going on with this patient? What do I need to focus on right now?

I think I have a distinct advantage in that I’m still doing both versus some of the folks that I’ve worked with who are only doing the telemedicine side of it. I can see how you become more out of touch with that bedside experience. You become a little more out of touch of what they’re trying to do and what their challenges are. I like being in touch. I want to be able to be that person who can say, I know what it’s like at the bedside — I still do it.

Tell me what your day looks like.

My day will start with getting an assignment of approximately 45 patients in five to seven facilities throughout the United States. I’ll come in and I’ll pull up all my technology, which is Philips monitors at the bedside. I pull up the electronic medical record that the nurses have at the bedside. Then I pull up three different applications that help me monitor the patients. One is just alarms and vital signs. If anyone’s vitals — heart rate, blood pressure, oxygenation — goes out of range, I get a notification for that. I have one screen that’s just a video camera that I can quickly access if I want to look into a patient’s room. 

Then I have our version of an EMR. It’s not part of the patient’s medical record, but we use it to admit our patients and create a profile. Our electronic medical record has vital signs, trending, and basic labs. It’s a quick snapshot. If I tell a physician, "Please look at this patient," they can pull up a screen and have a quick snapshot of everything they might need to look at for that patient.

I start out by doing rounds, much like the physicians go in and do rounds. I look at the chart. I look at recent vitals, the labs for the day, I will video camera in a room and look at the room, look at the IV pumps, look at the oxygenation, look at the patient’s general condition. How do they look? Have they been stable? What are their hemodynamic drips? What are their oxygen requirements? Are they safe? Do they look comfortable? That takes maybe five minutes per patient. If I see issues, if I see holes, if I have questions, I’ll go and delve a little bit deeper into that patient’s chart. Then I move onto the next patient.

I’m doing my rounds, and as I’m doing that, new patients will be coming in the system. I have to quickly assess, how sick is this patient coming into this bed? Do I want to send the message to my doctor and say, "I’m getting a really sick patient into this facility — please take a look at this patient." Or is it a relatively stable ICU patient that I can put them in the system and just keep an eye on them? You’re looking at alarms. If I see what we call the red alarms, which are the most acute values, I might have to click into the Philips monitor and say, that oxygen says it’s 80 percent. Is that really true, or could that be the patient pulling the monitor off their finger? There’s a lot of false alarms. I’m sure you know what alarm fatigue is. That’s a big problem in these monitor units.

When I see critical situations, I have to look at that and go, do I need to look at this right now or is this a false alarm? Your whole day is rounding. It’s answering alarms and looking at patients. Sometimes the bedside will call us and ask for a second med verification, or we can actually verify blood. Our video cameras are so specific that I can zoom in and read a patient’s armband. I can zoom in and tell you where an endotracheal tube has been taped at the lip. If you have a nurse with a flashlight in the room, we can check pupils. We can look at anything in that room, even to the minutiae.

If you find something wrong or need to communicate with other ICU nurses or intensivists, what do you do?

A lot of times, if something really serious is happening at that point, if there’s someone physically in the room, a nurse, I’ll be talking to them. If not, I’ll usually ask one of my colleagues, hey, call over to this facility, tell them to go into Room 12.

Let’s say it’s a patient who’s hanging out of bed. They’re going to fall out of bed. We get a lot of that. Confused patient, they’ve just pulled out one of their lines, they’re bleeding all over the place. If it’s a nursing thing, I have someone else call the actual unit and I usually stay with the patient virtually — I talk to them. Believe it or not, they’re actually very receptive if we direct them, “Don’t put your other leg over the bed.” We tell them what to do or what not to do. “Put your oxygen back on” if they can physically do it. A lot of times they’ll actually do what we ask them to do.

If it’s something very serious where they need a physician, we have instant messaging to our physicians. I’m in Phoenix, they’re in Los Angeles, they could be in Tel Aviv, Israel. Sometimes, they’re in the same core that we’re in here in Phoenix. Sometimes I’ll just walk over and say, “Dr. Shah, can you go into this room right now?” Or we’re all up on instant message, so I can instant message them, and within seconds they will be able to turn their video camera on and go in the room and assist with whatever situation is going on.

In the Banner configuration, are you an extra layer of eyes and ears or have they taken nurses away from the bedside and moved the coverage to the tele-nurses?

No, they haven’t. They have not taken anything away from the bedside. One of Banner’s main initiatives is to become a leader in this industry of innovation and telemedicine. They’re using a lot of their resources. 

We’re finding that our results are great. We’re saving money and length of stay in ICU patients. We’re bettering our morbidities and mortalities by this service. No, the nurses don’t have to do anything extra. They don’t take on extra patients or extra responsibilities. We used to refer to ourselves as a second layer of care, or second pair of eyes.

Do the bedside nurses see you as a Banner colleague who happens not to be sitting there or do they have some resentment that you’re overseeing them from afar?

Initially there was a lot more resentment, I think because the education that we provided probably wasn’t as much as it should’ve been when we would first go into a facility. What we learned was if we’re going to be providing a service, it’s really important for us to go there, spend several days, meet the staff. Really educate them, explain to them that we’re not watching what they’re doing. 

We’re not looking for mistakes. We’re not micromanaging what they’re trying to do. We’re just here. If I see something that maybe for whatever reason I’m not sure if they’re aware of, or I have a concern, I approach it like, "This is something I noticed. Do you need some help? Can I get an order for you? Do you want my doctor to come in and assist you in this situation?”

Here’s a brief example. Doing my rounds one morning, I noticed an oxygen level was at 70 percent for a patient. Normal is 93 to 100. I went into the room to take a look. The respiratory therapist and nurse were in there and the patient had a tracheostomy. They were using a bag. They were bagging the patient and trying to get the oxygen levels up. They were all working very hard, but I could see that the patient was not responding. I could see the patient had had several of these episodes in the past. I said, "Just coming in to check on you guys. Can I send you my doctor? Do you need some help?" One of the nurses said, "We were thinking about calling you." I said, "No problem. Let me have my doctor come in."

When our physician went in the room, he could immediately see the patient and what was going on and see that the patient was not being able to be ventilated. He gave several medications. He paralyzed the patient, gave sedation. He spent a good amount of time to get the patient in a condition where he could be ventilated because the patient was having some heart problems with his oxygenation.

They were doing what they knew to do. They were doing the right thing, but the patient needed more. What the patient needed was an expert physician who understood how to treat this patient. We were able to prevent that patient from coding because they were going to head in the direction of a cardiac arrest. That was a great idea of how I was able to go in and say, "Can I help you?" and they said, "Sure. What can it hurt?”

They’ll think about us, but they’re in the moment, they’re treating the patient. “Oh, I better call the primary care doctor and get some orders,” but in that situation, there really wasn’t time to wait for someone to respond to a page or come in. At my workplace, we call that a save. Our physician did some extensive interventions. We were able to save that patient from deteriorating.

Do you document in the electronic health record?

We do. If we have interaction, there is a special form that’s been developed into our electronic health record. We used to be called iCare and it’s called an iCare intervention form. If I have a discussion with a nurse or I see something, then I’ll put a quick note stating what I observed and that I spoke to the nurse. It will direct me to, did I escalate it to a provider or am I just going to continue to monitor the patient?

We do put our stamp in the medical record when we do some interventions or we have conversations. We need to be able to validate how we’re contributing to the patient care. That’s an important part of our job that they’re having us focus more on. It’s like, if you’re doing things, if you’re assisting with things, make sure that you make a note. We do that.

How do you see more generalized types of video visits fitting in with in-person clinician visits?

It mirrors where we are technologically in our society. Ten years ago, I don’t think any of us thought we would be able to be on the Internet on our phones. That seemed like a strange concept. We are using a lot of our two-way video now. We project our image into a patient room so that they can see us. It’s like anything — when people are exposed to it and they get used to it, it can and I think will become more of the norm.

The only thing our ICU physicians can’t do from a remote location is, of course, lay their hands on the patient. What we’re finding is that certain procedures that used to be physician-only, now we are training advanced respiratory care practitioners to put in central lines and do certain things. There are only very few things that we would need a physician to physically do.

The technology has allowed us to have a conversation. You can physically see the physician. The video, the audio quality is great. We’re going to more and more probably see that as being the norm. Banner is expanding their telehealth programs to tele-psych, tele-wound care, behavioral health, tele-OB. You’ll probably see what Banner is doing with the telemedicine program on the horizon.

Morning Headlines 8/10/15

Statement on FCC Decision to Allow Unlicensed Devices in Dedicated Health Care Spectrum

AHA sends a letter to the FCC criticizing a recent decision to open up new frequency bands for use by unlicensed devices because those frequencies had previously been reserved for use by patient monitoring devices.

Usefulness of Pharmacy Claims for Medication Reconciliation in Primary Care

A comparison between pharmacy claims data and EHR medication lists finds discrepancies between the two data sources 77 percent of the time. Researchers conclude that embedding pharmacy claims data into medication reconciliation workflows within EHRs could help increase medication list accuracy.

MedicineBall is the new Moneyball. WikiLeaks meets the #data scalpel

Healthloop founder Jordan Shlain, MD comments on the recent ProPublica surgeon scorecard publication, saying “the outcomes data feedback loop is in effect; forcing the house of medicine to take a data perspective on its future.”

Texas Health Resources Names New Chief Information Officer

Texas Health Resources names Joey Sudomir as its new CIO. Sudomir has held the position as acting CIO since April, when his predecessor Ed Marx, CHIME’s 2013 CIO of the Year, departed  to join the Advisory Board Company.

Monday Morning Update 8/10/15

Top News

The American Hospital Association complains that the FCC’s decision to open up TV and 600mHz bands to unlicensed devices such as wireless microphones places hospitals at risk since Wireless Medical Telemetry Service uses 608-614 mHz. The FCC denied AHA’s request for a delay but agreed to increase the geographical buffer zone to several hundred meters, leaving it up for hospitals to figure out how to enforce it to avoid interference with their vital signs and cardiac monitors. Hospitals request the buffer zone by registering each device in a central AHA database that unlicensed devices are supposed to check in finding a vacant frequency.

Reader Comments

From PollyWantACracker: “Re: Yale Physician Services. I played golf with two of their MDs. They both stated that Epic had a terrible rollout, they are still trying to figure it out, and they wished they hadn’t switched.” Sounds like par for the course (no pun intended) following an EHR rollout. I thought Epic had been live there for some time, so either they still aren’t over it or perhaps their practice was implemented later in the cycle.

From Howdy Partner: “Re: Microsoft’s US partners of the year. Will be announced soon, but here’s the slide from their user group meeting last week announcing the winners.” Hopefully Microsoft will realize that it spelled the name of its Rising Star Partner of the Year incorrectly – Health Catalyst is two words.

From Will Bloom: “Re: cloud. I ran across your 2008 article. It was pretty forward thinking then.” I had to dig to figure out which one the reader was referring to. I think it’s this one, where I argued for SaaS and connected networks in opining:

In other words, I don’t need a loaded PC any more than I need a gas generator, a TV antenna, or an outhouse. The grid is better, cheaper, and more reliable to meet those needs. All I need is a connected appliance. But more importantly, the network adds tremendous value. You contribute a little by joining, but you get a lot in return … The Holy Grail is to pull data back out in a way that lets hospitals learn something actionable, like which antibiotics work best or which lab values correlate with genomic profiles. Few hospitals have the capability to even get that kind of information from their own locally stored data. Fewer still can tap into the collective knowledge of their fellow IDN members. And nearly none can focus the accumulated intelligence of hundreds of peers when making important clinical and business decisions … It will soon make good sense to shut down the endlessly duplicated silos of locally maintained hospital IT and get on the grid instead.

From Hacky Sacker: “Re: hackable medical devices. You mentioned the FDA’s warning about wirelessly controlled infusion pumps that can be taken over by hackers. Here’s a live demo of an actual IV pump hack as performed at the recent BlackBerry Security Summit.” The live hack of a PCA pump is sobering, although hackers have limited incentive to prowl security camera-equipped hospital hallways looking for medical equipment to hack. The demo hacker connects the PCA pump to his laptop via Ethernet, uses hacker tools to see what network services and ports the pump is using, uses unsecured Telnet and FTP to gain root access to the pump, then finds the wireless network name and unencrypted WEP passwords to log into the pump wirelessly as well. He installs malware into the pump’s firmware and changes settings freely, such as increasing the narcotic dose to a level that would have killed the attached patient.

HIStalk Announcements and Requests

Poll respondents minimized Cerner’s contribution to the DoD win by Leidos, Accenture, Cerner, and Henry Schein, with 42 percent of them crediting the DoD’s incumbent vendor Leidos, 26 percent saying the selection was due to political influence, and 17 percent suggesting that  DoD chose the Leidos team strictly on price. New poll to your right or here, triggered by my report on Meditech’s latest financials and the company’s ensuing response: is Meditech’s market position getting better or worse?

Welcome to new HIStalk Gold Sponsor Bernoulli. The Milford, CT medical device integration company has been a leader since 1989 in real-time data integration and patient safety surveillance for clinical areas, ICUs, and telemedicine settings. Bernoulli Enterprise offers an enterprise, vendor-neutral medical device integration platform; alarm management; a virtual ICU; remote patient monitoring with built-in dashboards and viewers; and analytics that provide clinical decision support and outcomes analysis. Customers with some of the company’s 35,000 installed beds include Duke University Medical Center and Memorial Sloan-Kettering Cancer Center. The company’s CEO is industry long-timer Janet Dillione, who many folks will remember used to run Siemens Health Services and Nuance Healthcare. Thanks to Bernoulli for supporting HIStalk.

Elementary schoolteacher Mrs. F from Wisconsin sent a thank-you note and photos about the STEM professional development library and iPad Mini we funded via vendor donations (with matching funds from the  Bill & Melinda Gates Foundation). She says neither she nor her school district could have afforded the 20 books that she’s studying on her own time this summer in a pilot project to prepare for the upcoming school year. Her school is moving toward a STEM (science, technology, engineering, math) emphasis and she and her colleagues needed to dig deeper into how to prepare students for 21st century careers. She especially liked the units on MakerSpaces, do-it-yourself labs where students are provided with tools, supplies, and space to explore their scientific interests. Vendors who donate $1,000 or more to my DonorsChoose project get a mention here on HIStalk and have their funds matched by an anonymous vendor executive benefactor.

My latest LinkedIn gripe: executives who lack advanced degrees (usually sales and CEO types) who pad their resumes with “executive coursework” from big-name schools that offer expensive weekend programs for status-sensitive executives who couldn’t be bothered to actually attend graduate school.

The update on my Windows 10 experience is as positive as I could hope – I’ve had no problems or seen any puzzling or questionable behavior. I had ongoing memory and disk problems under Windows 8 , not a big deal, but near-lockups that occasionally required bringing up Task Manager to kill piggish, long-running apps like Firefox. I haven’t had to do that under Win10 and my CPU and desk utilization are still low, dropping down to 1 percent or so when I’m not doing anything. I hadn’t thought of using the laptop’s webcam microphone to give verbal requests to Cortana, but that’s working too, although its speech recognition isn’t nearly as good as on my Amazon Echo, so I’ll stick to keyboard entry.

Last Week’s Most Interesting News

• IBM announces plans to acquire Merge Healthcare for $1 billion to add imaging capability to Watson.
• The Senate moves along the confirmation of Karen DeSalvo as HHS assistant secretary for health.
• Cerner’s Q2 results miss analyst revenue expectations, sending shares down 9 percent for the week.
• Meditech’s quarterly results show a 16 percent revenue drop on a 42 percent decrease in sales.
• Allscripts announces flat quarterly revenue and reduced losses, with the company adding one Sunrise sale in the quarter.
• Papworth Hospital in England changes its plans to install Epic and instead will look for a more cost-effective system.
• Medical Informatics Engineering informs HHS that its May cyberbreach exposed the information of 3.9 million patients of dozens of provider organizations to unknown hackers.
• CHIME announces Gretchen Tegethoff as VP of its for-profit business that charges vendors for access and sales to its CIO members.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Sales

Streamline Health Solutions will implement the abstracting module of its Looking Glass solution at one of its existing, unnamed customers through a channel partner.

People

Texas Health Resources promotes Joey Sudomir to CIO.

Citra Health Solutions names Eric Olofson (Olofson Group) as COO/CIO.

Well-being technology vendor Healthways names board chair Donato Tramuto as CEO. He’s also chairman and CEO of Physicians Interactive, which sells “digital marketing tactics” to drug companies.

Announcements and Implementations

Physicians’ Desk Reference updates its mobilePDR smartphone app to feature concise drug label information such as indications, dosing, adverse effects, side-by-side drug comparison, interaction checker, and pill identifier. The iOS and Android apps are free for US healthcare professionals.

Technology

Baidu, the Google-like China-based web services company, develops “Ask a Doctor,” a voice translation application that allows users to speak their symptoms to then receive a possible diagnosis and link to a nearby medical specialists. The company says its goal is “to build a medical robot.” The company is building artificial neural networks to allow it to accept voice input in the complex Mandarin language. It also hopes to connect to EHRs, which are in early deployment in China.

The Privacy Visor, $240 eyeglasses that trick facial recognition systems so they can’t identify the wearer in a form of visual opting out, will go on sale in Japan within a year. They were developed by a government-affiliated institute.

Other

A Health Affairs Blog post asks a question I’ve raised many times myself: why do veterinary practices, especially those in chain pet stores, have far better patient portals and EHRs than their medical practice and hospital counterparts?

This tweet makes perfect sense: why are hospitals considered the organizations best equipped to manage overall individual or population health? Not only do most people spend only a tiny fraction of their lives interacting with hospitals, hospitals don’t even make up a significant percentage of the time a given patient spends interaction with the healthcare system since most care is delivered from physician practices, pharmacies, walk-in clinics, etc. Unstated bias puts hospitals in the healthcare driver’s seat when they have always been the poorest performing, most expensive, and most consumer-indifferent healthcare resource, not to mention the one patients would most like to avoid. Hospitals made their fortunes cranking out highly paid and questionably effective procedures while blaming insurance companies and doctors for most of what’s wrong with healthcare, and now that the market is less inclined to pay for those procedures, hospitals have suddenly developed a keen interest in the overall wellbeing of their customers.

Researchers find that EHR medication lists perfectly match a patient’s claims data only 24 percent of the time, with 60 percent of the discrepancies involving EHR-profiled meds with no claim filed and 40 percent having meds for which a claim was filed that didn’t appear in the EHR.

China’s technology-driven healthcare reform has stalled, with policy changes and innovative technology startups failing to overcome inadequate IT systems, overregulation, and pressure from the dominant state-run hospitals that still deliver 90 percent of visits. Doctors are also pushing back against reform that would reduce hospital reliance on drug sales for income, saying they need the money to stay open.

Greece’s financial crisis has led to the formation of illegal free clinics, most of which refuse to register with the government because they say the government is legally responsible for providing the care they are delivering. The country’s 25 percent of hospitals that are not government run are struggling with patients who can’t afford their services and who are instead crowding public hospitals, which are 40 percent fuller than before despite an austerity-mandated hiring freeze that has been in effect since 2011.

Healthloop founder Jordan Shlain, MD says public reporting of surgical outcomes (“data scalpels”) is causing surgical teams to review their overall performance since every person on it contributes to outcomes (“your income will be dependent on your outcomes.”) He urges physicians to collect and analyze their own data instead of letting insurance company statisticians boil it down to their own questionable conclusion.

Sponsor Updates

• The SSI Group and T-System will exhibit at the HFMA Region 10 Healthcare Conference August 12-14 in Colorado Springs, CO.
• Forward Health Group creates a music video to promote its August 27 open house. It seems to have been created as a single, two-minute roving video that involved everybody in the office lip syncing, which must have been quite a coordination challenge.
• Streamline Health will attend Medhost’s “The Nashville Experience” event September 16 in Nashville.
• Surescripts offers “I’ll Take One Refill, Hold the Fax.”
• SyTrue founder Kyle Silvestro is featured in a NewsReview article on data-driven healthcare.
• TeleTracking offers “Lean Strategies in Healthcare.”
• Fujifilm Teramedica offers “VNAs usher in new opportunities for healthcare.”
• GetWellNetwork publishes a white paper on Carilion Roanoke Memorial Hospital’s implementation of its interactive patient care system.
• TransUnion postss “For Healthcare Companies, Data Security is a Critical Test.”
• Verisk Health offers “5 Tips for a Successful HEDIS Season.”
• Versus Technology publishes “5 Myths and Misunderstandings About RTLS.”
• The Information Difference names VisionWare a leading technology vendor in the Master Data Management space.
• Recondo’s EmpoweredPatientAccess suite earns a most-improved score in a KLAS mid-year report.
• VitalHealth Software will host an Executive Forum on “Healthcare Outcomes – what we measure matters” August 12 in Minneapolis.
• Voalte offers a guest post, “Changing the Game and Getting it Right.”
• Huron Consulting will exhibit at CORE Conference 2015 August 12-14 in Salt Lake City.
• West Corp. offers “How Chronic Care Management is Like Going to the Gym.”
• Xerox offers “An Overlooked Member of an Effective Healthcare Team.”
• ZirMed offers “Diagnosing the Increase in Surprise Bills at Urgent Care Centers.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 8/7/15

Watson to Gain Ability to “See” with Planned $1B Acquisition of Merge Healthcare

IBM announces plans to acquire Merge Healthcare for $1 billion, with the goal of integrating Merge’s imaging services with IBM’s Watson initiative so that Watson customers could review diagnostic images with analytical assistance.

Karen DeSalvo nomination moves to the Senate floor

The Senate HELP Committee unanimously approves Karen DeSalvo, MD’s nomination for assistant secretary of HHS, a position she has filled in an interim capacity since last fall. Her nomination will now move to the Senate floor for consideration.

US hospitals urge DOJ antitrust probe of Anthem-Cigna deal

In a letter to the Department of Justice, AHA lobbies for a review of the proposed Anthem-Cigna merger, citing concerns that the shrinking payer market will inevitably reduce competition and drive up insurance costs.

Computer algorithm could aid in early detection of life-threatening sepsis

Researchers from Johns Hopkins have developed a new algorithm that detects early sepsis with an 85 percent accuracy, and without increasing false positives over current methods.

News 8/7/15

Top News

IBM will acquire Merge Healthcare for $1 billion, giving IBM’s Watson product “eyes” that will allow users to compare images within a single patient or across similar patients for diagnosis and treatment. IBM will pay $7.13 per MRGE share, a 32 percent premium to Wednesday’s closing price. Merge shares haven’t hit that price since late 2006, having dropped 58 percent in the past 10 years as the Nasdaq rose 135 percent.

Reader Comments

From Helen Waters: “Re: MEDITECH’s financial report. To reference a famous quote: ‘The reports of my death have been greatly exaggerated.’ (Mark Twain, 1897). MEDITECH is ushering in a long overdue level of energy and meaningful innovation to the EHR market. Our customers, and the EHR industry, should expect more. We are delivering disruptive innovation with fiscal responsibility, which we believe the industry very much needs. No other company is better positioned to deliver an advanced and contemporary EHR solution that addresses the needs of the market at an affordable price point. We are doing that. Let’s stop assuming that if you pay more, you get more. To what degree has that premise really been vetted? The EHR vendor community needs to work harder for your health care IT dollar. As healthcare leaders, you owe it to your organization, and as vendors, we owe it in partnership with the national agenda. We are all being called upon to drive down the cost of delivering efficient and effective quality healthcare, as well as to spend the healthcare dollar more wisely, and this includes information technology. We are fortunate to have a big seat at the EHR table, and we intend to preserve and grow it. While you note a change in our revenue and earnings, given these transformative efforts, this was not unexpected. Please know we are responsibly at the table, and we are committed to our existing customer base, providing them with an affordable option to migrate to our latest platform. We celebrate the success of our customer base and the impact they’ve had advancing the delivery of high quality healthcare for the communities they serve. At times, the EHR market feels a bit irrational relative to IT decisions and the promise of utopia often being trumpeted with selecting one system over another. We are proud of our past, executing in the present, and delivering for the future of healthcare technology.” Helen is VP of sales and marketing for Meditech and references my mention of the numbers above from its Q2 report.

From DoD: “Re: DoD contract. The actual amount Cerner got is very small and will need to be shared with Intermountain. I suspect we’ll see a tremendous amount of infighting in this group as they begin the work of delivering while not being paid until the users come online as the contract requires. That stretches payments over seven years, but the investment needs to be done up front. There are several off ramps built in and some strict deliveries. The prime will have to beat the subs into submission in order to deliver on the commitments while withholding payments for years.” Unverified. I’m not sure what Intermountain contributed to the bid or what they’ll get in return.

From Doogie: “Re: Epic. In light of news of Epic’s failures in the UK, coupled with DoD decision, Epic should probably start worrying about its public image. Judy’s silence may have worked for her in the past, but now that Epic is finally being held accountable for its shortcomings, people are going to start wondering if there’s nothing to hide why not comment? One thing is certain, Epic’s stubborn refusal to join CommonWell, among many other things, may finally be backfiring.”

From Concerned Reader: “Re: HIStalk. You’re a Cerner hater and an Epic lover. I have decided to stop reading HIStalk because your bias affects your reporting to the extent of being unethical journalism. On Monday the morning update headlined Cerner missing financial projections in the first line and Epic’s loss of the UK hospital as the very last line.” One thing I’ve learned in writing HIStalk for 12 years is that I can’t mention Epic, religion, or George Bush in any capacity without having a few hysterical, anonymous readers react like a bull instinctively charging a red cape. It doesn’t matter what I actually say — just seeing the words on the page sends a few grudge-bearing readers off screaming with fingers in ears. Lt. Dan writes the headlines and wisely chose Cerner’s earnings report (along with those of Allscripts and Meditech) as the top headline  – Cerner’s report and comments were more important given their DoD win and continued integration of Siemens Health Services. If you’re truly going to stop reading HIStalk (those who threaten almost never do), consider first Googling to see which of the cookie cutter, opinion-free alternatives covered Epic’s reported loss at Papworth – I don’t see even one, which means your only source of that negative Epic news was right here on good old unethical and Epic-loving HIStalk.

From Out of Touch: “Re: KLAS. Using ‘fighting words’ and posturing as they holding vendors hostage on a topic KLAS clearly doesn’t understand. Irrelevant. For a price, I bet.” KLAS says many large vendors “challenged KLAS to step up and be the Switzerland of interoperability,” an assignment it accepted “with trepidation” in offering to convene a meeting along with CHIME. It adds that, “Congress and federal agencies are likely to cheer when they know such action is voluntarily taken” and lists as participants CEOs of Allscripts, Cerner, Epic, Athenahealth, Meditech, and others. I’m not sure I would expect KLAS to be the Switzerland of anything or to lead the interoperability charge while selling non-interoperable vendors reports as its main focus, but we’ll see what the participants come up with.

From Mute Pointer: “Re: BJC. Says their downtime wasn’t due to a hack.” MP forwarded an internal email describing the results of BJC’s investigation, which concluded that “inadvertent actions within our own IS department” flooded the network and caused its protection systems to restrict application access. They’ve hired an external consulting firm to review their IT infrastructure, having not done one since 2013.

From Isadore Nobb: “Re: AHA Solutions. I don’t think any product has failed to earn their ‘vetting’ approval as long as the company paid. With one contract at least, they added a huge group of solutions from a business unit without any process other than to require another million dollars and a percentage of sales. Turns your ethical stomach.” Unverified.

HIStalk Announcements and Requests

I took a deep breath of hesitation before clicking the button to upgrade my primary PC to Windows 10. It was painless and has been perfect so far, with zero learning curve, no unexpected gotchas, and no incompatible programs. The only extra step for me was to install a new Win10-compatible version of Bitdefender Total Security 2015 and the upgrade even prompted me to do that automatically. Win10 has a good user interface and just feels right all around. Here’s what I’ve discovered so far with a small amount of use:

• The Cortana “ask me anything” digital assistant box is useful, even if only to avoid navigating trying to find commonly used functions like Device Manager.
• The Start Menu is not only back, it has been enhanced to display some of the Metro live tiles by default (but that can be turned off, too).
• The Edge browser replacement for Internet Explorer feels really fast and lightweight – it brings up the HIStalk page faster than Firefox by my timing.
• Task View does something with virtual desktops that would seem to be useful, although I haven’t done anything with it.
• The Action Center icon rides in the system tray and offers one-click access to some settings and a log of recent system activity. The much-hated “hover to see the charms” option is gone.
• I haven’t studied it in depth, but looking at Task Manager’s CPU and disk utilization, Win10 seems to be much more efficient. My CPU usage always seemed to be high under Win8, but it’s at 1 percent right now and so is disk utilization. I don’t know what actually changed, but everything feels snappier.

So far, I would say this is the best and easiest Windows upgrade ever. That only negative I’ve read is that some basic and not universally used features (being able to play DVDs, for example, or play ad-free Solitaire) have been removed from the basic free upgrade and are now paid options in the previously little-used Microsoft Store, raising the possibility that Microsoft plans to give away the basic OS (to previous consumer-only licensees, of course – businesses and new users still pay) and charge more for optional individual apps and services in a cafeteria-style promotion. In that regard, Microsoft may have moved Windows into the ultimate machine for generating recurring revenue instead of a one-and-done upgrade.

My server took a temporary break when I sent out the email blast about the IBM-Merge deal Thursday, just like it did last week on DoD news, which I thought was a one-time overload of readers. The result was a “you’re going to need a bigger boat” maxing out of server memory to the point it couldn’t even swap out storage even though I’m running a dedicated server with a Xeon E3 four-core processor, 16GB of memory, and solid-state disk. I’ve placed an order to upgrade the server yet again, a problem I’ll happily accept every time since it means someone is reading other than me.

My present grammar gripe, which isn’t really a gripe since it’s cutely old school: referring to a “piece of software” as though the user gets just one slice of the larger software pie.

This week on HIStalk Practice: Dr. Gregg composes a moving requiem for the patient portal. AncestryHealth Chief Health Officer Cathy Petti discusses company plans to move member health histories into EHRs. Practice Fusion ramps up executive team in preparation for IPO. WEDI survey confirms what other ICD-10 research has already shown: Physician practices aren’t ready for October 1. AMA lobbying dollars come under scrutiny. Azalea Health secures a new round of financing. Premier Physician Network goes live on Centricity. The newly formed Ohio Independent Collaborative looks to extend the livelihoods of independent physicians.

This week on HIStalk Connect: Yelp expands its consumer review platform to include Medicare performance data for hospitals, dialysis clinics, and nursing homes. The FDA issues a safety alert over cybersecurity vulnerabilities found within Hospira infusion pumps. Developers in South Korea introduce a new Braille-based smartwatch for the visually impaired. A new startup focused on women’s health unveils an earbud that tracks basal body temperature during sleep, plotting it on a paired smartphone app.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Acquisitions, Funding, Business, and Stock

Computer cart maker Capsa Solutions acquires Rubbermaid Healthcare., which offers basically the same product line.

Marlin Equity Partners will acquire ambulatory EHR/PM vendor AdvancedMD. ADP bought the company in early 2011. Marlin also owns e-MDs and MDeverywhere.

Health Catalyst acquires Health Care DataWorks, the early but lagging data warehouse vendor that was spun off from Ohio State with former CIO Herb Smaltz in 2008.

India-based Cognizant reports a 39 percent increase in its healthcare business is it continues to boost revenue and profits following its September 2014 acquisition of TriZetto for $2.7 billion.Health makes up 29 percent of the company’s business. Share price rose 50 percent in the past year, valuing the company at $41 billion.

Leidos Holdings reports Q2 results: revenue up 4 percent, adjusted EPS $0.73 $0.61, with its health and engineering segment losing $7 million vs. a loss of $482 million in the previous year. Chairman and CEO Roger Krone said of the company’s Department of Defense EHR bid, “We’re in that weird period between the award and the expiration of the protest period, so we’re not going to give a lot of guidance on what’s going on. We probably have another five days or so until we think we’re safely on the other side of the protest period.”

McDonald’s tries to stem its dramatic business downturn by naming Dignity Health CEO Lloyd Dean to its board. Perhaps it missed Dignity’s web page declaration that “in today’s fast-paced, fast-food society, it can be tough to make healthy decisions for kids.” McDonald’s is getting endless pressure from franchisees unhappy with out-of-touch management and lack of buyers for their underperforming locations; competition from fresher offerings at Burger King, Wendy’s, Shake Shack, and Chipotle; and strongly slumping sales.

India-based provider search website Practo raises $90 million in funding from investors that include Google.

Sales

WellStar Health System (GA) chooses Legacy Data Access to retire its McKesson Horizon applications.

The FDA awards genome informatics vendor DNAnexus a contract to build precisionFDA, an open source platform for sharing genetic information as part of the White House’s precision medicine initiative.

Announcements and Implementations

Extension Healthcare publishes a guide for hospitals working to comply with the Joint Commission’s January 1, 2016  alarm safety goal.

Long-term care software vendor PointClickCare adds the ability for customers to receive radiology tests results into their EHR using technology from Liaison Healthcare. 

Yelp will add ProPublica-produced data to its provider business listings, including ED wait times, fines paid, and readmission information. It’s a bit of an odd relationship given that ProPublica is a non-profit, public-spirited news reporting organization now turned data vendor to a commercial customer via an undisclosed business arrangement. I took the screen shot above Wednesday afternoon. Hospitals will learn that Yelpers tend to get dramatic given one bad experience even after many good ones, so it’s common for an otherwise quiet or even complimentary Yelper to suddenly go off on a one-star tirade over something only marginally related to the business’s main focus, as they often do when they can’t get a table at their favorite restaurant or find an error in their credit card charge after the fact (you really are only as good as your latest review).

HIMSS offers so many conferences that it is now co-locating them in confusing attendees about what they’re signing up for. The latest: the Connected Health Conference in chilly National Harbor, MD in November, which includes the mHealth Summit, Cyber Security Summit, and Population Health Summit. Each requires $695 registration, but signing up for one allows attending the others.

Apple’s ResearchKit gets its first international use as Stanford’s MyHeart Counts app is made available to people living in Hong Kong and UK.

Government and Politics

The Senate’s HELP committee unanimously approves the promotion of Karen DeSalvo, MD, MPH to HHS assistant secretary for health without a hearing Thursday, clearing the way for a full Senate vote following its recess through September 8. DeSalvo has been holding the assistant secretary position since October 2014 while remaining National Coordinator. In that role, she oversees the Surgeon General, communications, regional health administrators, and a number of public health related offices.

The SEC approves a new rule that will require most public companies to publish the ratio of CEO pay to its average overall employee salary.

Ireland will roll out a national patient identifier, with the automatically assigned record including a signature and photograph. According to the health minister, “It will allow us to follow patients and staff as they move through the service in a way we currently can’t. This will improve patient safety, reduce duplication and errors, and give us a huge amount of new data that we can use to make services more efficient and improve planning.”

The American Hospital Associates asks the Department of Justice to review possible increase in healthcare costs that the proposed merger of Anthem and Cigna could cause. Perhaps the insurance companies should ask DOJ to look at hospital mergers since those seem to be increasing opportunistic pricing as well.

Arizona Governor Doug Ducey announces a plan to improve the state’s Medicaid program that includes offering personal savings accounts for paying for non-covered services and an app- and portal-based member system that includes appointment reminders, disease management tools, and a provider locator. 

Innovation and Research

Johns Hopkins University researchers develop an algorithm that uses 27 factors to predict septic shock in 85 percent of cases.

Other

A Commonwealth Fund survey finds that 50 percent of primary care physicians see technology as improving care quality, with 28 percent feeling that HIT makes it worse. Their feelings about ACO impact are all over the place, with only 30 percent of those actually participating in an ACO saying they have a positive impact on patient care. Nearly half of PCP physicians say healthcare trends are causing them to consider early retirement.

Phoebe Putney Memorial Hospital (GA) will go live on Meditech on October 1 at a total project price of $50 million. It chose Meditech 6.1 in April 2014.

The family of a 14-year-old girl who died at a “Foam Wonderland” rave concert at the New Mexico State Fair sues the state, three promoters, two security firms, an ambulance company, a hospital, and two paramedics, claiming that all of them contributed to her death by their recklessness and negligence in failing to save her from her MDMA overdose.

Sponsor Updates

• Medicity CEO Nancy Ham co-authors the HFMA article “The Financial Impact of Population Health Analytics in the Shift to Value-Based Models.”
• Billian’s HealthData and Porter Research invite responses from professional marketers in a survey on marketing practices.
• Hayes Management Consulting posts “Prepping Your Staff for a Successful EHR implementation, what you need to know.”
• MBA Health Group and Netsmart will exhibit at the Allscripts Client Experience 2015 through August 7 in Boston.
• MedAptus offers “A Glimpse into the Facility Billing World from a Split-Billing Expert.”
• MedData offers “The Wait is Over: Welcome to ‘The Impatient Patient.’”
• Navicure offers “Increasing Patient Payments with Clarity.”
• Nordic offers the latest video in its “Making the Cut” series on Epic conversion planning.
• NTT Data offers “Six Reasons You’re Not Yet on the Cloud.”
• NVoq offers “Your iPhone has Good Dictation. Why Doesn’t Your Enterprise Application?”
• Oneview Healthcare will host Health Facilities Design and Development Victoria August 17-19 in Melbourne, Australia.
• Experian Health/Passport Director of Strategy and Innovation Karly Rowe is featured in Washington Business Journal’s “4 things to know about data security after the Children’s hack.”
• PatientSafe Solutions offers “Alarm hazards as patient safety concern.”
• UlteraDigital interviews Patientco Director of Marketing Josh Byrd about redesigning PatientWallet and the need for innovation in healthcare.
• PatientKeeper offers “The Physics of EHR Advocacy.”
• PerfectServe offers “Put down the phone, and other communication lessons from healthcare professionals.”
• PeriGen piblishes “How research resulted in a checklist solution.”
• Phynd Technologies offers “Is There a Solution to Provider Abuse of the Medicare System?”
• PMD posts “Client-Server Architecture and Finding the Right Balance.”
• Qpid Health offers “Getting meaning from patient records stuffed full of results and statistics.”
• Sagacious Consultants launches a charity ad campaign for Tri 4 Schools at the Dane County Regional Airport in Madison, WI.
• Salar Inc. offers “ICD-10 is still on track to launch October 1, 2015, will you be ready?”
• Sandlot Solutions will exhibit at the EHealth Initiative’s IThrive Innovation Challenge August 12-13 in Washington, DC.
• Elsevier Clinical Solutions, Impact Advisors, and Intelligent Medical Objects will exhibit at the Allscripts Client Experience through August 7 in Boston.
• EClinicalWorks offers “1.5 Million Referrals Exchanged via P2POpen.”
• Galen Healthcare Solutions publishes “Clinical Data: Hey, You Are Migrating Your EHR, Take Me with You!!”
• Greenway Health offers “CMS Expands ICD-10 Grace Period Guidance.”
• The HCI Group offers “Epic Consultant Corner: Robert Kight Interview.”
• HDS offers “Thoughts on Meaningful Use by the Brookings Institution.”
• Healthcare Growth Partners advises GMed on its sale to Modernizing Medicine.
• Healthfinch offers “It’s Not Just a Formality: Formal Refill Protocols are a Must.”
• Healthgrades recaps its second HG Challenge hackathon.
• HealthMedx will exhibit at the Arizona Health Care Association Annual Conference & Trade Show August 18-20 in Scottsdale.
• Holon Solutions offers “Next Up For Enabling Data Exchange: Transitions of Care Between Hospitals and Nursing Homes.”
• Influence Health posts “Engaging Patients for Impactful Changes.”
• Ingenious Med offers “IM1: Solving ZDoggMD’s Readmission Problem.”
• InterSystems publishes “From Opposition to Cooperation: Payers Join the Care Team.”
• LifeImage offers “The Top 5 Reasons to Integrate Image Exchange with Your EMR.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

EPtalk by Dr. Jayne 8/6/15

I’ve always been an early adopter of technology. When personal computers first came out, my parents made sure we had one. Sure, it was an Apple II+ and it TYPED IN ALL CAPS ALL THE TIME, but it put us on the cutting edge. It also put me on track to disassemble and modify devices after the Apple IIe came out (with its functional shift key) and I figured out you could run a jumper wire to make the II+ stop YELLING. My brother procured a used modem from his football coach and there we were, dialing up all kinds of trouble.

I learned the virtues of the “pretzel” key with a Macintosh Classic, then finally joined the world of color monitors with Windows Millennium Edition. After surviving a medical school that made us use Lotus Notes, I headed off to residency at a hospital with a half-baked Cerner system and finally found myself in practice with Medical Manager. I felt like I was really on the cutting edge, especially since some of my private practice colleagues still billed using ledger cards and made their appointments in the same kind of schedule book used by my hair stylist.

Through my continued interest in technology and a willingness to serve as a guinea pig on multiple occasions, I worked my way up in the world of “big” hospital IT. Having spent a good chunk of the last decade convincing physicians to add technology to their practices, I never thought I’d find myself feeling such a backlash against technology. According to USA Today this week, “46% of physicians report burnout: cynicism, less enthusiasm, low sense of accomplishment, too much bureaucracy.” Physicians feel overworked and are unable to cope with the stressors they currently face. They report being less empathetic toward their patients. Many cite EHR use as a key part of the problem, but I think there’s a lot more to it than that.

I’m wondering whether we as a society are becoming increasingly burned out and think that technology is a significant part of the problem. Instead of freeing us, smart phones are increasingly tethering us to the workplace. One of my friends recently reported working nearly 10 hours during her week-long vacation, citing the need to “protect” her boss from covering while she was out. I was certainly guilty of checking email on vacation when I was an employee, but I always felt supported in taking time off and knew I could forward critical emails to the person covering me so that she could address them. In turn I covered others while they were away. Eventually I learned to not even open Outlook.

Through social media, we’re under constant pressure to document every moment of our lives and share it so the world can see how interesting our lives are. There are plenty of studies citing Facebook and other social media services as actually making people feel like their lives are less meaningful or less satisfying than others because of what they see posted. Luckily most of the people I follow on my personal Facebook account are pretty mature – there are rarely photos of what they’re eating (unless there’s a great story attached) and don’t post their every move throughout the day. Although they post some spectacular vacation photos, when I see them I’m more likely to tease them about the risk of having their houses burglarized since they just advertised they were away than I am to be jealous.

I didn’t think too much about how technology is changing us as a society until I had the recent pleasure of taking my nephew on a trip to the East Coast. We visited several historical cities and quite a few monuments and landmarks. I was surprised to see that the atmosphere was very different than when I was in the same places just a few years ago. Rather than taking photos of the sights, everyone seemed to either be trying to take a selfie with the monument in the background or to take pictures of each other at the monument, blocking others from even seeing it in some cases.

Some of them were so obsessed with getting the perfect picture that they completely missed out on what they were supposed to be seeing. At one museum, I watched a mother force her children to wait in line to have their picture taken with an artifact and then she immediately bustled them off to do the same thing with another artifact. None of them spent any time looking at the phenomenally interesting collateral around it. (Moon landing note: Did you know the Apollo command module had to detach from the module with the lunar lander, turn 180 degrees, and re-dock with it? What could possibly go wrong? Learned it reading the sign.)

My brother is a photographer and once made a comment about his children’s generation being the most photographed but least seen. With the advent of digital technology, people don’t have to ration their shots any more. I tried to explain to my nephew about film coming in cartridges of 10 or rolls of 24 to 26 pictures back in the day. You had to choose your subjects carefully and you certainly didn’t take a picture of every single thing you found interesting. Although you might entertain your family and friends by showing them 35mm slides projected on a bed sheet (carousel if you were fancy, stacker if you weren’t) you definitely didn’t take hundreds of photos at a museum and make a nuisance of yourself. At one location, there were so many people taking pictures with tablets (including full-size iPads) you could hardly see the exhibit because of the air clutter. I hadn’t intended on seeing the world through someone else’s screen held aloft.

It turned into a teachable moment. My nephew and I had a good discussion about the psychology of all this and how technology makes people feel. We also talked about how it can physically affect people as well. He mentioned hearing that Disney had banned selfie sticks, and after this week, I think it’s a fantastic idea since I was almost hit a couple of times. I’ll be interested to see 10 or 20 or 30 years from now how immediate access to information has impacted our ability to leverage human memory. Personally I think we’re losing the ability to make good memories – rather than being in the moment and experiencing something, we’re either multitasking on our phones, listening to music, or trying to take a picture of ourselves doing it.

What’s worse is seeing people allow their children to be cheated by the lure of technology. At one famous site, I watched a family of four sit next to each other, completely absorbed in their devices. The pre-teen daughters were playing games, the dad was checking sports scores, and mom was just surfing. None of them were talking about the history of the property or why it was significant to our country’s history. Technology could have been a tool for them to talk about the site or the Civil War (which I also heard referred to as the War of Northern Aggression, which was slightly amusing in 2015) but instead it was a distraction. They certainly weren’t giving it the reverence it deserved as a burial site.

We also watched people on the subway interacting with children in strollers with some clearly generational behaviors. Older individuals (who appeared to be grandparents or hired caregivers based on some of the conversations) turned the strollers to face them so they could keep an eye on the children, which also meant they were interacting. Younger individuals tended to leave the strollers facing out and often had earphones in while using a smart phone, so there was very little interaction. If this is a common pattern, will it cause attachment problems, anxiety, or other disorders? And what about the toddlers using electronic media for hours a day? We know that’s an issue. While kids need to learn patience and how to deal with situations they may find boring, it’s helpful for parents to engage with games of “I Spy” or “Twenty Questions.” (Some of the answers this week: Robert E. Lee, Thomas Edison’s light bulb, and a bald eagle.)

As technology professionals and leaders in our field, I think that some re-examination of how technology impacts our lives may be warranted. We may not be able to change the technology demands of our organizations, but we can certainly advocate for wise use in our workplaces. Let’s start with rational email policies. My favorite boss had a three-day policy – if you needed a response within three business days, you weren’t allowed to send an email but had to actually talk to another human being. It was one of the most cohesive teams I’ve ever experienced. We also need to support our employees and colleagues in taking real vacations that don’t involve the expectation of checking email or voice mail. If something doesn’t change, we’re going to need a bunch of new ICD codes to address it.

What do you think about the pervasiveness of technology in today’s society? Did you know that you can turn your toast into a selfie? Email me.

Email Dr. Jayne.

IBM to Acquire Merge Healthcare for $1 Billion

IBM announced this morning that it will acquire Merge Healthcare for $1 billion, planning to add Merge’s imaging and clinical systems to its Watson Health analytics unit. IBM says Merge’s systems will allow Watson to “see” and will “unlock the value of medical images to help physicians make better care decisions.”

Merge has 7,500 customer sites, which IBM sees as prospects for its Watson Health Cloud. The company suggests it could be used to compare a patient’s images to previously taken ones and with those of similar patients. Specific use cases include clinical trials design, making diagnosis and treatment decisions, optimizing patient engagement, and delivering value-based care.

IBM SVP John Kelly said in a statement, “As a proven leader in delivering healthcare solutions for over 20 years, Merge is a tremendous addition to the Watson Health platform.  Healthcare will be one of IBM’s biggest growth areas over the next 10 years, which is why  we are making a major investment to drive industry transformation and to facilitate a higher quality of care. Watson’s powerful cognitive and analytic capabilities, coupled with those from Merge and our other major strategic acquisitions, position IBM to partner with healthcare providers, research institutions, biomedical companies, insurers and other organizations committed to changing the very nature of health and healthcare in the 21st century. Giving Watson ‘eyes’ on medical images unlocks entirely new possibilities for the industry.”

Morning Headlines 8/6/15

Primary Care Providers’ Views of Recent Trends in Health Care Delivery and Payment

Survey results from The Commonwealth Fund and The Kaiser Family Foundation measuring primary care provider attitudes toward payment and care delivery reform finds that while views on health IT are generally positive, patient-centered medical homes and ACOs are met with mixed feelings, and the use of quality metrics to assess performance and rationalize financial penalties generates negative feelings.

Yelp’s Consumer Protection Initiative: ProPublica Partnership Brings Medical Info to Yelp

Yelp partners with ProPublica to begin embedding a subset of health care statistics into its listings pages for hospitals, nursing homes, and dialysis clinics.

SEC gives green light to new CEO pay ratio rule

Five years after its initial passage, the SEC has approved a highly-contested regulatory requirement included in the Dodd-Frank Act that requires publically traded companies to report the ratio of CEO compensation to median employee compensation, effective January 1, 2017.

AG Zoeller urges credit freeze in wake of data breach affecting 1.5 million Hoosiers

Cloud-based EHR vendor Medical Informatics Engineering updates an earlier disclosure to clarify that as many as 3.9 million patient records were potentially exposed during a May 2015 cybersecurity breach.

Morning Headlines 8/5/15

Cerner profit falls as operating costs surge

Cerner reports Q2 results: revenue increased 32 percent to $1.13 billion, adjusted EPS $0.52 vs. $0.40, missing analyst estimates for revenue and reporting a 53 percent increase in operating expenses.

Allscripts earnings rise on bookings growth

Allscripts reports Q2 results: revenue was flat at $352 million vs $351 million for Q2 2014, adjusted EPS $0.12 vs. $0.09. Bookings for the quarter increased 11 percent to $260 million, but the company still posted a net loss of $3.2 million.

MEDITECH United States SEC Form 10-Q

Meditech reports Q2 results: revenue falls 16 percent to $117 million, EPS of $0.46 vs. $0.63. Service revenue increased five percent to $80 million, while sales revenue dropped 42 percent to $37 million for the quarter.

Papworth says no to Epic

In England, Papworth Hospital NHS Foundation Trust rescinds its Epic selection following recently reported problems with the Epic install at Cambridge University Hospitals. Papworth had entered into a joint procurement process with Cambridge in 2012 and was slated to install Epic in 2016.

News 8/5/15

Top News

Cerner announces Q2 results: revenue up 32 percent, adjusted EPS $0.52 vs. $0.40, meeting earnings estimates but falling short on revenue expectations as service revenue declined and operating expenses jumped 53 percent. The company raised full-year earnings guidance but lowered full-year revenue guidance, sending CERN shares down 3.5 percent in after-market trading following the market’s close Tuesday. CERN shares are up 26 percent in the past year vs. the Nasdaq’s 17 percent.

From the Cerner earnings call:

• CFO Marc Naughton says the company is disappointed that it missed its guided revenue estimates, but is happy with its all-time high strong sales and positive outlook.
• Recurring revenue from the Siemens acquisition is tracking as expected, but fewer than expected customers committing to moving to Millennium or buying additional of the former Siemens solutions as they are “holding pat with their hand.”
• President Zane Burke says Cerner differentiates itself (presumably from Epic) on predictable costs of ownership, fixed-fee implementations, and partial or full IT department outsourcing.
• Cerner says (without naming names) that it is gaining ambulatory business at the expense of Athenahealth because it offers better service and value.
• Burke says Cerner is happy to have been chosen by the DoD as part of the Leidos bid, but doesn’t expect a material impact on sales, revenue, or profits in the near term. He adds that the DoD’s project estimate is $9 billion over 18 years, but the value of the contract awarded is less.
• Cerner says its customers “are actually very excited” about its DoD win.
• Cerner’s new campus construction will require a capital expenditure of $150 million in the fiscal year.
• CEO Neal Patterson was supposed to join the call for Q&A, but did not participate.

Reader Comments

From Captain Cupric: “Re: CHIME’s for-profit vendor-CIO matchmaking service. Isn’t that what the AHA’s AHA Solutions group does? Vendors pay hundreds of thousands of dollars (sometimes more than a million dollars) for an agreement, then pay a percentage of sales for ‘introductions’ to decision makers.” I believe that’s the case, although AHA Solutions does have some sort of vetting procedure (other than having the vendor’s check clear) before anointing their solutions as “endorsed.” It annoys me when supposedly non-profit member organizations can’t resist the lure of transforming themselves into richly rewarded pimps who arrange vendor-member liaisons in exploiting the “Ladies Drink Free” business model. The healthcare history is rich with examples (AHA, AMA, HIMSS, etc.) and CHIME seems anxious to pile onto the financial bandwagon in selling access to its provider members.

From CIO Doc: “Re: DoD EHR coverage. HIStalk had all I needed to know, from the early rumors to Dim-Sum’s webinar to critical analysis of the selection and then contract and vendor insight.” The other sites didn’t get anything wrong, they just didn’t add much value to the single-paragraph DoD contract notice (which is all they had to work with) in cranking out mindless articles and tweet-seeking missiles like (a) plucking a few random tweets or reader comments about the selection and passing them off as an insightful article representing the industry’s collective reaction; (b) running a long piece about how Epic feels about getting passed over in repurposing content from a rather sloppy Madison newspaper article; (c) asking but not answering questions in headlines; and (d) assembling random, pointless factoids together in proclaiming “X things to know” that were in fact not at all worth knowing. I don’t see much value in having writers with zero healthcare or IT experience rewording public information to seem like fresh news, hoping to attract reader eyeballs and advertiser support with stories that provide those readers with little value, but that’s just me.

From Horse Hockey: “Re: Healthcare IT News. Tooting its own horn in an odd press release. It’s odd that they brag on their unstated DoD reader numbers and even more that they issued a press release about themselves – what editor other than their own would think something like that is newsworthy?” I hesitate to comment since this reader’s email came after I had already written my media diatribe in response to the comment above, but the HIMSS-owned HITN issues a self-congratulatory news flash stating that its (unstated) readership numbers temporarily rose by an (unstated) percentage after they stopped the online presses for lightweight articles as, “CIOs ‘surprised’ at Cerner DoD win,” “Is DoD’s EHR modernization bound to fail?” and “The good, the bad, and the ugly: social media’s response to DoD Cerner EHR contract win.” I don’t read any health IT sites since I’ve yet to find anything there that wasn’t amply described elsewhere, but more power to everybody who can earn and keep readers, especially if they’re trying to do it as cheap seats observers.

From Informatics Please: “Re: Tampa General Hospital. Has extended their instance of Epic to the University of South Florida in a large ambulatory Epic Connect project involving 850 physicians and 2,800 users.” Unverified, but the source is sound.

From RingRing-Tom Brady: “Re: question for clinical readers. What about a vendor prompts them to want more in going to the vendor’s website or picking up the phone? I’m interviewing and am amazed at how much faith sales and marketing people place in their CRM and automated marketing platforms to drive sales. Is email outreach and social media really making an impact or is it just lazy selling? Does it matter how many touches you hit a prospect with, or do they just hit delete? Does an old-school ‘let me tell you how I can help solve your problem’ work?” I’ll let readers weigh in, but I’ll say this: I often find that clueless sales and marketing people who measure vanity but irrelevant metrics such as ad clicks to be employed by equally clueless and unsuccessful vendors. I’ll also opine that any company that relies on Twitter and Facebook to drive sales might as well lock up and go home since most heavy users of social media (both vendors and providers) are junior employees rather than decision-making executives. I would wager that most healthcare IT sales come from word of mouth or existing personal relationships, not a flashier HIMSS booth or insultingly boilerplated emails.

HIStalk Announcements and Requests

Welcome new HIStalk Platinum Sponsor VitalHealth Software. The company, co-founded by Mayo Clinic and Noaber Foundation in 2006, offers cloud-based solutions that include chronic disease care management, patient questionnaires, an integrated digital interventions portal, a next-generation heath IT application development environment for deploying cloud-based EHR solutions, and a Mayo-designed EHR for specialty practices. The company is a certified supplier of ICHOM, which defines global outcomes standards for issues that matter most to patients. The company’s global eHealth solutions are used by 100 healthcare networks in the US, Argentina, China, Spain, and several other countries, with a project in China, for example, providing cost-effective telemedicine services with shared medical records, risk profiles, and patient access to their medical records by smartphone. Thanks to VitalHealth Software for supporting HIStalk.

I found this YouTube video describing the use of VitalHealth Software’s QuestLink questionnaire platform for patient-reported outcomes.

I was about to eat an apple this morning and polished it on my shirt, leading me to ponder, why do I do that? The apple has passed through a lot of unwashed hands on its way from orchard to me, so anything short of washing it or peeling it isn’t going to accomplish much (not to mention that polishing it will deposit cloth particles and whatever’s on my shirt on the peel I’m about to eat). It’s almost as mystifying as why many men (not me) pointlessly spit in a public restroom urinal before using it.

Listening: Vaults, a London-based synth pop trio that nobody seems to know anything about — their website says nothing about them and they aren’t even on Wikipedia or Amazon. Their melodic, slow, bass-heavy music is fronted by a siren-like singer. Trying to find them turned up “In Vaults,” a new album of Chicago-based, female-led prog rock from District 97. The band played an amazing live version of “Starless” that features King Crimson’s vocalist/bass player John Wetton, who sang the original version of that King Crimson musical epitaph to itself on the group’s 1974 final album “Red” and who delivered an engaged performance here, unlike most of his 1970s-era music peers who just prop themselves up on stage like sagging, lip-syncing Disney audio-animatrons.

I’m happy to report that most of the HIStalapalooza sponsorship spots have been claimed, meaning the odds have improved that I won’t go broke in throwing the industry a free party next February. Still available are the all-access CEO Rock Star package and one I’m calling HIStalkacabana, although we’ll still consider the needs of smaller companies who want to be involved (we’ve customized some packages already). Contact Lorre. Thanks for the companies that have stepped up – it’s going to be a great evening as always.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Acquisitions, Funding, Business, and Stock

Activist investor Starboard Value, which holds an 8.7 percent stake in MedAssets, calls for the company to replace some of its board members, questioning its acquisition track record and undervalued share price. MedAssets also files SEC disclosure that Tenet will not renew its group purchasing contract with the company, costing MedAssets $44 million in annual revenue or about six percent of its total, but Tenet will continue using its revenue cycle technology products under a separate agreement. MedAssets reiterated that it is continuing to pursue a “value creation plan” and the loss of the Tenet contract may cause “expense reductions, restructuring charges, and/or investments in products or services to help drive long-term growth.” Above is the one-year share price chart of MDAS (blue, up 1 percent) vs. the Nasdaq (red, up 17.3 percent). The company’s market cap is $1.3 billion, helped along by the prospect of Starboard Value taking control from present management.

Preventative care and disease management platform startup Zest Health, co-founded by former Allscripts executives Glen Tullman and Lee Shapiro, raises $6 million in Series A funding, with an unstated amount of the money coming from the Tullman-Shapiro-led 7wireVentures.

Aetna announces Q2 results: revenue up 4 percent, EPS $2.05 vs. $1.69, falling short of revenue expectations but beating on earnings. AET shares rose 46 percent in the past year, with CEO Mark Bertolini holding $83 million worth.

CVS Health announces Q2 results: revenue up 7.4 percent, EPS $1.12 vs. $1.06, beating earnings expectations but reporting a front-of-store sales drop of 7.8 percent following the company’s decision to stop selling tobacco products last fall.

The Advisory Board Company reports Q2 results: revenue up 30 percent, adjusted EPS $0.40 vs. $0.30. The company also announces a new healthcare marketing product, Audience RX.

Allscripts reports Q2 results: revenue flat, adjusted EPS $0.12 vs. $0.09. GAAP numbers showed the company losing $3.2 million in the quarter. From the Allscripts earnings call:

• CEO Paul Black is happy with the company’s sales, revenue, profitability, gross margin, and recurring revenue.
• The company added 180 new customers in the quarter.
• The company signed one net-new Sunrise client, a 50-bed hospital.
• Allscripts will work with NantHealth on API integration between their respective systems and in integrating genomic data.

I reported a reader’s rumor on July 29 that said a company (whose name I omitted) would divest several hospitals and its consulting company. I omitted some of the details since they involved the publicly traded Community Health Systems, which announces exactly what the reader reported – it will spin off 38 of its rural hospitals and Quorum Health Resources. CYH share price has risen 60 percent in the past year, valuing the company at $7 billion and the holdings of CEO Wayne Smith at $61 million.

Premier acquires supply chain and performance services vendor CeCity for $400 million. The company offers PQRS reporting, an educational platform, clinical data registries, and a performance and population health management system. CEO Lloyd Myers, a pharmacist, founded the Pittsburgh-based company in 1996.

Meditech’s Q2 report shows total revenue down 16 percent and product revenue down a startling 42 percent as the company moves from $23.4 million net income to just over $17 million quarter over quarter, reporting EPS of $0.46 vs. $0.63. Six-month net income dropped from $85.4 million to $37 million. Sales dropped nearly $26 million as maintenance fees made up more of the company’s total revenue, with that big sales drop seeming to prove the market perception that Meditech is no longer a significant challenger as Cerner and Epic make it a two-horse health system EHR race as they move down the food chain into smaller and acquired hospitals.

Sales

Delaware Valley ACO chooses Wellcentive’s value-based care solution.

Presbyterian Healthcare Services (NM) will deploy Zynx Health’s Knowledge Analyzer to standardize its clinical decision support using evidence-based intelligence.

University Health System (TX) chooses Spok for enterprise clinical communications.

Baptist Health South Florida chooses Cerner Millennium and HealtheIntent for all of its locations, apparently replacing Soarian clinicals but keeping Soarian financials in favor of Cerner’s own offering.

Spartanburg Regional Healthcare System chooses HCTec Partners for Epic 2015 implementation consulting.

People

Hebrew SeniorLife (MA) names Peter Ingram (MetroChicago HIE) as CIO.

Diana Nole (Carestream Health) will join Wolters Kluwer Health as CEO.

Ingenious Med names Todd Charest (Cogent Healthcare) as chief innovation and product officer.

SRG Technology, which offers population health management technology it developed with Massachusetts General Hospital, hires Adrian Zai, MD, PhD, MPH (MGH) as CMIO.

Greenway Health names David Wirta (Vista Consulting Group) to the newly created position of chief revenue officer.

Announcements and Implementations

NTT Data acquires global exclusive rights to products from it business partner InteHealth, which include a cloud-based HIE and portals for patients and physicians. The LinkedIn profile of former InteHealth VP Frank Nash (now senior director at NTT Data) says NTT Data acquired the assets of InteHealth on June 1, 2015 and the company is now part of NTT’s Healthcare Convergence Group.

London-based EY (the former Ernst & Young) consolidates its health consulting offerings in a barrage of obfuscatory buzzwords, promising to “collaborate with clients on improving efficiencies, catalyzing new digital health technologies, and helping to ensure wellness and prevention.” The company promotes Jacques Mulder to Global Health Sector Leader, a title that begs to be uttered in a Darth Vader voice.

Government and Politics

The Senate’s HELP committee is scheduled to discuss Karen DeSalvo’s nomination for HHS assistant secretary of health on Thursday, August 6. This is probably the Senate’s first step in confirming President Obama’s May 2015 nomination of DeSalvo for the HHS promotion, which would leave ONC searching for its next National Coordinator. She won’t get much if any opposition. 

Privacy and Security

Sensato and Divurgent will offer a three-day workshop titled “Designing Secure Healthcare Systems” October 27-29, 2015 in Long Branch, NJ. It would be fun to attend a hacker’s conference – I bet they are constantly trying to pry into each other’s Wi-Fi connections to earn happy hour bragging rights before the World of Warcraft all-nighter.

Indiana-based NoMoreClipboard vendor Medical Informatics Engineering says the medical information of 3.9 million people was exposed its May 2015 breach by unknown hackers. The long list of affected health organizations include Concentra, Franciscan St. Francis Health Indianapolis, and Rochester Medical Group. The company’s former president says it took in $18 million in 2014 revenue from 2,500 commercial clients, all of which could go right down the tubes after this massive breach. MIE’s other claim to fame is that it invented the phony Extormity and SEEDIE sites that made fun of EHRs a few years back, an attempt to gain the company publicity that unfortunately fell far short of the exposure it’s getting from spilling the data of millions of people into the hackersphere.

Innovation and Research

The FDA approves Spritam, the first drug to be manufactured by 3D printing. Manufacturer Aprecia holds an exclusive worldwide license for MIT-developed 3DP (powder-liquid three- dimensional printing) technology, which can deliver a high-dose drug in a quickly dissolved tablet. Spritam is a new formulation of the existing epilepsy drug levetiracetam (Keppra).

Other

In England, Papworth Hospital NHS Foundation Trust backs out of its commitment to implement Epic following an investigation into the Epic implementation of Cambridge University Hospitals NHS Foundation Trust, with which Papworth jointly chose Epic in the spring of 2013. Papworth’s board concluded last week that Epic won’t deliver optimal value and says it will consider other vendors to provide “a cost-effective ICT system which meets our patients’ needs.” I like that they’re thinking value, as they obviously do in working from building that looks like a slightly decrepit hotel rather than the obscenely glitzy edifice complex palaces commonly found in even financially teetering US hospitals.

Athenahealth posts a video of CEO Jonathan Bush interviewing oncologist, author, and Affordable Care Act contributor Ezekiel Emanuel, MD, PhD. Emanuel says excess hospital bed capacity, low margins, and the fact that nobody really wants to be hospitalized will cause 1,000 hospitals to close as their bond market drives up, while the survivors will shift into other care venues. He’s against health system consolidation, which focuses on controlling the market, vs. more care-focused integration. He says most hospital executives have no idea what it costs to perform a given procedure or service, so any claims that they lose money on Medicare or Medicaid patients aren’t fact-based. Emanuel says EHR information can drive quality and price transparency. He thinks video visits are the wave of the future.

Researchers find that hospitals that score well on clinical quality metrics often have quality-focused boards of directors.

Computer systems at the fantastically named Credit Valley Hospital in Ontario, Canada go down for a day and a half following flooding that took out its telecommunications systems. As is always the case, the hospital claims patient care was not impacted in moving back to paper, which if you take at face value raises the question of why they bothered installing those systems in the first place.

Sponsor Updates

• Peer60 names Nuance as the leading provider of medical image-sharing offerings with its PowerShare Network.
• ADP AdvancedMD offers “5 ways to enhance your current ICD-10 transition plan.”
• Aprima will hold its user conference August 7-9 in Dallas.
• Aventura, Capsule Tech, CareSync, and Culbert Healthcare Solutions will exhibit at the Allscripts Client Experience August 5-7 in Boston.
• Billian’s HealthData offers “Traversing the Path to Patient Data Access.”
• Caradigm posts “Moving Healthcare Analytics from Measurement into Management.”
• Jaffer Traish, director of Epic consulting with Culbert Healthcare Solutions, publishes a letter to the editor of the Boston Globe titled “Celebrating strides being made in electronic health records.”
• CitiusTech wins the “2015 Best Companies to Work For” award from the Great Place to Work Institute for the fourth consecutive year.
• ClinicalArchitecture offers “Semantically Enabled Medication Reconciliation.”
• The Detroit News features Clockwise.md in a profile of the Henry Ford QuickCare Clinic.
• CoverMyMeds offers “Prior Authorization, Step Therapy and Quantity Limit … What’s the Difference?”
• Cumberland Consulting Group is named by the Nashville Business Journal as one of the 25 fastest growing private companies for 2015.
• Innovista Health CIO David McCormick explains how the organization’s partnership with Medecision helped move the network towards value-based care.
• Burwood Group is named one of Chicago’s “101 Best & Brightest Companies to Work For in 2015.”
• Recondo Technology will exhibit at the HFMA Region 10 Conference August 10 in Colorado Springs, CO.
• Practice Unite offers “6 Ways Secure Texting & Mobile Patient Engagement Apps Improve Patient Experience.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 8/4/15

Community Health Systems to spin off 38 hospitals, shift focus to larger markets

Community Health Systems will shed 38 of its 196 hospitals as it restructures to focus on larger markets. The health system, which currently owns 196 hospitals, will lose its status as the largest health system in the process.

FDA Clears First 3D-Printed Drug

The FDA has cleared a new 3D-printed oral epilepsy drug designed to dissolve with just a sip of water, even at doses as large as 1000 mg. The drug marks the first 3D printed medication to earn FDA approval.

Impact of the HITECH act on physicians’ adoption of electronic health records

A study published in JAMIA looks back on EHR adoption rates during  the five years since the passage of the HITECH Act, Surprisingly, researchers claim that the MU program only spurred EHR adoption by seven percent above the anticipated adoption rate given pre-MU adoption trajectories.

Curbside Consult with Dr. Jayne 8/3/15

I spent most of this weekend doing something that I really enjoy. Most physicians dread it, IT people tolerate it, and vendors may or may not love it (depending on whether they’re getting paid for it.) I won’t keep you guessing on the riddle of what I was doing – I was running a client’s upgrade project. As a CMIO, I picked up a lot of skills I never dreamed I’d have. It’s fulfilling to use them to help clients who are struggling or who want to take on something that’s bigger than they’re used to handling.

This wasn’t just any upgrade – the client wanted to install new hardware, upgrade the operating system, and upgrade the EHR/billing system all in the same weekend. There are varying opinions on whether that combination of tasks should be done at the same time. Does it make it too hard to troubleshoot? Does it create too much stress for the team? Is it just a bad idea?

Ideally most of us would prefer not to have to do all of these things at once, but unfortunately this client’s parent organization backed them into a corner from a timeline perspective, so we had to make it work. They realized the need to have some project management support so they could focus on other things they needed to complete prior to the upgrade. I was happy to agree, although somewhat nervous about the whole idea.

The client is one that I’ve been working with for some time. Even before I left my full-time CMIO gig, I had done some side consulting work and was therefore familiar with the team’s abilities and work ethic. I knew they had a strong leader – one of those “the buck stops here” types – who wasn’t afraid to roll up her sleeves and get dirty if needed. They also had a proven track record for solid communication and problem-solving. Upgrades of this magnitude aren’t without issues and I strongly suspected that with those factors in place that we would be successful.

The other asset of this team is its culture. They’ve embraced the idea that it’s OK to ask questions even if it seems to be challenging the status quo or questioning someone’s expertise. All the members seem genuinely motivated to deliver a quality product whether that product is software, connectivity, training, or support. They also have relatively thick skins and don’t take things personally, which is my favorite part of working with them. Sometimes the role of the consultant is to turn over every rock and make sure there isn’t anything hiding under it, even if it makes people uncomfortable. I appreciate being able to do my job without any hurt feelings or drama.

This team also has a strong record of aggressive project management, detailed planning, and constant refinement. They’ve done many individual upgrades over the last half-decade and have continually modified their plans to make sure that every detail has been attended to and that they have planned for a variety of contingencies. When they decided they wanted to try this plan, they already had proven methodologies for doing each of the component parts and it was fairly easy to figure out how we could fit them together.

When they first presented their plan, I was impressed. They had data on each of the last several upgrades they had done, including the elapsed time for various steps and a log of what didn’t go as planned as well as the modifications they identified for the future. They also had worked with the various vendors involved to identify potential timelines and to determine whether the combined project was even possible. A review of their documentation showed that the planning was sound, so the next step was to perform a tabletop exercise and walk through all the moving parts to identify any other potential gotchas.

This was several months ago, but I still remember how they walked through it all, talking through each step and verbalizing the handoffs. Several team members also added specific comments on their steps, such as, “… and now I’m going to stop process A, because we know that if we just pause it we’ll have a problem. Process A is now stopped. Clear for the handoff to the DBA.” It was overkill from anything I’d ever seen, but it let me know that they knew their stuff and were ready to tackle something larger. It did feel a little bit though like being in mission control for a spaceship launch, however.

Over the last several months, they’ve performed each upgrade separately in a test environment except for the hardware piece. Although they experienced some performance issues, they were within the expected realm considering that their test servers were several years older than their production servers. They started training end users several weeks ago and ensured that not only did the users demonstrate mastery of the content, but of the support process and troubleshooting steps and downtimes procedures that would be needed if something didn’t go as expected.

Our final test came about a month ago when they received their new hardware and did a complete dry run. There were a couple of glitches, but nothing that couldn’t be addressed. All training was complete the week before last and they’ve been in a code freeze, so all that was left was to review the downtime plan and train a couple of stragglers.

Most of my work with this client has been remote (I do so love working in my fuzzy slippers), but I wanted to be on site for the go-live. They’re in a city that has a lot to offer and I headed to town on Thursday to spend time with friends as well as to make sure I was in position if anything unexpected happened. When we took the system down on Friday evening and the clock started ticking, I admit it was a little bit of an adrenaline rush. I wasn’t prepared for what was next though – this is the most anxious I’ve ever been on an upgrade project. It wasn’t necessarily because I was worried, but because it was so quiet. I’m used to getting phone calls here and there with questions about sticky situations and I wasn’t hearing anything from this client.

When we reached our first pre-scheduled checkpoint call, everything was under control and they were even a little bit ahead on the timeline. I’m not used to working with a team that is this capable and organized and found myself having to come up with strategies to just mentally let it roll. The friends I was staying with have a pool, so I spent the better part of the weekend contemplating the mysteries of various kinds of rafts and floats while waiting for my next checkpoint call.

Everything finished early Sunday morning and we were able to get some end users on the system for quick testing before we released it to the urgent care locations that were just getting ready to open. I have to admit, with all the pool time this is the most relaxed I’ve ever been going into post-live support. The urgent cares represent only 10 percent of the typical user load, however, so Monday morning might be a different story.

We’re as ready as we can be – issue tracking processes are in place, people know where they need to be, the communication plan has been reviewed, and I’ve ordered enough food into the command center to feed an army. Every practice site will get a personal visit from someone on the team at some point during the day, whether there are issues or not. And every visit will be accompanied by a snack basket. Maybe it’s because of my roots (don’t ever go visiting without a covered dish, seriously) but I believe in letting the users know that we care how they are doing and wanted to bring a little something to brighten up the day.

It’s now Sunday evening and the daily close process is running. The nightly backup will kick off soon and I hope everyone is settling in for a good night’s sleep. I’ll let you know later in the week how it goes. Despite its magnitude, this has been a lot of fun.

What’s your favorite kind of IT fun? Email me.

Email Dr. Jayne.

HIStalk Interviews Grahame Grieve, FHIR Architect and Interoperability Consultant

Grahame Grieve is a principal with Health Intersections of Melbourne, Australia and was the architect-developer of HL7’s Fast Healthcare Interoperability Resources (FHIR, pronounced “fire”) specification that allows EHRs to exchange information.

Tell me about yourself and what you do.

I qualified as a bench scientist in a hospital, but got dragged into working for a lab systems vendor. I got more and more involved in interoperability. Eventually I cut loose and consulted in interoperability and system integration in healthcare. Then I got gradually more and more involved in leading the standards in the area. Mainly I consult with the national programs.

Programmers call FHIR public API for EHRs. How would you define FHIR to a clinician and explain to them why it’s important?

It’s a framework for finding and exchanging data between two different systems so that they can exchange data in the background to provide services in the foreground that make people’s ability to do medicine better. You have to sort out flows, data contents, and agreements about responsibilities. FHIR focuses on doing those through modern technology, the same kind of agreements that support the massive systems around Facebook, Google, Apple, and the current social web system.

What lessons have we learned from the adoption of HL7?

It’s really hard to get people to agree. The content agreements and business agreements are valuable things that accrete very slowly. People line up with very long life cycles to them. You can’t expect quick change. You can legislate for it, you can pay for it, but you won’t get it. It takes time to get people to perform surgery on their systems while they’re going.

The criticism of HL7 is that vendors took advantage of its flexibility in making it less of a standard and more of a general framework. Is there a fine balance between being prescriptive enough versus making a standard too open?

Yes, it’s really difficult to find the right balance there. This variation in implementation was because vendors didn’t know any better and we didn’t have any way to encourage consistency of interpretation. We’ve tried to do what we can about that more recently.

There’s also variation because we have no authority to tell people to behave better, to act consistently, to make consistent decisions. Because we can’t dictate behavior, we have to tolerate a lot of inconsistency in the base specification. That fosters inconsistency in interpretation. It’s an ongoing process getting people to agree about those decisions.

What they don’t like is telling them how their business should work. But they do like to tell us that we should solve their business problems.

Are there concerns that the FHIR standard may fall short in meeting the lofty expectations that have been set for it?

There’s people out there who think that with FHIR we’ve solved all the problems. We haven’t, because we’re not authorized to solve lots of the problems.

What we’re trying to do is to get the interoperability format and framework out of the way of the problems that exist. They’re still real problems that will require real hard work to solve. I’m proud of what we’ve done with FHIR, but we only solve one of the set of problems that exist.

What else has to be done beyond developing and using FHIR?

There’s a set of things around security and understanding the balance between usefulness and risk in healthcare. Until we get a degree of agreement across a broad set of stakeholders about what risk is acceptable and what the trade-offs between risks and benefits are, that will continue to be a roadblock.

Then there’s a bunch of things needed around legal liability for exchange of data. There’s always ongoing tension about how much data people want to exchange. Exchanging data and commoditization are related. People will always resist commoditizing their core business. They’ll always be in favor of commoditizing their plumbing. Not a lot of awareness about the relationship between people’s interoperability and commoditization and plumbing in core business. Until core businesses align, then that will continue to be a challenge as well.

Finally, at the clinical level, there’s strong disagreements about clinical content and what kind of clinical statements you should be able to make and be able to exchange. Until the clinicians agree about what clinical interoperability is — not IT interoperability, but clinical interoperability, and that we actually need that — then the amount of clinical interoperability we have will be highly limited.

Was the past focus on document-based exchange a good learning experience and a good alternative or did it take us away from where we should have been going all along?

One of the things that I keep saying within the standards community is that you’ve got to accept your limitations. You can have what’s possible. We weren’t in a position to offer a data-centric standard. The industry went with a document-centric approach. It has great limitations around the ability to do workflow and data integration, but it has a great advantage around the ability to have some kind of immediate, computer-assisted data exchange for humans, where you have low agreement about workflow and clinical content.

Lots of the systems that have come to exist have come to exist because we did what you might call the low-coherency, document-based exchange approach. That’s continued to be a valid thing to do. We’ve gone out of her way to make that possible with FHIR while at the same time allowing people to cherry pick things and do data-based integration and exchange where the clinical processes support and need that. It’s going to continue to be a mixed picture.

When you look at the lack of interoperability, what do you think are the most important or the most difficult issues to address?

Moving data around costs money. Nobody really knows how much that should cost. There seems to be a strong view that the market value is not a fair value because the market is rigged. But none of the proposals that I’ve seen to fix that involve less rigging of the market. They’re just rigging it differently.

It’s extremely difficult to have any sense of what fair value for the cost of exchanging data is. It’s too easy to extract rent one way or another. That will continue to be a major obstacle because for most data exchanges I get involved with, there’s a real asymmetry between the cost of moving the data and the benefits of moving the data. The benefits typically accrue further downstream to someone who’s not paying for the data exchange and really thinks they shouldn’t need to. That will continue to be a big barrier to progress.

Other than that, getting clinical agreement about what the clinical interoperability needs to be and driving clinicians to change their practice to be consistent and to practice medicine consistently rather than inconsistently. That’s a huge cultural gulf that they’re going to have to confront soon.

How long will it be before patients can reasonably expect a new provider to have instant access to their existing data?

It’s a process. In the past, we didn’t have any way of exchanging data. We figured out how to exchange billing and identification data and some diagnostics. Then we added the ability to do some pretty crude document-based transfer of the data. That was a big achievement. I worked on that.

Now we’re extending that to cover through the JSON API task report to cover availability of limited data that can be looked at and maybe processed a little bit. A bunch of consortiums are working on getting better quality and more consistent data. That will take a lot longer.

You build a mountain, you stand on top of it and see a bigger mountain that you can go and stand on top of. The urgent need to build bigger mountains never goes away. We’ll just keep climbing up the stack towards a useful system. Each mountain is about a 10 to 15 year building process. That’s how it has gone historically.

Are we trying to do something in healthcare that other industries haven’t done in asking competitors to share their customer data with each other?

There’s a number of industries where they have data sharing arrangements of one kind or another. Those things are possible and they work to some degree. They need some kind of governmental interference or mandate to make them happen. Very often, most of those industries wouldn’t go back to the chaos they had before.

I live in a country where there’s not a lot of competition for business, but the interoperability picture is not very different. It’s really hard to move data. The US focus on competition and anti-competition is a bit overstated. Countries that don’t have a lot of competition still have trouble exchanging data unless they have a single provider providing all of the clinical systems. It’s just a matter of time to drive consistency.

One big problem people don’t talk about very much is legacy data. Almost all of us could easily get to an interoperable state if we simply one day turned off our legacy data and threw it away. Most practicing clinicians and clinical institutions are kind of reluctant to part with their legacy data. They call it ongoing care of a patient. As long as take that attitude — which we should — to healthcare interoperability, it’s got to be a slow process to move everything forward.

You mentioned that there’s a disconnect between who gets benefits from sharing data versus who pays for the cost of sharing data. What would be the ideal model? Should those who contribute data be rewarded in some way by those who receive it?

I don’t really know. Standards arise in a broken market. That’s a question that I’ve heard a lot of speculation about, but no convincing story. If the incentives were aligned, we wouldn’t need standards and people would just do it. We’re trying to move the market to a better, stable place.

Perhaps countries where they have a more holistic approach to funding … there’s a professor at my local university who says that we have an "ill-thcare" system rather than a “healthcare system.” If we focused on health and paid for health, then maybe the incentives would align differently. I don’t think that’s a very easy transformation to make.

What do you think of the work of the SMART group that uses FHIR as their data query method?

We love SMART. The SMART team are members of the FHIR team and vice versa. We have a very strong working relationship indeed. I think that 80 to 90 percent of the deployment of FHIR systems will also be a deployment of SMART on FHIR systems. It’s possible, although not certain, that SMART on FHIR will eventually become part of the FHIR specification. That’s water to go under the bridge yet. They’re doing great work. I really personally endorse their goals and they endorse our goals to the point where at some stage we might just be one team.

If you could wave your interoperability magic wand and have one wish granted, what would it be?

I wish the clinicians would believe in clinical interoperability the way that the IT people believe in IT interoperability. We’ve had doubters in the past, but pretty much everybody believes in it now if only we can get there. I wish the clinical people thought that that was a clinical problem.

Morning Headlines 8/3/15

Cambridge University Hospitals NHS Foundation Trust investigated over finances

In England, the Cambridge University Hospitals NHS Foundation Trust will be investigated by Monitor, the primary regulator within the NHS, over financial problems, including the introduction and management of its $300 million Epic install.

FDA warns of security flaw in Hospira infusion pumps

The FDA has issued a safety alert warning that Hospira’s Symbiq infusion pumps contain software vulnerabilities that allow attackers to take remote control of them over hospital networks. The alert recommends discontinuing use of the pumps and moving to a new infusion system as soon as possible.

Health Care Scheduling and Access: A Report From the IOM

The Institute of Medicine publishes a report on issues related to access, scheduling, and wait times in healthcare. The report outlines ten strategic initiatives it hopes will improve access and care delivery options for patients.

Monday Morning Update 8/3/15

Top News

England’s Monitor regulatory program is investigating the $300 million Epic rollout and overall financial management of Cambridge University Hospitals NHS Foundation Trust. Cambridge was Epic’s first UK client, with the 10-year, $250 million contract announced in early 2013. 

Reader Comments

From Military Medicine: “Re: DoD EHR bid. Your estimate of 10-20 percent of the total contract value going to Cerner is a bit high from what I’ve heard – it might have been as low as 9-15 percent, which is why Cerner cautioned investors not to get overly excited about their potential revenue and profit. I also suspect Leidos won’t be all that excited about rolling out a new solution since they have the lucrative contract to maintain the old system – they will let the government delay at every step they can bill for working on both systems at the same time.” Leidos its later spinoff SAIC have been paid billions to create and support the DoD’s AHLTA, the renamed Composite Health Care System that wags say stands for “oh, hell, let’s try again.” Leidos has incentive to milk AHLTA for as long as possible while simultaneously collecting checks for its new project work. Using the low end of that range, Cerner’s cut of the rumored $1.7 billion in guaranteed money over 10 years would be only $15 million per year, which given Cerner’s annual revenue would indeed not be an investor-cheered windfall.

From Grunt in Green: “Re: DoD EHR bid. For those who say this is the world’s largest HIT procurement, 60 percent of DoD care is handled by civilian delivery systems under TriCare, so quite a few systems are already larger than DoD, including Kaiser for sure and probably Sutter and Providence.”

From Bang a Gong: “Re: DoD EHR bid. I hope everyone watches closely as Leidos goes over their $1.7 billion bid, then blows through the $2.6 billion in contingencies, and then keeps right on running up the project’s tab while simultaneously renewing their sustainment contracts for AHLTA. By the time they realize how far over this will go, they’ll be beyond the point of no return and will have to finish it, even with huge overages, to avoid an even bigger NPfIT debacle.” Of that I have little doubt since government IT projects never come in on schedule and at the original cost estimate.

From UberUser: “Re: Uber’s user rating added in the latest update. Lots of HIS consultants and vendors use Uber. I wonder if anyone has attained the elusive 5.0 rating? I have a 4.7 with 50 rides, so I probably got a 1 from a guy I complained about.” I checked mine and it’s 4.9. I’m a bit less enamored than I once was with Uber due to (a) frequent surge pricing that makes me suspect that it’s more reflective of company need for profits rather than the demand for rides; (b) drivers who cancel the arranged ride because they don’t want to travel that far to pick me up; (c) lack of drivers in some areas so that you can’t get a ride at all; and (d) imposition of minimum pricing in some cities and when traveling from some airports such that it’s cheaper to just get a cab or an airport limo. I miss Uber when it’s not available, though, such as in Las Vegas, where cab driver protests and the city’s powerful taxi lobby (which includes two former Nevada governors as lobbyists) got Uber shut down awhile back, although I hear it may return. I tried to use Uber in Seattle and only Uber Black (not Uber X) is available at the airport, with the $50 flat rate charge to downtown being $5 more expensive than booking a car on the spot, which in my case turned out to be a stretch limo for the flat $45.

HIStalk Announcements and Requests

Eighty percent of poll respondents check their work email or voicemail at least once per day while on vacation, most just a handful of times, but 12 percent admit that they do so nearly constantly. New poll to your right or here: what factor was most responsible for the Leidos-Cerner-Accenture DoD EHR win?

Readers continued to seek information on the DoD’s EHR project Thursday, when HIStalk pages were displayed 17,000 times in 12,000 unique visits, beating the all-time record set the day before. Since then, though, newsworthy “news” has been close to non-existent. Today’s post is short, but includes everything important — there just isn’t much of it post-DoD announcement and I won’t waste your time with faux news.

Here’s a tip to folks running tiny (or even one-person) companies: it’s pompous to call yourself CEO when you don’t really have many executive duties. I hereby create an industry rule: you can use the title “president” once you’ve hit five employees, but you can’t brag on being “CEO” until you have 25 employees. Fewer than five employees makes you a “principal” or “owner” or whatever else you like the suggests roll-up-your-sleeves work rather than jetting off to board meetings or delivering weighty speeches.

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

My Medical Records Saga Continues

I faxed my request for a copy of my medical records to the hospital on June 26. This past Friday, five weeks later, an letter-sized hospital envelope came in the mail with my name and address handwritten on it with no indication of what was inside. I opened it up and there was my visit summary, contained on two pages front and back as printed off from the hospital’s Epic system. The hospital didn’t include a greeting or explanation or anything to indicate why they had sent the copies – it was just the two pages in an envelope with the hand-scrawled address, which was a long way from being professional. I was surprise they didn’t include a marketing or personal message knowing that most people request their records because they’re going to seek care elsewhere or file a lawsuit, either situation being an excellent time to engage positively with the patient.

Last Week’s Most Interesting News

• The Department of Defense chooses the team of Leidos, Cerner, Accenture, and Henry Schein for its EHR implementation project.
• McKesson CEO John Hammergren says in the company’s earnings call that “we have been struggling in the hospital IT business.”
• Rep. Renee Ellmers (R-NC) introduces the Flex-IT 2 act that would delay Meaningful Use Stage 3 until at least 2017.
• An investment fund co-founded by Harvard professor and disruption author Clayton Christensen invests $8.4 million in care coordination vendor ACT.md, whose platform was developed by Zak Kohane, MD, PhD and Ken Mandl, MD, MPH from the informatics department of Harvard’s Boston Children’s Hospital.
• NantHealth Founder Patrick Soon-Shiong, MD takes his cancer drug firm NantKwest public, valuing his holdings at $1.6 billion, 33 times the amount he paid for the company a year earlier.
• UMass Memorial Health Care (MA) says its implementation of Epic will cost $700 million over 10 years, the health system’s largest capital expense ever.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Sales

Department of Vermont Health Access chooses eQHealth Solutions for population health management technology.

People

Gretchen Tegethoff (TechExec Advisors) is named to a newly created CHIME VP position overseeing its for-profit CHIME Technologies. The business apparently charges vendors an enrollment fee and then takes a percentage of each sale made to CHIME members. Even HIMSS isn’t so brazen as to pimp out its dues-paying members for a percentage piece of the sales action.

Announcements and Implementations

Allscripts Sunrise user National Institutes of Health Clinical Center attains HIMSS EMRAM Stage 7.

Privacy and Security

FDA advises hospitals not to use Hospira’s Symbiq infusion pump following a Homeland Security warning that it is susceptible to attacks from hackers who could gain access to a hospital’s network. It’s the first time FDA has issued a cybersecurity-related medical device product warning. Hospira had been phasing out the Symbiq pumps since 2013, when FDA raised product quality concerns.

Innovation and Research

An Institute of Medicine report titled “Transforming Health Care Scheduling and Access: Getting to Now” lists patient scheduling best practices that include having the scheduler delve deeper into the patient’s need, give the patient options for appointment times, and providing alternatives to a clinician visit.

Other

I was talking to an ENT surgeon last week and asked him about his EHR. He says his office uses the NextGen practice management system, but gave up on its EHR because it was too cumbersome and slow. He said he enjoys e-prescribing, but uses a standalone product instead because NextGen’s module isn’t workflow friendly. It sounds as though he might be better served with a specialty EHR.

Ten leukemia patients in Australia receive half the intended dose of cytarabine due to what sounds like an incorrectly created order set.

Former Kaiser Permanente semantic interoperability expert and former HL7 board member Robert Dolin, MD surrenders his medical license following his September 2014 sentencing for possession of child pornography.

Rocky Mountain Health Plans rolls out its MyDigitalMD video visit service with a funny parody video called “Save the Hipsters.”

Weird News Andy calls this a “s-s-s-selfie.” A man poses for a photo with a rattlesnake in Yellowstone National Park, with his resulting snakebite requiring a five-day, $150,000 hospital stay for treatment and antivenin (which only one company makes at $5,000 per vial.) That reminds me of an old snakebite joke you probably know whose punch line is, “He says you’re going to die.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 7/31/15

Ellmers Legislation Delivers Relief to Healthcare Providers

Congresswoman Renee Ellmers (R-NC) introduces the Flex-IT 2 Act, which proposes delaying MU Stage 3 rulemaking until at least 2017, citing as a reason the fact that only 19 percent of providers have met Stage 2 attestation requirements thus far.

Health IT & Health Information Services 2015 Midyear Market Review

Healthcare Growth Partners publishes its 2015 midyear review, focusing on health IT investments and IPOs. The report finds that private investments have increased 509 percent since 2007, while the number of IPOs has climbed 367 percent.

BJC HealthCare hobbled by system wide computer outage that lasted 20 hours

13-hospital BJC HealthCare (MO) experiences 20 hours of network downtime that impacted both its EHR system and its corporate email across all of its facilities.

McKesson Reports Fiscal 2016 First-Quarter Results

McKesson reports Q1 results: revenue grew nine percent to $47.5 billion, adjusted EPS $3.14 vs $2.47. Revenue from the company’s technology solutions business unit fell four percent.

EPtalk by Dr. Jayne 7/30/15

I received a fat envelope in the mail today. Unfortunately it was from my former employer’s credential verification service, reminding me of the need to renew my medical staff privileges. I thought it was odd since I resigned my appointment when I quit, but a call to the medical staff office confirmed they never received my letter. In keeping with the digital age (even if it doesn’t comply with the medical staff bylaws) they let me resign via email and confirmed receipt. This is the first time I’ve been without hospital privileges since finishing residency and it feels a little odd.

Speaking of receipts, my new pet peeve: Outlook users who have their accounts set up to request a “read receipt” for every email they send, regardless of its importance. One of my consulting clients gave me a corporate email account and my inbox is plagued by two analysts with this behavior who also engage in extreme carbon copying. You can bet our next discussion of their communication policy will include these elements.

Another pet peeve: sales teams who use physician directories to try to drum up business from people they think might have money. “I called your office earlier and spoke with Katherine, but wanted to follow up with you via email about our event.” Interestingly, I’ve never worked with anyone named Katherine and haven’t had an office for months. I’m not sure I’d trust someone to manage complex affairs like asset protection and financial advice if they can’t manage the truth.

From Cardinal Fan: “Re: BJC HealthCare experienced a system-wide computer outage lasting over 20 hours across more than a dozen facilities. It wasn’t just the clinical systems – everything was down including email. Corporate mouthpieces celebrated our contingency planning, but things were far from smooth. Emergency departments went on diversion and transfers from other hospitals were impacted. Although there is no official root cause, lots of employees are speculating hackers might be involved.” Local media agree with the lack of smoothness, noting problems with moving patients from the emergency department to patient care floors without a functional bed tracking system. An internal email forwarded to me described “system-wide information systems non-functionality.” I admire their fine use of synonyms to avoid saying “outage” or “downtime.” Definitely a bad week to practice medicine in St. Louis – about four hours into the incident, a 20-inch water main broke outside flagship Barnes-Jewish Hospital, sending water into lower levels of the facility and shorting out electrical equipment. At least one backup generator failed and over 130 patients were evacuated.

Some physicians I was having lunch with earlier in the week were discussing the recent Forbes article about curing “Doctor Dropout.” Young physicians see the stress levels of their teachers and mentors and are selecting careers outside of traditional practice. The piece cites Stanford as having just 65 percent of their students going on to residency training in 2011. That doesn’t surprise me – although it was a few years before 2011, nearly 10 percent of my medical school graduating class elected not to pursue residency training or even physician licensure. Of those who did complete their training, quite a few of us have left the careers we trained for.

The author comments that “trying to combine revenue maximization into a clinical process results in a system best described as a Gordian Knot designed by Rube Goldberg. Common sense would suggest that adding yet more complexity (e.g. new payer reporting requirements) on top of an already-flawed model is a recipe for disaster.” That about sums it up.

In case you were getting bored waiting for the Meaningful Use final rule, CMS released proposed rules addressing long term care facilities. The nation’s 15,000 nursing facilities would be required to send care summaries when patients are transferred. I’m disappointed that they’re not requiring electronic transactions in the same formats required of the rest of us. Instead, they’re just proposing a set of information to be communicated. Problems with transcription errors and inaccuracies were cited as why the rest of us need to exchange data electronically with prescribed formats, but I guess CMS thinks nursing homes don’t need to be held to the same standard. The actual language states:

Transfers or Discharge: We propose to require not only that a transfer or discharge be documented in the clinical record, but also that specific information, such as history of present illness, reason for transfer and past medical/surgical history, be exchanged with the receiving provider or facility when a resident is transferred. We are not proposing to require a specific form, format, or methodology for this communication.

I can’t believe that not even a problem list, a medication list, or an allergy list made the cut. At least when they’re done torturing eligible providers and hospitals, CMS will have plenty to work on with other facilities.

What do you think about the proposed rule for nursing facilities? Email me.

Email Dr. Jayne.