News 11/13/15

Top News

Bloomberg Businessweek puts medical device hacking on its cover, profiling a security expert who was criticized for announcing that he had found that medical devices are full of security holes. “All their devices are getting compromised. All their systems are getting compromised. All their clinical applications are getting compromised and no one cares. It’s just ridiculous, right?” The security expert was hospitalized himself and played around with an automated dispensing machine for medications just outside his room, which he easily penetrated using a known, hard-coded password that let him open any drug drawer he wanted. He’s buying his own medical devices to prove how vulnerable they are.

Experts say hospitals rely on device manufacturers to implement security, but they remain a weak link in exposing a hospital’s entire network. A security firm describes what it learned by creating a “honeypot” fake medical device to see who tried to penetrate it:

The decoy devices that TrapX analysts set up in hospitals allowed them to observe hackers attempting to take medical records out of the hospitals through the infected devices. The trail, Wright says, led them to a server in Eastern Europe believed to be controlled by a known Russian criminal syndicate. Basically, they would log on from their control server in Eastern Europe to a blood gas analyzer; they’d then go from the BGA to a data source, pull the records back to the BGA, and then out … In addition to the command-and-control malware that allowed the records to be swiped, TrapX also found a bug called Citadel, ransomware that’s designed to restrict a user’s access to his or her own files, which allows hackers to demand payment to restore that access.

Reader Comments

From Occasional Angel: “Re: Theranos. I thought you’d get a laugh out of the company’s job posting for a communications director, which includes the requirement for an ‘agile thinker ability to respond quickly in shifting situations.’” Theranos certainly continues to experience shifting situations, nearly all of them causing further damage to the company. The latest headline is that grocery store chain Safeway is trying to wangle its way out of a previously unannounced Theranos partnership going back several years to put draw stations in 800 of its stores. The chain’s executives noticed that Theranos results sometimes differed wildly from the same test run by other commercial labs. Safeway also questioned why Theranos often drew samples from both a finger stick and by vein, with one of its executives astutely questioning “If the technology is fully developed, why would you need to do a venipuncture?” Safeway spent $350 million on the in-store clinic areas that featured granite countertops and video monitors, but is now using those areas only to administer vaccines.

My most positive impression of Theranos is that they were able to get the funding to invest in what must have been an ultra-expensive array of automated lab testing equipment (Nanotainer-powered or otherwise) that allowed it to undercut the price of huge-scale competitors. Lab testing is a lot more like a factory than a Silicon Valley startup and it requires brick-and-mortar drawing stations that send samples off to centralized labs, which as why I assume Theranos tries to convince everyone it’s the next Apple instead of an ambitious drop-off dry cleaner. It’s hardly a national diagnostic powerhouse given that its only locations are in California, Arizona, and Pennsylvania. In addition, most of those locations are in the drugstores of  Walgreens, which seems to be distancing itself from Theranos pending review of its test process.

From Marketeer of the Beast: “Re: your rebranding of a health system to the made-up name Blovaria. Here’s how I would explain it. ‘Blovaria is a unique way to recognize our evolution in the marketplace. Our new name is the ideal platform to help us deliver market-leading bloviation with extreme variation in patient outcomes’… and on and on.” I like marketing folks that see the humor in what they do. I disdain marketing-speak and committee-driven company depersonalization into a “brand” that often tries to rewrite history and overpromises future company performance, but I believe strongly in much of what makes up marketing. Honest marketing tries to effectively convey a company’s values and vision in a noisy market, which is problematic when the paying customer wants marketing to cover up their incompetence or misplaced mission of simply pocketing cash by any means possible. Marketing people usually write well and are entertaining, so I’d be interested in running a guest article (anonymously, if that helps) from someone willing to explain the goods and bads of what they are asked to do.

HIStalk Announcements and Requests

Mrs. Read from Florida sent photos of her students using the STEM exploration tools we provided via her DonorsChoose grant request. She says they’re working on a project where they’ve programmed the Sphero app-enabled robotic ball to detect underwater forces, adding that some of the students have been motivated to join the school robotics team as a result. Ms. Santoro from Connecticut sent photos of her first graders working with the tablets we provided, saying some of them don’t have access to technology at home and are asking to use them even when their assigned work is finished.

I got a kick out of this tweet from Nick Kennedy, who apparently enjoyed my mhealth Summit rant. He has history in healthcare IT, but is now the founder and CEO of a private flight-sharing company. It’s fun knowing that someone reads HIStalk just because it entertains them.

This week on HIStalk Connect: Walgreens expands its telehealth offering to 25 states and updates its wellness app to capture glucose and blood pressure readings from its line of wireless medical devices. Researchers from Cedars Sinai Medical Center and UCLA find no improvement to 30-day readmission rates or six-month mortality rates when enrolled in a remote patient monitoring program. The American Association for Cancer Research has launched a data-sharing campaign that will create a central repository for researchers to store and analyze tumor gene mutation data. TigerText raises a $50 million Series C investment to help it expand its healthcare-focused communications platform.

This week on HIStalk Practice: The Wright Center receives the 2015 HIMSS Ambulatory Davies Award. Rep. Tom Price introduces the Meaningful Use Hardship Relief Act. The Patriot Promise Foundation launches to help connect veterans with better, technology-enabled care. PracticeMax acquires Medical Management Corp. of America. Greenway Health’s Rob Newman dishes on the KLAS Keystone Summit. The Retina Group of Washington selects a new EHR from Modernizing Medicine. New DreamLab app crunches cancer research data while you sleep. Ask the Doctor acquires Patients Connected.

Webinars

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

November 20 (Friday) 2:00 ET. “The Athenahealth Leadership Institute Presents: Dr. John Halamka Interviewed by Jonathan Bush.” Sponsored by Athenahealth. Presenters: John Halamka, MD, MS, CIO, Beth Israel Deaconess Medical Center; Jonathan Bush, CEO, Athenahealth. Providers are fed up with interface fees and the lengthy, fragmented narratives we’re exchanging today. But what is the right course of action to help deliver better care across the continuum? Bring your questions as we join Dr.Halamka and Jonathan Bush to discuss the current state of healthcare and how we can improve care coordination and interoperability.

December 2 (Wednesday) 1:00 ET. “The Patient is In, But the Doctor is Out: How Metro Health Enabled Informed Decision-Making with Remote Access to PHI.” Sponsored by Vmware. Presenters: Josh Wilda, VP of IT, Metro Health; James Millington, group product line manager, VMware. Most industries are ahead of healthcare in providing remote access to applications and information. Some health systems, however, have transformed how, when, and where their providers access patient information. Metro Health in Grand Rapids, MI offers doctors fast bedside access to information and lets them review patient information on any device (including their TVs during football weekends!) saving them 30 minutes per day and reducing costs by $2.75 million.

December 3 (Thursday) 2:00 ET. “501(r) Regulations – What You Need to Know for Success in 2016.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare Solutions. Complex IRS rules take effect on January 1 that will dictate how providers ensure access, provide charity assistance, and collect uncompensated care. This in-depth webinar will cover tools and workflows that can help smooth the transition, including where to focus compliance efforts in the revenue cycle and a review of the documentation elements required.

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

Here’s the recording of Thursday’s webinar titled “Top Predictions for Population Health Management in 2016 and Beyond,” sponsored by Medecision.

Acquisitions, Funding, Business, and Stock

TigerText raises $50 million in Series C funding to expand the rollout of its secure messaging app.

The HCI Group acquires UK-based High Resolution Consulting and Resourcing. HCI CEO Ricky Caplin says the company is in “major expansion mode” and will likely announce additional acquisitions shortly.

Arizona-based HealthiestYou gets a $30 million investment from Frontier Capital. The company offers video visits, insurance connectivity, a provider director, and drug pricing lookup.

Turing Pharmaceuticals, the most-hated company in America after pharma-brat founder and former hedge fund manager Martin Shkreli jacked up prices on ancient but vital drug Daraprim, records a $15 million loss on revenue of $5.6 million for Q3. The privately held company will soon start clinical trials for drugs for treating epileptic encephalopathies and PTSD, introducing both hope and despair among those patients who might benefit from the drug but know how hard Turing will put the financial screws to them or their insurance company to obtain it. The first drug earned the FDA’s fast track designation, which makes it surprising that Shkreli didn’t just sell that certificate on the open market since they’ve gone for as much as $350 million. Shkreli is also looking for producers for his upcoming (c)rap album. Those with artistic aspirations but minimal talent always seem to settle for being posers in recording rap, writing children’s books, or appearing on reality TV shows.

People

Galen Healthcare Solutions hires Steve Brewer (Origin Healthcare Solutions) as CEO. Former CEO Jason Carmichael will remain on the board.

Former IDX CFO Jack Kane joins the board of Health Catalyst. He also serves on the boards of Aesynt (which was just sold for $275 million), T-System, and Athenahealth. He’s also involved with several other former IDXers (including former CEO Jim Crook) in OpenTempo, which offers staff scheduling and workforce management solutions for large medical practices.

Practice Fusion names interim CEO Tom Langan to the permanent role.

Jeff Surges (Healthgrades) will join health plan enrollment technology vendor Connecture as CEO.

Gene Amdahl, who went from being educated in a one-room South Dakota school without electricity to leading the development of the IBM’s System/360 mainframe and later the formation of compatible mainframe competitor Amdahl Computing, died Tuesday at 92.

Announcements and Implementations

Caradigm adds electronic prescribing of controlled substances (EPCS) to its Identity and Access Management solutions (single sign-on, context management, and identity management).

Privacy and Security

A proof-of-concept medical records project wins the Blockchain Hackathon in Ireland. It uses the blockchain to anonymize a patient’s electronic records and make them viewable to doctors or others to whom the patient gives their public identifier, retrieving the information via BitTorrent. A blockchain database securely stores a public ledger of transactions, in essence an ever-growing, append-only transaction log that does not require the participation of any third party to change hands. If you’re excited about the potential healthcare use of blockchain, consider writing an HIStalk guest article so educate the rest of us who have heard the word but don’t know much about it.

Technology

The Philadelphia-based Health Care Innovation Collaborative issues a call for chronic disease health project ideas, from which it will choose winners who will work with one or more of its partners that includes CHOP, Drexel University, Independence Blue Cross, Jefferson Health, and University of Pennsylvania Health System. The group was formed by the Greater Philadelphia Chamber of Commerce to increase Philadelphia’s health IT activity. 

In England, hospitalized children are being monitored by early warning software originally developed for Formula One race drivers. The pilot project involves wireless vital signs sensors attached to the chest and ankle that send data for real-time analysis and alerts. 

Other

BIDMC CIO John Halamka, MD expands on his observations and recommendations for the Meaningful Use program, which he says served its purpose but should be dismantled as it tries to do too much and interferes with patient care. Some of his observations:

• EHR certification threatens usability, interoperability, and EHR quality while also diverting resources away from more important work.
• Nobody is intentionally blocking information exchange – it’s really “incompetence that feels like blocking.”
• Government regulation isn’t the answer to solving societal problems and each new requirement adds a layer of clueless auditors.
• Prescriptive regulation, additional structured data elements, and new quality measures don’t help create disruptive innovation. A business imperative is required.
• The MU program should be rolled into other CMS incentive programs such as Alternative Payment Models and MIPS.
• ONC has become distracted by political agendas, excessive focus on certification, and issuing grants, where it would provide better results as a policy shop that addresses specific problems such as safety and error reduction.
• Stop blaming health IT vendors and providers as the enemy.
• Focus on the few things that really matter, not the 117 goals in the Federal Interoperability Roadmap.

A Health Affairs article says the Meaningful Use program increased hospital EHR adoption, but the effect of penalties as opposed to rewards is uncertain and small and rural hospitals continue to lag. Hospitals cited their challenges as cost, lack of physician cooperation, and the complexity of the MU program.

The San Diego paper profiles startup Doctible, which has created a network of local providers who offer discounted cash prices and online booking for people with high-deductible medical insurance. It bugs me that, like most other sites that list physicians, it puts “Dr.” in front of their name and “MD” after, which is incorrect.

Epic and Cerner face off on interoperability at the Disruptive Healthcare Conference at UW-Madison. A Cerner VP again calls for Epic to join CommonWell, while Epic’s VP says the company already helps its customers connect to CommonWell and shouldn’t have to “buy in” to CommonWell just to keep doing that, explaining, “There is not a magic future down the road in which there is one health information exchange network called CommonWell.” Both VPs agree that hospitals and practices need more incentives to share information.

Sponsor Updates

• AdvancedMD offers a $10 Amazon gift card to anyone who requests their information kit.
• PDR will exhibit at the McKesson Chain & Health System Pharmacy User Conference November 17-18 in Pittsburgh.
• Stella Technology is sponsoring and attending the NYeC Gala Awards to promote health IT in New York City November 18.
• Liaison Healthcare will exhibit at the PointClickCare Summit November 16-19 in Palm Desert, CA.
• LiveProcess will exhibit at the first annual Association of Healthcare Emergency Preparedness Professionals Conference November 17-18 in Omaha, NE.
• MedData will exhibit at the HFMA Region 9 Conference November 15-17 in New Orleans.
• Recondo Technology, the SSI Group, and Streamline Health will exhibit at the HFMA Region 9 Conference November 15 in New Orleans.
• PatientPay sponsors the iPatientCare National User Conference.
• PerfectServe will exhibit at the American Association for Physician Leadership Fall Institute November 13-17 in Scottsdale, AZ.
• Lexmark will exhibit at RSNA15 to benefit Camp Invention’s STEM programs for children across the US.
• ZirMed is sponsoring and will present at “Data-Driven Revenue Cycle” November 18 in Atlanta.

Blog Posts

• Insider Theft: The Human Version of Malware (ID Experts)
• Nothing but Net (Ingenious Med)
• Ask the Expert: EMV, Encryption and Reducing your PCI Scope (InstaMed)
• Pro Tips for Implementing Epic’s MyChart (Nordic)
• One Size Doesn’t Fit All (NTT Data)
• Dictation Made Easy (NVoq)
• New Survey Benchmarks Patient Engagement Tactics (Oneview Healthcare)
• Telemetry Care: Cure smartphone alerts (PatientSafe Solutions)
• The Other Socialized Medicine (PatientKeeper)
• Inaccurate Provider Data can be Very Costly! (Phynd Technologies)
• What’s New in Meaningful Use Stage 3? (Sagacious Consultants)
• Reducing Waste by Applying Interoperability Best Practices Presented at Lab Quality Confab (Sunquest Information Systems)
• Technology and Electronic Prescribing Aids in the Fight on Prescription Drug Abuse (Surescripts)

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 11/12/15

I’m headed to San Francisco for the AMIA meeting and will be reporting from there for the next several days. I haven’t been to a conference that is this academic in a long time and I have to say that planning for it has been more rigorous than I expected.

From everything I hear as well as from the pre-symposium orientation webinar, there is going to be more to do, see, and learn than one person could possibly do. There are more than 2,000 pages of content available already, plus a few hundred pages of questions and answers for Maintenance of Certification (MOC).

There are also Twitter feeds and an event app for managing your schedule. I’ve enjoyed going through everything and flagging the sessions I plan to attend or that I want to keep on my list as a backup. For someone like me who dabbles in many different areas of informatics, it’s a bit like being a kid in a candy store.

I’ll be attending some of the pre-symposium sessions as well. Dealing with them has been the only negative part of my experience so far.

When I signed up for AMIA several months ago, the list of sessions that are available for MOC credit for clinical informatics wasn’t available. Even though they’re no charge, the pre-symposium sessions required advance registration. Once the list of MOC-approved sessions was available and I had time to go back through them and see whether they matched what I had registered for, those that I wanted to switch to were full.

Attending conferences is expensive. Given the status of MOC for Clinical Informatics, I want to maximize the amount of credit I bring home. Although I’m not choosing sessions strictly by whether they are approved or not, given two sessions at the same time that I’m equally interested in, I’m going to lean towards the one that will give me credit.

I suspect AMIA is seeing a spike in registrations due to being one of the few providers of relevant and approved continuing education credit for our subspecialty. It will be interesting to see how it shakes out. In the mean time, I’m going to continue refining my battle plan to get the most out of the conference.

Whenever I head out for an extended trip, I gather up any hard-copy publications that can be read during taxi, takeoff, and landing so I can read and recycle them on the way. I saw this Healthcare IT News headline and it just struck me as somewhat offensive. Although IT is a key player in most industries, to say that a hospital would be “nothing” without its IT department is obnoxious. It would still be a hospital, it would still provide patient care, and it most certainly wouldn’t crumble to the ground.

The associated article is about best hospital IT departments, so I don’t expect it to address the fact that there are worse things than having no IT department – namely, having a bad IT department that creates chaos. Or one that behaves aggressively towards clinicians and doesn’t respect the input of various stakeholders. Or one that’s flat-out incompetent.

As a culture, we’ve become obsessed with these “best of” lists. I always think about one of my good friends that continued to make the “best doctors” list in my city despite having moved away several years prior.

The loss of any department — whether clinical, administrative, support, or other disciplines — would negatively impact any hospital. Headlines like this don’t help bring people together. I’d love to drop this in the physician lounge and see what kind of responses it gets. Maybe that’s an idea for a reality show – kind of a candid camera for healthcare IT users. I know some people who would watch.

What’s your idea of good entertainment? Email me.

Email Dr. Jayne.

Morning Headlines 11/12/15

The Path Forward for Meaningful Use

John Halamka, MD and CIO of BIDMC, publishes a blog outlining his assessment of the MU program. He explains, “Clinicians cannot get through a 12 minute visit, enter the necessary Stage 3 data elements, reconcile problems/allergies/medications from multiple institutions, meet the demands of the  Stage 3 clinical quality measures, make eye contact with patients, and deliver safe medical care. There needs to be a new approach.” 

For US Hospitals, A Mixed Report In Electronic Health Record Adoption

A study published in Health Affairs finds that by 2014, 75 percent of US hospitals had adopted a basic EHR, while 40 percent had implemented the functionality needed to meet MU2 criteria.

Boston Children’s looks to IBM’s Watson for rare-disease help

Boston Children’s Hospital will work with IBM’s Watson team to bolster the supercomputer’s nephrology database and enhance its logic to help spot rare kidney disorders..

Safeway, Theranos Split After $350 Million Deal Fizzles

The Wall Street Journal continues with its Theranos coverage, recounting a failed deal with Safeway that cost the grocery store merchant $350 million spent on in-store clinics designed to house Theranos analyzers that were never delivered.

Readers Write: Supply Chain Data Meets Clinical Outcomes: The Holy Grail

Supply Chain Data Meets Clinical Outcomes: The Holy Grail
By Andy Cole

The term “Holy Grail” has always been intertwined with stories of epic searches to find the Holy Chalice used at the Last Supper. From Dan Brown’s bestselling novel “The Da Vinci Code” to the always entertaining Spielberg/Lucas film “Indiana Jones and the Last Crusade,” fans have been drawn to the idea of finding something so elusive…so mysterious….so game-changing.

When I think about what it will take to dramatically change the cost, efficiency, and effectiveness of our healthcare system, the solutions too often seem as unattainable as the Grail itself. It dawned upon me that the “search for the Holy Grail” is a perfect metaphor for the ongoing efforts to deliver high-quality, medically-necessary and cost-effective healthcare across this country and beyond.

But as I think even deeper about the dilemma, I realize that the healthcare providers who are charged with solving this crisis already have the tools they need to do so. It’s at the tip of their fingertips. Literally.

For decades, healthcare providers had been in the dark about how much it cost to deliver their services. More importantly, thanks to inefficient reimbursement models, they really didn’t need to know. As long as payers (both private and public) paid them based on how much they charged, there was no incentive to truly understand those costs, and in turn, wrangle them in.

Soon, payers and policy makers realized this model was unsustainable and changes started to happen. Once they understood that reimbursement was driving care, they realized the only way to drive lower cost of care was to reduce reimbursement. With less money coming in the door for their services, healthcare providers had to undergo a paradigm shift. They had to cut costs wherever they could to meet the thin margins that were now in the marketplace. Efficiency was the name of the game, and classic cost-reduction strategies entered the arena.

Cut throat supply competition and Group Purchasing Organizations began playing a huge role in offering the lowest possible prices for supplies and bringing economies of scale to healthcare providers. CFOs began paying attention to how many supplies were being purchased and at what price. With a keen eye on the bottom line, cutting supply expense was usually low-hanging fruit that met their cost-saving objectives. With this need came slick analytic tools that aggregated supply and service spend data and clearly suggested areas for savings, whether that be utilizing a less-expensive vendor or taking advantage of a GPO contract.

We have fallen into our current state of “quality data” as an unintended consequence. Providers had historically focused on collecting data for every service they performed in order to receive maximum reimbursement from various payers. More services =  more money. As a result, claims data was serving only as an excellent vehicle to capture charges and little else was being done with it. As the environment shifted, and reimbursement focus shifted from fee-for-service to pay-for-value, the industry didn’t have to look very far to find the data they needed to analyze.

Since charge data provides a detailed representation of all of the services rendered in a healthcare facility, it was a logical next step to begin analyzing a patient’s data holistically, rather than just from an episode by episode basis. Payers and providers could now longitudinally piece together a patent’s entire health record and use it either increase reimbursement for positive outcomes or decrease it based on negative ones.

When the government bought in and incented providers to use certified EHRs, this only increased the amount of data that was collected. That’s where we find ourselves now — swimming in a sea of healthcare data. The objective now is to harness the power of data and take that next step to uncover new solutions to our cost problem.

With the right tools, we can now take a look at clinical outcomes and supply cost together, whether that’s for an individual patient stay, across many for the life of that patient, or all patients. For the moment, I’ll put myself in the shoes of the CFO of a multi-facility IDN.

Taking a deeper look at a cardiac rhythm management supply analytics reports may suggest that I could get a better deal on my pacemakers if I buy them from a vendor named Jolt instead of my current vendor, KickStart. In fact, with my agreement that I just signed with my GPO, I could save upwards of 20 percent this coming year if I convert to Jolt. A quick review online of Jolt products show no red flags. My chief cardiologist has heard good things and gives me the go ahead. I sign the deal and warm up my calculator to count my savings.

My argument is that there is a crucial step missing in that process, the one that takes into consideration the universal value of making that conversion. Having access to quality and outcomes-based data allows me to cross-analyze the cost of the new pacemakers with the outcomes of patients that use them across my facilities. Perhaps I would save 20 percent on them next year, but I see that patients who have them have higher readmission rates, which would result in Medicare penalties and reduce my reimbursement.

Additionally, I am now taking on risk for my patients because of the Accountable Care Organization arrangement we have negotiated with a major private payer. My goal is to deliver the highest quality care at the lowest cost. The payer gives me a set fee for each “covered life” I take on. If a patient utilizes an over-abundance of services in my network, I will most likely lose money on them. However, if I keep them healthy and can avoid expensive treatments and services, I keep anything left over from my payment. Since data is telling me that patients with Jolt pacemakers are twice as likely to take a costly trip to the ER than those with KickStart’s, I will take a much harder look to determine if that conversion truly makes sense.

With this “Eureka” moment fresh on the minds of healthcare CFOs around the country, they are now tasked with changing the paradigm of purchasing. Marrying clinical outcomes and supply chain costs takes new tools, a new culture, and a new vision. It is an essential shift that will help providers and payers stay financially solvent, and in the end, keep the patient healthier.

Our industry has the information we need to make smarter purchasing decisions. We just need to act on it. We actually have an advantage over Indiana Jones, who traveled the globe searching for his Holy Grail. We already have the Holy Grail we’ve been searching for at our fingertips. All we need is to look closely, smartly, and polish it to a glittering shine. This is a game changer.

Andy Cole is national director of PremierConnect Supply Chain solutions at Premier,Inc.

HIStalk Interviews Joshua Mandel, MD, Harvard Medical School

Joshua Mandel, MD is on the research faculty at Harvard Medical School and is the lead architect for the SMART project collaboration between HMS and ONC.

Tell me about yourself and your job.

I am on the research faculty at Harvard Medical School. I’m in the department of biomedical informatics there. I work on making it easier for patients, clinicians, and researchers to work with electronic health data. I got there via medical school, where as a medical student I realized there was a lot more that computers could be doing for us than they were doing.

Describe the SMART project and how it relates to FHIR.

SMART Health IT, which is an acronym for Substitutable Medical Applications and Reusable Technologies, is a project that was originally sponsored by the federal government, by the Office of the National Coordinator for Health Information Technology, with a goal of building an app platform that allows third-party apps to plug into various kinds of health information systems. We specifically focus on apps that plug into electronic health records, which might be apps that clinicians use, apps that plug into patient portals, personally-controlled health records the patient would use, or apps that plug into data warehouses that researchers might use.

The goal is to provide apps with everything they need to be able to present a consistent user experience. The apps shouldn’t have to know about all the internal details of each different health IT system. The goal is to abstract the apps from those details. That’s the high-level goal of SMART.

We use a number of technologies under the hood to make that work. We use a set of open technologies everywhere we can. We use an emerging specification from HL7 called Fast Healthcare Interoperability Resources, or FHIR, to provide the data layer of access. FHIR gives us a set of data models and it gives us a Web-oriented REST API that application developers can use to query an electronic health records system for data.

Then on top of that, we layer a security model using OAuth 2 and OpenID Connect so that users can sign into apps using their existing accounts so they don’t have to create a new account for every app they want to use. That includes a permissions model, so you can give apps access just to the data that they need and you don’t have to give apps access to everything in your system.

We wrap all that together with a little bit of glue so that we can actually plug these apps into, for example, an electronic health records system. You might be a clinician working with an EHR system from Cerner, Epic, or any number of vendors beginning to implement these specifications. When you’ve got a patient record open inside one of these systems, you can launch an app and it knows about the context of what you were doing inside of the EHR, so that app can launch directly on the patient that you already have open and help you get some new jobs done that the original EHR didn’t have any functionality for.

How will that be positioned against vendors who have declared themselves to be open and created their own equivalent of an app store or an ecosystem with partners that they’ve approved?

We’re seeing interesting trends from the electronic health record vendors towards allowing certain kinds of third-party tools to integrate with these EHR systems. There’s still some big, open questions about the extent to which we’ll see standards as the basis for that integration versus vendor-specific data access.

We can actually separate out two questions. One question is, what are the technical mechanisms by which the access works? Are we using standards like FHIR? Are we using vendor-specific APIs? That’s the technical piece of it.

Then there’s a policy piece. Regardless of whether you use standards or whether you use vendor-specific APIs, there’s a policy piece about which apps are going to be allowed to talk to a given system and how are vendors and healthcare provider organizations together going to control that access.

What levels of capability or interest in SMART are you seeing from the three significant inpatient EHR vendors?

Overall, the goal of SMART is to provide an interface where apps can plug into outpatient systems, inpatient systems, and various other kinds of health information systems, including health information exchanges and researcher-facing systems. We don’t have an exclusive focus on the inpatient world, but of course it is an important area.

We’ve been very encouraged over the last few months by the participation of a number of the big EHR vendors in a project called Argonaut. Argonaut is running an open implementation program, where anybody who’s building an app or an EHR can join for free and go through a series of development steps with us, where they can build out support for SMART on FHIR one step at a time. We’re running this open implementation program and we’ve had a couple of dozen organizations actively participating. That includes many of the big-name electronic health record vendors.

EHR vendors and even providers themselves don’t have much incentive to let patients choose and use whatever apps they want that tie into their legacy systems. How hard will it be to gain traction when the patient is the only obvious advocate?

There’s a lot of moving parts to an ecosystem like that. I talked a little bit about what’s the technology to make the platform work. I talked a little bit about what’s the access control policy. The other big question is, who’s the audience? Who’s using these apps?

We see a very clear motivation on the side of provider organizations to be able to rapidly adopt, and even to build, new applications that serve direct business interests or direct clinical interests. We see a strong internal motivation from healthcare organizations to be able to launch new apps.

For example, we have an app that we deployed at Boston Children’s Hospital that helps take better care of children with high blood pressure. It takes data from the EHR and uses them to compute blood pressure percentiles, which are normalized by a child’s age, height, and gender. That’s how you’re supposed to make a diagnosis of high blood pressure in children, by calculating those percentiles.

The EHR has all the data, but it doesn’t do the calculation, so we built an app to do the calculation. There’s a very clear motivation on the part of the clinical organization to be able to deploy an app like that –it runs inside the hospital, runs on top of hospital data, helps take better care of patients. We can think about other kinds of apps, which might be patient-facing applications, where a patient says, "I want to use this new health management tool I found." That represents a paradigm shift for provider organizations.

It’s still an open question how internally motivated these organizations will be to let patients bring these apps to the table, but I’m very encouraged by the recent Meaningful Use Stage 3 final rule, which came out and said that patients should have the right to access their own health data using whichever apps they want.

It’s been said that people didn’t know they needed an iPhone until it came out. What would be the equivalent that would tell patients that they need interoperable health apps?

I don’t think we’ve seen our first killer app, so to speak, in this space yet, but we certainly see a strong interest along the lines of patients who are managing chronic diseases, where they have to see a number of healthcare providers and the system is not tight knit enough today that the healthcare providers from these different organizations really communicate very well. A patient is very motivated to improve that communication, so apps and tools that help them do that are a powerful selling point.

Another area which we’re only just beginning to explore is apps that help you shop around for the right healthcare services, whether it’s deciding on the healthcare insurance that’s the best fit for you given your actual usage patterns or shopping around for a procedure or drug given the insurance that you have. The more data that apps can access, both about you individually and about other patients in the ecosystem who might be like you, the better you’ll be able to make decisions that work for you.

What data sources would you need to provide an estimation of utilization? Would it be claims data plus EHR data?

I think looking at a combination of electronic health record data plus insurance claims is a very good place to start. There are some open kinds of claims data at the population level the government makes available that you can use for a very rough cut, but I think we’ll also see more partnerships being formed with aggregated data being shared that can help compute better decisions.

Geisinger formed XG Health to commercialize their apps that tie into Epic. Is that an early example of the kind of ecosystem that could be created around legacy EHRs that aren’t necessarily done through vendor-specific proprietary technology?

We’re seeing a trend in several places and Geisinger is a great early example of an institutional drive to innovate and to find a broader market based on these innovations. If you invest a lot of institutional time and money building a tool that works inside your own organization, that’s great — you can reap the benefits internally.

But more and more, there’s a desire to be able to share these tools, or sell these tools, outside of an organization. Anything you can do to build apps in a vendor-agnostic way, to build them in a standards-compliant, openly integrated fashion, lowers the cost of integrating this app with more systems downstream, makes it easier to export innovations beyond your own organization.

Vendor of mobile apps haven’t usually done the research to prove that the product improves cost or outcomes. They also often seem to target users who are already health focused. Will app developers need prove the value of what they’ve created?

I think there’s a few ways to measure the value of an application. One is to figure out how people like it and how they perceive that value. Two is to try to measure objectively how the app performs on some metrics that you define.

One of the really exciting things about this health app ecosystem is you can start to use apps as the instruments of research. We see examples of this happening along traditional institutional lines. For example, Duke Medicine has built an app that they’re using as part of a research project to evaluate how well patients know their medication regimen — how well they know which medications they’re supposed to take at which time of day. They’ve built a tool as a SMART on FHIR app that provides a patient with an interface for saying, "Here’s what I take in the morning, at noon, and at night." They’re able to drag and drop pictures of pills from a virtual pill box into these various categories. Then researchers can correlate how well patients perform at this task with other measures of medication adherence and start to figure out whether tweaking the parameters of this task can lead to improved adherence.

Whether you think that’s a great idea or not, the fact is we can use an app to do a measurement and to produce a traditional clinical research result, which you would never be able to do if you had to start from scratch and integrate this thing into the EHR just to fetch the med list. The fact that you can get the med list from the EHR and get all the patient demographics from the EHR out of the box with standards is what makes that kind of research possible.

Then we also see research happening in other new and exciting ways, for example, with mobile applications that collect data explicitly through surveys and implicitly through sensors. There’s a lot of good work happening, for example, on the iOS platform with ResearchKit in that direction today.

Are patients involved enough in the design of what they want, need, and will use instead of letting health systems manage app design?

I think the healthcare industry always struggles to figure out where and how to involve patients. Frankly, there’s a lot of bottom-up work that’s happening today in the patient application space, where companies are starting to build consumer-facing tools that don’t always make sense to the traditional healthcare ecosystem. But as consumers adopt them, we have a better and better idea of what’s really interesting and useful from the patient perspective.

I think it’s very hard for institutions, in a lot of cases, to do the right thing by involving patients. But we’re seeing very good bottom-up innovation that happens from outside of the institutions, and that might be the best indication we have of what really matters.

What do you expect to hope and see in the next five to 10 years in terms of how systems are opened up or interconnected?

Looking out to the longer term, my main hope is to see connectivity become more and more invisible, to have established pipelines where data arrive where they need to, and are available at the point of care, and are available at home without our having to take many explicit steps to make it happen.

What I’d like to see are clinical systems that understand the job that a user’s trying to do. Understand what it means to make a diagnosis or choose a correct treatment, taking into account clinical practice guidelines, the particular clinical situation at hand, taking into account patient preferences, and making it much easier to understand the risks and benefits across the board.

We need readily accessible data, both from the individual patient level and from the clinical knowledge domain. We need all those kinds of data available at the point of decision-making. My hope is that, by standardizing the core of these data access protocols, we can get there in the next five to 10 years.

Do you have any final thoughts?

From the perspective of the SMART Health IT project, we’ve seen an incredible amount of interest and enthusiasm around these APIs that, when we started building them in 2010-2011, the feedback we often got was that it felt like a science fair project and it wasn’t ready for the real world. The interesting thing is that not that much about the technology has changed, but given the overall landscape of EHR adoption and an increasing level of demand from end users for tools that fit their needs better, suddenly this technology has become incredibly mainstream in really short order. It’s been really humbling to be part of that experience.

Morning Headlines 11/11/15

Walgreens Announces New Digital Health Initiatives

Walgreens updates its app to provide users from 25 states integrated telehealth services. The company is also launching a program that will pay users 20 Walgreens Balance Points per day to sync their blood pressure or glucose monitor with the Walgreens app and log daily readings.

Physicians Use Nuance Cloud-Based Voice Recognition Solutions to Tell More than 100 Million Patient Stories Annually

Nuance reports that its cloud-based clinical voice recognition service sales are up 30 percent month-over-month since the start of the year.  Stock prices are up 20 percent over the same timeframe.

Proposed National Patient Matching Framework Dramatically Increases Health Exchange Partner Match Rates

The Sequoia Project and Care Connectivity Consortium publish a proposed framework for a national patient matching solution. They are now soliciting public feedback.

2016 Top 10 Health Technology Hazards

ECRI publishes its annual top 10 list of healthcare technology hazards, with improperly sterilized endoscope tubes topping the list. Missed alarms, poorly configured HIT workflows, and misuse of USB ports on medical devices also made the list.

News 11/11/15

Top News

Walgreens expands its $49 MDLive-powered telemedicine services to 25 states, integrating it into the Walgreens mobile app rather than requiring users to install and run MDLive’s own app. The company also launches the ability for Walgreens Balance Reward members to connect to Walgreens-brand glucometers and blood pressure machines and will pay members for recording their measurements regularly. The company says 500,000 active devices are already connected. It’s amazing what can be accomplished with healthcare technology when incentives are aligned.

I have zero doubt: Walgreens is the most technologically advanced and most consumer empowering company in healthcare. They’ve driven more innovation into the health experience than anyone.

Reader Comments

From Solid-State Component: “Re: mHealth Summit. Is it just me or is the conference the same recycled buzz year after year? Everybody is always talking about what they’re going to do or how wonderful mHealth and wearables will eventually be, but I don’t see a lot of real-life action or results.” The conference’s premise has moved from shaky to absurd as the expiration date has been reached on the idea that mobile health is an edgy concept that stands separate from any other kind of health or healthcare. Everything is mobile by definition – when did you last hear the phrase “mobile banking” or “mobile music?” Wearables have run their course (no pun intended) without accomplishing anything other than to allow healthy people to stroke their egos. I’ve heard of nearly none of the companies or presenters at this week’s conference, which seems unchanged from the two I’ve attended previously that were painfully unfocused and uninformative, a weird conglomeration of mobile messaging projects in Africa, mostly bored venture capitalists, pedantic academics, and clearly doomed startups with laughably minimal healthcare experience. It has become the industry’s Single A farm team, where most of the players will deservedly never see an inning in The Show but keep plugging away hoping to attract a paying customer or paying acquirer, huddling together for validation in National Harbor, MD and pretending they wouldn’t really rather be at the HIMSS conference with the big boys. I ran across a few interesting people and companies when I attended previously, but mostly I was kind of embarrassed to be part of it, rather like the one and only time I attended the TEPR conference as it was wheezing its last breaths.

From Nom de Nonsense: “Re: pointless company rebranding and strange names. I thought you would enjoy this Economist editorial.” I did indeed, as the author calls out the “ever-sillier ways” in which companies are identifying themselves. Examples: AbInBev/SABMiller (the multi-merged global beer conglomerate) and Diageo (another alcoholic beverage conglomerate that hides cool names like Guinness under its bland skirt). It calls Yahoo “tediously wacky,” dislikes made-up conjoined names (PingStamp), and loathes misspellings (Kabbage). It calls out PricewaterhouseCoopers (one of those infuriating “we can’t decide which name is most important after we’ve merged” company names, later rebranded to PwC) for being convinced by a branding agency to call its spinoff consulting business Monday, although it sold the business to IBM before the change. The article concludes that plenty of good names remain (Alphabet was good enough for Google) to obviate the need for “Scrabble spillage,” assuring that great companies will do just fine with boring names but clever names won’t save struggling ones. The article’s only omission is not mentioning companies that pointlessly capitalize their entire name, the marketing equivalent of shrieking and stomping childishly to be heard over the competitive din. Here’s my challenge to you: what are the most-contrived, least-informative, or most-annoying company names in healthcare IT? Let me know and I’ll run a list of what I’m sent.

From What’s the Vector Victor: “Re: SNOMED. Has terms for the number of prior abortions. Our vendor, Practice Fusion, displays quantities of 1, 6, and 8 under the search. Does this happen in other SNOMED crosswalks?”

From Truven Watcher: “Re: Truven Health. Continued dismal operational performance.” The latest 10-Q shows that the company lost $15 million in the quarter and $66 million in the first nine months of the fiscal year. It contains a lot more financial detail than my attention span can manage. 

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor TierPoint. The St. Louis-based IT and data center services provider offers flexible, scalable, and secure solutions: production and disaster recovery clouds, co-location, and managed services (managed backup and business continuity, managed security, managed networks, DDoS protection, and enterprise hosting). A case study from services provider Clario Medical describes its migration from TierPoint-hosted servers to a private cloud infrastructure (load-balanced servers and SSD drives running VMware’s VSAN) with managed security services and HIPAA compliance. Some of the company’s 3,000 customers include Kootenai Health, WellDoc, and the Bill & Melinda Gates Foundation. Thanks to TierPoint for supporting HIStalk.

I found a TierPoint video titled “Tips for a Successful Cloud Migration.”

My inexpensive but capable Asus tablet developed a charging problem after a couple of years of reliable use, which gave me the excuse I needed to skip a repair and instead get something zippier and slicker (although it turned out to have been a curling iron-scorched power cord that I’ve replaced and it’s working fine again). A bit of research turned up my deal: Walmart has the iPad Mini 2 16GB for $199 with free shipping or in-store pickup. I had it running almost instantly after I picked it up yesterday at the store — it automatically brought over most information from my iPhone, even (shockingly) my recent browser searches and auto-completes. Screen resolution on the Retina display, Netflix streaming, and speed are great and the battery life seems excellent. I had considered a direct-from-China off-brand that has good reviews for $60, but I think it’s probably worth the difference to get Apple, plus the eight-inch screen is much better for reading or streaming than the seven-inch standard while not being as bulky as the 10-inch iPad. It would make a great Christmas gift for almost anyone since it’s really easy to set up and use. I’m far from being an Apple fanboy, but this is a great deal, especially since Apple sells the same model for $269.

Ms. W sent photos of her Washington fourth graders using the headphones and flash drives we provided via DonorsChoose. She says struggling readers are getting more engaged by using the audio versions of some textbooks and are using the flash drives to take their writing assignments home or to the public library.

I’m annoyed at banks and other companies whose recorded greeting asks me to say or enter my account number, reads it back painfully slowly from the computer for my confirmation, but when I finally get a human on the phone, they have no idea who I am or why I’m calling.

I’m also annoyed at doctors and others who smugly observe (with no originality whatsoever) that EHRs were designed “just for billing,” as though they wouldn’t stoop so low as to use computers to get paid. I suspect they aren’t seeing patients pro bono or as a hobby.

Unrelated, but for fellow geeks: Joel Hodgson launches a $2 million Kickstarter campaign to bring back the original Mystery Science Theater 3000 with 12 new episodes. We’ve got movie sign!

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

November 20 (Friday) 2:00 ET. “The Athenahealth Leadership Institute Presents: Dr. John Halamka Interviewed by Jonathan Bush.” Sponsored by Athenahealth. Presenters: John Halamka, MD, MS, CIO, Beth Israel Deaconess Medical Center; Jonathan Bush, CEO, Athenahealth. Providers are fed up with interface fees and the lengthy, fragmented narratives we’re exchanging today. But what is the right course of action to help deliver better care across the continuum? Bring your questions as we join Dr.Halamka and Jonathan Bush to discuss the current state of healthcare and how we can improve care coordination and interoperability.

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

Acquisitions, Funding, Business, and Stock

GE Healthcare acquires consulting firm The Camden Group.

Sales

Great Plains Health Alliance chooses Cerner Millennium for its 25 affiliated critical access hospitals in Nebraska and Kansas.

Heart of the Rockies Regional Medical center (CO) chooses Aprima for its ambulatory clinics.

People

DeLicia Maynard (Christus Health) joins Besler Consulting as VP of solution strategy.

Orion Health hires Susan Anderson (Alberta Health) as managing director of its operations in Canada.

OhioHealth Marion General Hospital promotes interim Regional VP of Medical Affairs Mrunal Shah, MD to the permanent role. He was previously SVP of healthcare informatics at OhioHealth.

University of Vermont Medical Center promotes Doug Gentile, MD to CMIO.

Announcements and Implementations

Validic and Quintiles will work together to develop digital health technologies to recruit drug study participants via disease-specific patient communities, capture the remote activity biometric information of drug study participants, and monitor the long-term drug efficacy of drugs after their FDA approval.

Flatiron Health enhances its OncologyCloud to link to EHR and practice management systems to find missed or incorrect drug charges.

University of Mississippi Medical Center will provide telehealth monitoring services to 1,000 new patient enrollees each month by the end of 2016 using technology from Intel-GE Care Innovations.

Boston Children’s Hospital will use IBM’s Watson in a project that will match genetic mutations to kidney disease to identify treatment options.

Nuance announces that its cloud-based Dragon Medical voice recognition is capturing 100 million “patient stories” each year as sales have increase 30 percent month over month since the beginning of the year.

Bottomline Technologies announces that its Investigation Center, which it describes as a surveillance camera for monitoring user and network activity for privacy and security problems, has earned Meaningful Use Modular Certification.

XG Health Solutions launches XGLearn, an educational platform for population health management that uses approaches developed by Geisinger Health System.

Government and Politics

The Department of Defense awards CACI a three-year, $77 million contract to develop clinical analytics tools. CACI created its healthcare business by acquiring analytics vendor IDL Solutions in January 2013. CACI announced just five days ago that it had been awarded a three-year, $39 million contract to continue support of the DoD’s Theater Medical Information Program. Shares of the publicly traded CACI value the company at $2.5 billion.

A Minneapolis TV station finds that local VA hospitals are listing phony board certifications for some of their doctors. An ED doc whose profile says he is licensed in Michigan and Wisconsin was actually turned down for Wisconsin licensure because he owed $69,000 in back taxes. 

The Senate’s HELP Committee asks HHS to explain what it’s doing to prevent medical identity theft. The first four of its 12 questions are above.

Privacy and Security

Hackers develop encryption ransomware for Linux servers, requiring website administrators to pay a Bitcoin ransom of several hundred dollars to regain access to their files.

A judge rules that University of Cincinnati Medical Center isn’t liable for the Facebook posting of a patient’s medical records by an employee. The patient was the new girlfriend of the employee’s former boyfriend. The photo of the medical records, which contained a diagnosis of maternal syphilis, was accompanied by the employee’s comments that the patient was a “hoe” and a “slut.”

Technology

Apple CEO Tim Cook says that while he doesn’t want to put the company’s Watch through FDA’s approval process as a medical device, he “wouldn’t mind putting something adjacent … maybe an app, maybe something else.”

The Sequoia Project (the former Healtheway) and Care Connectivity Consortium propose a framework and maturity model for a national patient matching. They’re seeking feedback.

Other

ECRI Institute lists its top 2016 technology hazards. Most interesting to me was #10, where people plug a random gadget into the USB port of a medical device that causes it to malfunction.

Another New York hospital system rebrands itself, with the New York City Health and Hospitals Corp. asking everybody to call it NYC Health + Hospitals. The president of the system, which wants people to stop calling it HHC, vomits up the marketing blather he was obviously force fed in explaining, “Our new brand graphics symbolize a true evolution as we transition from a hospital-centric corporation to a healthcare delivery system focused on providing an exceptional patient experience and building healthy communities.” The package includes a new tagline, “Live Your Healthiest Life.” The organization formerly known as HHC declined to say how much the name change will cost. My view of how encounter-driven hospitals have renamed themselves over the years without really changing anything goes like this:

• Smithtown Hospital
• Smithtown Medical Center
• Smithtown Regional Medical Center
• Smithtown Health – Regional Medical Center
• Blovaria (my idea for a made-up descriptive name, although I need a marketing person to come up with an overwrought and thoroughly unconvincing explanation of what it means and why a new name was necessary)

Publicly traded genomic test kit vendor Foundation Medicine, alarmed by reduced test ordering volume, says it will “educate” oncologists on ordering more tests, market itself harder, and push for higher reimbursement from Medicare.

A woman sues a gym after she falls asleep in its sauna for two hours and the resulting burns require amputating all of her toes. She says the gym “should at least watch out for your safety and well-being,” adding a backup argument that the sauna was improperly installed. As is always the case, the woman says it’s not about the money, but her heartfelt desire to prevent it from happening to others.

Sponsor Updates

• USA Today features AirStrip President Matt Patterson, MD and innovation partner IBM.
• Anthelio Healthcare Solutions will exhibit at HFMA Region 9 November 15-17 in New Orleans.
• AHA Solutions endorses the YourCareUniverse consumer engagement platform.
• Aventura explains how its Roaming Aware Desktop works in a new video.
• Bernoulli CEO Janet Dillone is featured in OR Today.
• Xconomy profiles Qualcomm Life’s acquisition of CapsuleTech.
• CoverMyMeds will exhibit at the Medicaid Health Plans of America 2015 Conference November 11-13 in Washington, DC.
• Experian Health will host its annual Financial Performance Summit for clients in San Antonio November 16-18.
• Divurgent receives the Inside Business Roaring 20s Award, ranking as one of the area’s top 20 fastest-growing companies.
• EClinicalWorks will exhibit at the 2015 Western States Health-e Connection Summit & Trade Shows November 17 in Scottsdale, AZ.
• Extension Healthcare will exhibit at the National Veterans Small Business Engagement November 17-19 in Pittsburgh.
• Medecision is recognized by Black Book Market Research as a top financial solution for value-based healthcare.
• Healthcare Growth Partners advises iVantage Health Analytics on its sale to The Chartis Group.
• Healthgrades Chief Marketing Officer Emeritus Judy Blackwell receives the John A. Eudes Vision and Excellence Award.
• Healthwise will exhibit at the ACO Congress November 16-18 in Los Angeles.

Blog Posts

• Modified Stage 2 Objectives with Alternates for Stage 1 (AdvancedMD)
• 8 Things You Need to Do in a Secure Software Development Shop (AirWatch)
• Overcoming the trickier parts of Meaningful Use: insights from a Nordic nurse (Nordic)
• The Revenue Cycle After ICD-10 (Culbert Healthcare Solutions)
• Mobile Offers Engagement, Quality and Revenue-Generation Opportunities (PatientSafe Solutions)
• Optimizing Oncology Workflows (Galen Healthcare Solutions)
• Hiring Leads That Quickly Get Distracted with New Opportunities … Squirrel (Hayes Management Consulting)
• 5 Epic Upgrade Cost Considerations (The HCI Group)

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 11/10/15

GE Healthcare Acquires Leading Healthcare Advisory Firm, The Camden Group, to Enable Healthcare Organizations to Navigate Industry Transformation

General Electric acquires the Camden Group for an undisclosed sum. GE will integrate the Camden Group into its healthcare consulting business unit, GE Healthcare Partners.

Differences in the Prevalence of Obesity, Smoking and Alcohol in the United States Nationwide Inpatient Sample and the Behavioral Risk Factor Surveillance System

Johns Hopkins researchers find that the Nationwide Inpatient Sample, the dataset used by CMS to calculate hospital reimbursement rates, has substantially lower rates of obesity, overweight, tobacco smoking, and alcohol abuse and is an inaccurate representation of the actual population.

Remote Telemonitoring in HF Patients Fails to Reduce Hospitalizations

Researchers from UCLA and Cedars Sinai Medical Center conclude that remote patient monitoring technology has no effect on 30-day readmission rates or six-month mortality rates for heart failure patients.

Google, American Heart Association Announce Joint Research Effort

Google’s Life Sciences unit announces a five-year, $50 million partnership with the American Heart Association that will focus on bringing new tools to heart disease research.

Curbside Consult with Dr. Jayne 11/9/15

My parents are quite the travelers. Although they’ve avoided most illnesses on the road, they did wind up recently at a walk-in clinic in rural Australia. The facility is staffed by a rotating slate of physicians who fly in periodically. They were eager to be seen before the doctor flew out.

Given my career with electronic health records, my father thought I’d get a kick out of his visit note. It’s a grand total of four pages (two which really matter) and features such complex notations as “unwell” and “sinusitis.”

The physician note is the haiku of clinical documentation and made me wonder what kind of job satisfaction this physician has related to topics such as “administrative simplification” and “regulatory documentation.” I think it’s pretty good since he doesn’t appear to have too concerned with gathering bullet points or capturing all the screenings that we’re required to document on patients in the US regardless of their presenting problem.

I’m betting the form was captured electronically since he was discharged with the original document. Talk about OpenNotes and transparency for patients. It reminded me of a note I saw in a chart when I first went into practice. We had purchased a retiring physician’s charts and it said simply: “Sore throat – PCN – $10.” You can bet the patient paid at the checkout desk and that the note was complete before the patient left the room. It may not be interoperable, but it certainly is elegant in its simplicity.

My mother also had a visit. Both were treated appropriately for their conditions and with low-cost generic medications. It’s interesting to hear about healthcare delivery in its purest form. Although their situations were low complexity and low risk, not every visit needs to have a full-court documentation press. There may be times where minimalist documentation is appropriate, but unfortunately our systems don’t support that. Even with the push for value-based care, I don’t see any payers loosening their documentation requirements.

It was with that situation in mind that I headed out this morning to work with a practice on a population health initiative. They’re a mid-sized primary care group that’s already running pretty lean, but they want to try to figure out how to better reach patients who need preventive services or who may have missed follow up steps on their chronic conditions.

Although it’s really a productivity and optimization project that doesn’t necessarily need clinical oversight, practices like to hire me because I’m an actual doctor. They feel like I have a better understanding of their needs because I’ve been a practice owner myself and have been in their position. Sometimes it makes things difficult, though, because I see clinical issues that are outside the scope of my current role but still need to be addressed.

Today was one of those days. While I was shadowing the triage nurse to get an idea of her workload and the flow of her day, she was interrupted by a call from a patient’s family member. Apparently the 87-year-old patient has been having low blood sugars after recently being placed on diabetes medication. Her sugar has been less than 50 several times in the last few weeks, which typically isn’t compatible with good brain function and puts her at risk of falls and other serious complications. As she was talking to the family and later the patient, I was watching over her shoulder to see the patient’s lab values.

Hemoglobin A1c is a marker of longer-term blood sugar control. Hers was barely elevated even before she was started on medications. She immediately had low sugars when starting drug therapy, so the physician had changed her dosing to three days a week and she was still having issues. I started wondering why in the world this doc had her on medication to begin with. With many diabetic patients, if you can keep them at a reasonable level with just diet and exercise, you try to avoid medications. Her near-normal value was certainly reasonable by most physician’s standards.

The whole goal of keeping people’s sugars in the normal range is to prevent the long-term complications of diabetes. I didn’t see any complicating diagnoses on the patient’s chart – no kidney disease, nerve damage, eye problems, etc. There’s plenty of literature that shows that especially in older patients, it’s more risky to try to keep blood sugar control too tight. Once the patient was scheduled for an appointment, I gently queried the nurse about the physician’s typical treatment of these kinds of patients.

She mentioned that he is “obsessed” with his performance scores and this isn’t the first time she’s dealt with this issue. Apparently he’s worried about “being dinged” in reporting and “losing his star” with a payer. It made me immediately remember the old adage from medical school about needing to “treat the patient and not the numbers,” which means to consider the person in front of you and not just their labs or the data. I asked her if they knew how to exclude these kinds of patients from clinical reporting if there were good reasons that they shouldn’t be treated in a certain way or managed to a certain level.

She hadn’t heard of the ability to do this in their EHR, so we asked a couple of other nurses and none of them knew it either. Excluding the patient from reporting on this particular parameter would prevent the physician from being penalized for less-tight blood sugar control in this patient who clearly should not be managed so aggressively. By lunch time, we were able to grab a few minutes with the physician in question and he didn’t know about the ability to exclude, either.

Although he was initially offended and felt that I was questioning his care, he realized that I was not only trying to help the patient, but to help him be able to practice in a more rational patient-centric manner without running afoul of the scorecards that we’re all slaves to now. Excluding patients such as this one may take a few more clicks, but they’re well worth it. Although Big Data can provide impressive insights and help us change how we practice, we need to make sure we’re changing in the right way and for the right reasons.

How has Big Data impacted your care delivery system? Email me.

Email Dr. Jayne.

EHR Design talk with Dr. Rick 11/9/15

The TimeBar: A Timeline-Based, Interactive Graphical User Interface for the Electronic Health Record

Dear Friends and HIStalk Readers:

Once again I can’t begin to tell you how happy I am to start blogging again and to resume sharing ideas about improving EHR User Interface design. I am very grateful to have this opportunity.

Had I been born half a century earlier, I would not be alive. As you recall from my last blog in May, I was recovering well from acute myelogenous leukemia (AML) and was just starting to resume blogging, introducing my concept of a timeline-based, interactive GUI for the EHR.

Life is never simple. Although I continue to have no evidence of recurrence of my acute myelogenous leukemia, about two weeks after my last post I developed unstable angina with dyspnea on exertion requiring urgent coronary artery bypass grafting, which went very well.

Unfortunately, immediately post-operatively I developed Acute Respiratory Distress Syndrome (ARDS – the etiology is still not entirely clear). After surgery, I was in the Beth Israel Deaconess Medical Center (BIDMC) ICU in Boston on a mechanical ventilator and heavily sedated for 48 days, followed by some improvement, a setback, and then a slow weaning from the ventilator. I am getting much better. My tracheostomy tube was removed about a month ago and I am now at home and am doing very well.

Although I had initially wanted to introduce my ideas for a timeline-based, interactive graphical user interface for the EHR in sequential order as a series of blogs, given the uncertainties of life, now more than ever I have decided to post my entire TimeBar design as it stands right now. It is a work in progress and comments and suggestions are most welcome. As I wrote before, I would love nothing more than to see some of the TimeBar concepts developed, improved, and expanded as an open source application.

Aside from being with my family and friends, nothing is more fulfilling for me than collaborating on the development of new cognitive tools to improve the usability of EHRs, especially given my medical history and seeing firsthand how much cognitive work my doctors and nurses expend on unnecessary EHR tasks.

New cognitive tools do not come automatically. Recall that true alphabetic writing only developed about four thousand years ago, after a very rocky start. The Arabic numeral system was only invented a little more than a thousand years ago. After Euclid described the mathematics of the triangle, it took two thousand years for Newton and Leibniz to do the same thing for the circle by inventing calculus. The first accurate timeline was only invented and published about 250 years ago. As Donald Norman famously wrote, “The power of the unaided mind is highly overrated.”

And now, despite being in the computer age, many of our EHR workflows and tools are still leftovers from the mechanical age – the age of the paper chart. Unfortunately, the electronic versions of paper charts tend to retain the worst aspects of the paper chart without taking advantage of new designs better suited to electronic charting. Specifically, I am interested in human-computer interaction designs which shift the balance of mental effort from cognition to perception, allowing us to use our extremely fast, high bandwidth visual processing system to perceive much of the data, sparing our working memory and capacity for abstract reasoning for actual patient care issues.

The document above describes the EHR TimeBar. Click the two-headed arrow bar icon to display it full screen since it will be hard to see otherwise. It can also be downloaded as a PDF file here.

Rick Weinhaus, MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

Morning Headlines 11/9/15

Quality Systems, Inc. Board of Directors Elects Jeffrey H. Margolis as Chairman of Board

Sheldon Razin, founder and board chairman at Quality Systems, Inc., retires after 41 years leading the company’s board of directors. He will be replaced by Jeffrey Margolis, a QSI board member, as well as the CEO of Welltok and founder of Trizetto.

Hartford Hospital, contractor to pay $90,000 in 2012 data theft

Hartford Hospital (CT) and its contractor, EMC, will pay the state a $90,000 settlement stemming from the 2012 theft of an EMC employees unencrypted laptop. The laptop, which was stolen from the EMC employees home,  containing PHI on 8,000 patients.

In 5 Minutes, He Lets the Blind See

The New York Times profiles Sanduk Ruit, MD, an ophthalmologist working in Nepal that has reduced the cost of a cataract replacement procedure to just $25 per patient. The American Journal of Ophthalmology published an RCT study confirming Ruit’s technique has exactly the same outcomes as modern Western techniques, both resulting in 98 percent success rates at a six-month follow-up.

Bellevue doctor sues patient who blasted him on Yelp

In Washington, a surgeon acting as his own lawyer sues a patient over a bad Yelp review, citing defamation of character and damage to his business and reputation.

Monday Morning Update 11/9/15

Top News

Sheldon Razin, who founded Quality Systems, Inc. (NextGen) and has served as the company’s board chair for 41 years, retires. He will be replaced by board member Jeffrey Margolis, who is also chairman and CEO of Welltok and the founder of TriZetto.

Razin’s first QSI retirement came in 2000, when he resigned his president and CEO roles as a result of longstanding power struggle with activist shareholder Ahmed Hussein. Hussein resigned his own board position in 2013 with a parting shot in publicly announcing that Razin’s board involvement was damaging the company. QSII shares are trading at less than half their 2010 price and about the same as their value in mid-2005. Razin holds shares worth $150 million.

Reader Comments

From PM_From_Haities: “Re: Allscripts’ quarterly results. Don’t fall for anything less than standard accounting, which shows the company lost money in Q3. See here – no one ever adjusts EPS down.” I’ve always been torn by whether to report GAAP or adjusted earnings, but leaned toward the latter only because the big investment firms seem to favor excluding supposed one-time events that are under the company’s control such as stock compensation and restructuring costs. Allscripts turned its most recent quarter’s $5 million GAAP loss into a $25 million non-GAAP gain; the company hasn’t reported a GAAP profit since September 2012. The article eloquently describes why CEOs love less-stringent accounting measures that are similar to the “our patients are sicker” excuses that hospitals embrace in explaining objectively measured but unimpressive outcomes:

Insofar as CEOs and CFOs understand their job to be upholding the fragile psychological state of their shareholders by managing earnings in an emotionally supportive way, GAAP makes their jobs harder by sometimes requiring firms to issue financial statements that are not uplifting. But companies have a response. Because GAAP rules must cover a broad variety of circumstances, firms can usually make the argument that GAAP fails to comprehend relevant complexities. Everyone is special, especially when they miss earnings estimates.

From Lawn Dart Trauma: “Re: Main Line Health. Word is they’ve chosen Epic. They’ve always been Siemens – I’m surprised Cerner wasn’t able to keep them in the fold.” Unverified.

From I’ll Show You Mine If You Show Me Yours: “Re: Epic. I’m a director at a customer hospital. Our analysts are getting calls from Epic’s support representatives asking for our hospital’s operating margin. A friend of mine at Epic told me that Judy asked employees to get this information for all Epic customers. I suspect they’re trying to assess if there’s financial trouble at other Epic sites in the way of some recent news reports. It’s frustrating since the general sense I get from colleagues is that development and service of Epic’s billing applications have atrophied greatly with the outsized focus they’ve had on clinical applications and when Epic is opaque about how it spends our money. The slow reaction times in the past few years is galling when I go to UGM and see where most of the money has been spent. I enjoy the show one day a year in Deep Space, but the quality of the other 364 days is suffering.” Unverified.

HIStalk Announcements and Requests

It was a 60-40 split on whether customers or patients would be impressed with the respondent’s employer if they had inside information. New poll to your right or here: is the impact of private equity and venture capital firms on the health IT industry positive or negative?

Ms. W. from Texas was so excited to hear that reader donations had funded her DonorsChoose grant request for electronic quiz tools and math activity stations that she immediately emailed, “I cannot express the excitement and happiness that has consumed me. When I saw the email that said ‘funded,’ my eyes began to water. As a classroom teacher, I saw the struggles and have come out of pocket for so many other projects. It hurt that this was something I couldn’t provide them with. Then we were blessed by you. Your generosity will help so many students better grasp the concept of math.” Meanwhile, Mrs. S in Colorado says her fifth graders vie for the chance to use the math games and materials we provided, sending the photo above.

A reader who wishes to remain anonymous donated $500 to my DonorsChoose project, asking that I fund elementary/pre-school science and math classes. I applied various sources of matching money, including from my anonymous vendor executive, to fully fund these grant requests:

• Two Amazon Fire HD Kids Edition tablets for Ms. Torres’ pre-K class in Dallas, TX.
• Five physics STEM kits for Ms. Owens’ elementary school class in Indianapolis, IN.
• Math manipulatives for Mrs. Johnson’s elementary school class in Tulsa, OK.
• Four Chromebooks for Mr. Wild’s high school math classes in Kealakekua, HI (I deviated a bit from the donor’s wishes in choosing a high school project because available matching money made the cost nearly nothing).
• Two refurbished iPad Minis for Ms. Desai’s elementary school class in Alvin, TX.
• Hands-on STEM learning tools for Ms. Lam’s first grade class in San Francisco, CA.

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

Last Week’s Most Interesting News

• MedAssets will be acquired for $2.7 billion by Pamplona Capital Management, which will divest the company’s group purchasing and consulting business and combine the revenue cycle segment with Precyse, another of its holdings.
• Cerner’s quarterly report meets earnings expectations but falls short on revenue.
• Meditech’s quarterly report shows the continuation of an ongoing slide in revenue and profit, with services rather than product sales making up an ever-greater percentage of total revenue.
• Francisco Partners sells it Aesynt pharmacy robotics business to Omnicell for $275 million just two years after acquiring it from McKesson.
• Quality Systems announces that it will acquire cloud EHR vendor HealthFusion for up to $190 million.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

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

Acquisitions, Funding, Business, and Stock

From the Allscripts earnings call:

• Recurring revenue made up 75 percent of the company’s total revenue.
• Non-GAAP earnings removed $9.9 million in expenses for severance, work on the company’s unsuccessful DoD bid, and settlement of outstanding litigation.
• GAAP earnings were reduced by $1.4 million to account for the company’s equity investment in NantHealth.
• The company says that inpatient EHR competitors who are leaving the market (presumably McKesson and the former Siemens) give Allscripts more opportunities.
• President and CEO Paul Black says TouchWorks and Sunrise will begin integration with NantHealth’s protocol and algorithm work within six months.
• The company says it has under-penetrated its client base in services sales compared to “one of our large competitors” (presumably Cerner) and hopes to improve that.

Evolent Health announces Q3 results: adjusted revenue up 45 percent, adjusted EPS –$0.16 vs. –$0.31. Shares rose 13 percent on Friday, but are still down 20 percent from their first day of trading in June.

People

As a reader previously reported, Graham King, former president of Shared Medical Systems and McKessonHBOC, died last week at 75.

Privacy and Security

Hartford Hospital (CT) and EMC will pay a $90,000 settlement to the state for allowing an unencrypted laptop to be stolen in June 2012 from the home of the hospital’s contractor, EMC. Both organizations agreed to encrypt patient data and provide privacy and security training to employees.

Police officers who wear body cameras have to remember to turn them off when entering a hospital to avoid violating patient privacy, according to the Kinston, NC police department. The department says officers will otherwise be violating HIPAA, which isn’t true because police departments aren’t covered entities and therefore have no obligation to follow HIPAA requirements.

Other

A Texas man pleads guilty to wire fraud for conspiring with others to pose as Cerner employees in order to sell hospital equipment and to defraud investors. The group registered a Cerner LLC corporate name, opened a bank account under that name, and registered Web domain CernerInc.com in selling a $1 million MRI machine to a Texas hospital, which the hospital reported to authorities when the real Cerner declined to help them install it.

CMS reinstates Faxton St. Luke’s Healthcare (NY) after it says it fixed ED problems that allowed a violent psychiatric patient to be  released without evaluation. He killed three family members hours later. The hospital changed its order entry system to make it easier to order mental health assessments, added a hard stop so that triage nurses can’t skip documenting suicide risk assessment, and ordered physicians with illegible handwriting to use dictation software.

A judge orders Geisinger Health System to provide salaries of its executives and doctors to the family of one of its medical residents who died of a brain hemorrhage while admitted to one of its hospitals. The family is suing Geisinger and wants the salary information to determine the value of the resident’s lost life. The health system has fought the disclosure of executive salaries, arguing that the information is proprietary and strategic.

A Bellevue, WA orthopedic surgeon sues a patient who posted an unflattering Yelp review of his work, saying she damaged his business and personal reputation. The patient’s also filed a complaint with the state medical board, but they dismissed it as lacking evidence of a violation.

The New York Times profiles a Nepal-based ophthalmologist nicknamed the “God of Sight” who developed a five-minute, $25 cataract removal procedure that he has used to restore the vision of 120,000 people. The doctor manufactures his own $3 replacement intraocular lenses to avoid the $200 cost of commercially produced ones. His success rate is the same as that of US doctors who use $1 million machines.

The Pensacola, FL paper profiles local businessman and philanthropist Quint Studer, who worked his way up through hospital administration to become CEO of Baptist Health Care (FL), a job he left to start consulting firm Studer Healthcare Group in 1998. He sold 70 percent the company for $217 million in 2011, after which it was sold to Huron Consulting Group for $325 million in January 2015.

Johns Hopkins BSN student Stephanie Olmanni, whose background includes education and experience in music and film scoring, creates a nice parody of Adele’s “Hello” that describes her frustration trying to wade through the bureaucracy of obtaining a California RN license. 

Sponsor Updates

• TransUnion President and CEO Jim Peck is featured on the cover of The CIO Review.
• Valence Health and Aldera share insights on risk-based healthcare landscape.
• Health Catalyst ranks first among healthcare technology companies on the list of Utah’s 100 Fastest Growing Companies of 2015.
• Winthrop Resources SVP Brad Swenson will present at the Virginia Hospital and Healthcare Association Annual Meeting November 11-13.
• Xerox Healthcare wins the Best New Venture Award as part of Market Gravity’s 2015 Corporate Entrepreneur Awards.
• ZeOmega places twelfth on the Metroplex Technology Business Council’s 2015 Fast Tech Awards List. The company also received MTBC’s Momentum Award for placing on the list five years in a row.

Blog Posts

• Leading with Passion: Lighten Up (T-System)
• From Bed Management to Workflow Management (TeleTracking)
• Interoperability update: Federal planning and the benefits of VNAs (TeraMedica)
• What is Value-Based Insurance Design? (Verisk Health)
• Overcoming the trickier parts of Meaningful Use: Insights from a Nordic nurse (Nordic)
• Creating a patient-focused revenue cycle, and keeping a pulse on practice operations (ZirMed)
• On Being Someone Else (Zynx Health)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 11/6/15

Allscripts Announces Third Quarter 2015 Results

Allscripts reports Q3 results: revenue increased three percent to $355 million, adjusted EPS $0.13 vs. –$0.06.

Walgreens Healthcare Clinics to Implement Epic Electronic Health Record Platform

Walgreens will implement Epic across all of its health clinics, citing access to Epic’s Care Everywhere network as a key benefit. The rollout will begin in early 2016.

The November HIT Standards Committee

John Halamka, MD and CIO of BIDMC, recaps the November HIT Standards Committee meeting while advocating for an end to the Meaningful Use program and a consolidation of Stage 3 requirements within upcoming Merit-Based Incentive Programs.

Medivo Forms Agreement with Quest Diagnostics to Analyze Laboratory Data to Help Pharmaceutical Companies Match Caregivers with Therapies

Quest Diagnostics will begin selling de-identified lab results to Medivo, an analytics company that will use the information to help drug makers run targeted marketing campaigns aimed at individual providers.

News 11/6/15

Top News

Allscripts announces Q3 results: revenue up 3 percent, adjusted EPS $0.13 vs. –$0.06, meeting revenue expectations and beating on earnings.

Reader Comments

From Worried: “Re: HHS and Department of Justice. Investigating [vendor name omitted] for fraud in EHR certification and safety issues.” Unverified, so I’ve left out the company’s name. Let me know if you have specific information.

From All Hat No Cattle: “Re: KLAS’s proposed interoperability measures. These are good and will really help highlight the issues, especially those that allow users to call out issues from within their own provider organizations. Issues like opt-in/opt-out are huge. I think it will also highlight the incredible job that Epic has done in allowing its clients to share information, which is becoming the gold standard.” The draft KLAS questionnaire for providers to assess their interoperability capability and use is indeed pretty good, targeting high-value connections rather than giving credit for connections that patients and clinicians don’t really care about. My only tiny quibble is that the document defines interoperability as “the ability” to exchange and use information, while the survey far more importantly assesses whether providers are actually doing it. The downside of the provider survey approach is that those who are unwilling to share information will point fingers at everyone else, skewing the results since it’s easier to blame generic “technical barriers” than to admit that you don’t want to provide information to your competitor and vice-versa. I guarantee that if health systems and doctors were paid a per-record fee for sharing their information, they would quickly overcome every alleged barrier and would pressure their technology vendors to figure it out (see: Meaningful Use bribes). The business case for helping patients being seen elsewhere is shaky.

From Poor Quality: “Re: University of Mississippi Medical Center. Gets an F in quality from Leapfrog, making it the worst in the state.” The hospital responds with the standard “our patients are sicker” excuse, saying other hospitals dump their problem patients on UMMC and that patients should not avoid the hospital just because it earned a failing grade. Sicker patients or not, UMMC scored horribly in all six surgical safety categories, such as leaving objects in the bodies of surgery patients. The chief medical officer says it’s not about whether the hospital earns an F or an A, it’s about improving outcomes for patients as a group, although not leaving sponges in patients might be a good start toward accomplishing both.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor LogicStream Health. The Minneapolis-based company, co-founded by a pharmacist and a physician, applies algorithms to hospital or clinic EHR data to develop clinically appropriate protocols, with one client reducing its post-surgical venous thromboembolism by 80 percent in improving outcomes and saving $1.1 million by applying individual risk assessments. The company’s platform quickly identifies clinical process problems to support data-driven adjustments that improve quality and provider satisfaction. It offers specific quality improvement modules for VTEs, catheter-associated UTIs, and central line-associated blood stream infections; cost containment solutions for high-cost labs and drugs; and the ability to measure the impact of order sets and nursing flowsheets. Co-founder Daniel Rubin, MD, MHI presented a webinar on reducing care variation that provides background. Thanks to LogicStream Health for supporting HIStalk.

Reader donations of $150, to which I applied available matching funds via DonorsChoose, provided math activity stations and wireless quiz technology for the fourth grade class of Ms. Williams in Lancaster, TX;  a CD player, lapboards, and clipboards for small-group math instruction for the class of Ms. Penagos in Carrollton,TX; and math supplies and games for Mrs. Johnson’s kindergarten class in Silvis, IL. Meanwhile, Mr. Moore sent an update from Minnesota with the photo above of his students using the STEM materials we provided.

A brilliant Twitter enhancement request comes from @Farzad_MD as he’s getting bombarded by conference attendees (some of them reporters paid by their conference presenter employer) live-tweeting banal observations and quotes that are useless out of context (and often within context). His idea: allow Twitter muting by hashtag. That would work great for squelching dull tweetchats as well, or to allow users to create Twitter “folders” that you could follow separately to bypass their sports cheerleading and instead focus only on their work-related tweets. I might add a second variant: allow muting a Twitter account for a user-defined time out, like shushing them until the conference they’re yapping about is over. The few people I follow on Twitter are mostly insightful 95 percent of the time but some of them are insufferable when they get unduly aroused by some meeting, sporting event, or personal accomplishment.

I still haven’t heard a word from anyone who has actually seen an EHR gag clause, so I’m calling BS on the reporter who stirred up that whole issue in the first place (along with the mindless parrots who squawked about that article despite its lack of evidence and obvious confusion as to what a “gag clause” even is). My assertion is unchanged: the pressure you feel to avoid speaking up about patient-endangering software problems is far more likely to come from the executive suite of your health system, not that of your software vendor.

This week on HIStalk Practice: Healthcare.gov opens with no signs of IT trouble … yet. EClinicalWorks breaks into the UK market via a new partnership. The NC Medical Society Foundation works with Chess to transition rural practices to ACOs. Sanctus Healthcare implements CCM services from McKesson BPS. Wellero President Hanny Freiwat offers physicians advice on increasing patient payments before the end of the year. SHIN-NY targets physician practices after reaching RHIO milestone. The Toledo Clinic joins the Ohio Independent Collaborative. Culbert Healthcare Solutions Director Jaffer Traish offers best practices for streamlining the efforts of IT and operations.

This week on HIStalk Connect: Teladoc’s stock price falls 10 percent after reporting its Q3 results, which showed signs of impressive organic growth but still shows the company operating in the red after 13 years in business. Fitbit reports its Q3 results, posting better than expected earnings. The company was also named in a countersuit from rival Jawbone alleging that it has established a monopoly in the fitness tracker market. Monclarity raises $5 million to launch a "brain games" cognitive training app, despite widespread skepticism from neuroscientists over the effectiveness of such apps. Lumo raises $10 million to launch a B2B wearables platform that sets a company up with sensors, software, and an API to launch their own fitness tracking wearables powered with Lumo’s technology.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

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

Acquisitions, Funding, Business, and Stock

Consulting firm The Chartis Group acquires iVantage Health Analytics.

From the Cerner earnings call:

• EVP/CFO Marc Naughton said the company is disappointed about missing revenue expectations by $20 million, but delivered record bookings and has a strong pipeline that includes a $13.9 billion revenue backlog. The drive is that clients are tying payments to milestones and even to specific health system performance targets.
• The former Siemens Health Services brought in $250 million in revenue, 22 percent of Cerner’s total revenue, but was responsible for half of its $20 million revenue miss as some former Siemens clients dropped their maintenance agreements. Cerner says sales of the former Siemens products are “minimal … Siemens is negligibly impacting us” and that was the plan all along.
• President Zane Burke says the company differentiates itself from Epic by “the ability to deliver value along with predictable costs and timelines” as opposed to “their list of clients, where the significant costs of deploying and maintaining their systems have been cited as a key reason for financial challenges is starting to impact them in the marketplace.”
• The company says Epic-using Geisinger chose Cerner for population health management because “our capabilities could not be equaled by a competitor.”
• The company had two displacements of an unnamed ambulatory cloud competitor (presumably Athenahealth) due to “their lack of execution, failure to meet established objectives, rising costs after teaser rates, and a realization by the client that they ended up needing similar or more staff even though they thought they had outsourced the function to our competitor because they left much of the harder work and complex work to the client.”
• The company warns that revenue from its Department of Defense subcontracting will be slow, with the first Leidos task order representing less than 1 percent of Cerner’s quarterly bookings. That task order was valued at $98 million and 1 percent of Cerner’s quarterly bookings is $16 million, so at least for the quarter, Cerner’s cut of the DoD contract is less than 16 percent.

Cognizant reports Q3 results: revenue up 24 percent, adjusted EPS $0.76 vs. $0.66, beating revenue expectations but falling short on earnings. The company’s healthcare segment, which includes its $2.7 billion acquisition of TriZetto last year, contributed 30 percent of Cognizant’s revenue ($939 million) in a 43 percent jump.

Dell is rumored to be planning the sale of $10 billion worth of its non-core divisions to ease the $50 billion in debt it will take on to acquire EMC, with the former Perot Systems being one of the assets that could be placed on the block. Dell bought Perot for $3.9 billion in 2009.

Sales

For-profit, 16-hospital Iasis Healthcare (TN) chooses Cerner for EHR and revenue cycle systems.

San Joaquin General Hospital (CA) will implement Cerner.

Walgreens will implement Epic’s EpicCare in its 400 retail clinics beginning early next year, replacing its proprietary EHR. I think the drug chain’s 8,200 pharmacies use Greenway’s EHR, which I would expect to be at significant risk of eventual displacement since they obviously looked elsewhere for the clinics and they are bragging on the interoperability opportunities Epic will provide. Some of the sites and fast-on-the-draw tweeters missed the fact that this announcement pertains only to the in-store clinics, not all of Walgreens (yet).

ZappRX chooses the e-prescribing state law review data set and services from Point-of-Care Partners.

People

Rush Health (IL) hires Julie Bonello (Access Community Health Network) as CIO. I’m fascinated by her LinkedIn profile that shows she earned a BSN and then an MS in computer science, dropped out of the CIO role for several years to run the family’s chain of noodle shops as she cared for her aging parents, then jumped right back in as CIO of Cook County Health and Hospitals.

J. P. Fingado (Francisco Partners) joins healthcare talent manager software vendor HealthcareSource as president and CEO. Francisco Partners acquired the company in May.

Community Health Systems announces that SVP/CIO Gary Seay will retire at the end of the year.

Orion Health hires Robert Pepper (NeuroTrax) as VP of marketing for North America.

Announcements and Implementations

Influence Health announces a new version of its Connect clinical portal, which alerts physicians of frequent visitors who may be at risk for readmission and integration of DynaMed’s clinical information.

Medecision and Forward Health Group partner to provide population health management solutions to New York DSRIP participants.

Quest Diagnostics will sell de-identified patient lab results through analytics vendor Medivo to drug companies, which will then use the information to target their marketing to individual physicians. Medivo calls their business “delivering the promise of precision medicine by providing decision support on the use of targeted therapeutics,” which is probably not what pie-in-the-sky “precision medicine” dreamers have in mind when they picture using data to treat patients rather than to sell more drugs.

Healthgrades will expand its online appointment scheduling capabilities in partnership with MyHealthDirect.

Lincoln Surgical Hospital (NE) uses Summit Scripting Toolkit to import scanned documents from clinical modalities into Meditech, requiring just eight hours of analyst time to create and test the script and move it to production.

Durham, NC-based Touchcare, which offers a $99 per provider per month telemedicine app, adds a web-based provider dashboard and integrated billing capability.

Government and Politics

John Halamka, MD, recapping the November HIT Standards Committee meeting, repeats his call to dissolve the Meaningful Use program and move Stage 3 requirements into CMS’s upcoming Merit-Based Incentive Programs (MIPS).

Privacy and Security

An ED study finds that 71 percent of patients who use Facebook or Twitter don’t mind doctors looking at their accounts, although I can’t imagine any ED doctor who would find that any more useful that the uneventful stream of wearables data they rightfully ignore. Maybe that would be more useful for PCPs who could possibly wade through all the inevitable junk to piece together some sort of social history that the patient could have just told them directly. Or, perhaps there’s your startup idea: a private, Facebook-like app just for the intuitive entry of health status information that you share with whomever you want (doctor, family member, etc.) Maybe you post your weight or sleep schedule and your doctor gives it a “like” or adds a slightly scolding comment.

Technology

Amazon Web Services could bring in $16 billion in annual revenue by the end of 2017, making it the company’s most valuable business at up to $160 billion.

Researchers from Vanderbilt University School of Engineering make the hardware and software of their swallowable medical robots available via open source. The devices, also known as wireless capsule endoscopes, can be guided rather than just carried along by intestinal activity as are PillCams.

Precision medicine is here after all: CDX develops a chemical sensor that also uses big data and machine learning to analyze a sample of marijuana and apply the experience of that strain’s users to determine whether it will deliver the desired outcome (medical or otherwise) to the app user. The company will earn revenue from displaying paid advertising of dispensaries. The company plans to expend its “electronic nose technology” into other areas, such as air and water quality. This is a brilliant business model all around.

Other

In Pakistan, Hayatabad Medical Complex, alarmed by employees and physicians moonlighting in nearby medical facilities on company time, requires them to clock in using biometric ID. Board members also mandated that all procurement be moved online.

I’m amused that the AMA’s Thursday tweetchat on digital medicine innovation was led by its CMIO – who doesn’t even have a Twitter account.

I don’t understand this at all. A DC business paper profiles ListenPort, which it contrasts to Yelp and Twitter in providing a private place to complain directly to management. I thought we had that already in products called “email” and “texting.” They offer a free basic account, so maybe I’ll try it out.

A former purchasing assistant with England-based health IT firm Ascribe is sentenced to four and a half years in prison for stealing $900,000 from the company over five years. She used the money, obtained by paying phony invoices to herself, for vacations, cars, a house, and to pay off her son’s drug debts. Ascribe hired her even though she had previously been convicted for stealing from a previous employer. Ascribe sold itself to EMIS Group in 2013 for $88 million but says it could have gotten $5 million more had the theft not reduced its profitability.

AMIA will induct 13 new Fellows in the American College of Medical Informatics on November 15.

An Atlantic article says programmers should stop calling themselves “engineers” since they aren’t regulated, certified, or required to take continuing education. It says the tech industry has cheapened the term “engineer” by applying it to everybody who isn’t in sales, marketing, or design.

I haven’t watched TV for years, but this week’s episode of “CSI: Cyber” titled “Hack E.R.” (although “Hack E.D.” would have been better) apparently spins a tale of a hospital whose network was penetrated by ransom-seeking hackers through a smart TV (what the heck hospital has those?), causing the death of a patient when they disable her heart monitor. The hospital couldn’t take the network down because it would disable all their ventilators (huh?) Then a patient died when the malware-affected EHR didn’t give his doctor an allergy warning as he entered an order. The entire episode, which seems absurdly hammy and unrealistic (being TV, after all), streams here with a ton of commercials and gratuitous on-screen graphics as annoying as those “pop up” shows from years ago. I couldn’t hack (no pun intended) more than a few seconds’ worth, but I notice the series stars Ted Danson (who looks like Sam Malone’s grandfather even with his wig on) and the episode was directed by Eriq La Salle, who played Dr. Peter Benton on “ER.”

Sponsor Updates

• A hospital group in Indonesia reports success in deploying InterSystems TrakCare.
• A Rand Corporation study finds that Health First (FL) improved patient throughput significantly using systems from study sponsor TeleTracking Technologies to identify bottlenecks and improve processes.
• InterSystems publishes a new white paper, “Creating Sustainable 21st Century Health Systems: EHealth and Health Information Technology.”
• Navicure will exhibit at MGMA Mississippi November 6 in Pearl.
• Strata Decision Technology announces highlights from its Decision Summit.
• PeriGen will demonstrate its new PeriCALM CheckList at the Synova Associates Perinatal Leadership Forum November 11-14 in Dallas.
• Obix will exhibit at 2015 Perinatal Leadership Forum November 11-14 in Dallas.
• Medecision and its customer Baystate Health will present a session on population health management at the HIMSS 2015 Big Data & Healthcare Analytics Forum this week.
• Experian Health will exhibit at the HMA CFO Forum November 11-14 in Utah.
• Jefferson College of Public Health recognizes PatientSafe Solutions VP of PatientTouch Coordinated Care Amber Thompson as a 2015 Health Education Hero.
• PDS CEO Asif Naseem is profiled in the local paper.
• Validic announces client growth and enhancements that allow mobile app developers to connect to clinical devices and to Apple Health.
• PerfectServe will exhibit at the American Association for Physician Leadership Fall Institute November 13-17 in Scottsdale, AZ.
• Sandlot Solutions will exhibit at the HIMSS Connected Health Conference November 8-11 in National Harbor, MD.
• The SSI Group will host a user group meeting in Nashville on November 10.
• Streamline Health will exhibit at the HFMA Big Data Analytics Conference November 10-12 in Denver.

Blog Posts

• Medical Data Everywhere: Danger in the Cloud (ID Experts)
• Legacy Data Management: Strategic Considerations for Successful Clinical Data Abstraction (Impact Advisors)
• A Day in the Life of FHG Account Management, or How It’s All About the People (Forward Health Group)
• Patient Engagement for the Entire Family (Influence Health)
• The Sharing Economy Behind the Sharing Economy: Cloud Platforms (Liaison Technologies)
• Revolutions in Healthcare Analytics, Part 2 of 6 – New Data Sources (Optimum Healthcare IT)
• And though we use it here … I can’t use it over there …” (MedAptus)
• Four ways to prepare for next year’s price transparency dialogue with patients (Recondo Technology)
• Billing Office Horror Stories Hit the Box Office (Patientco)
• Care Coordination: A Challenge mHealth vendors are choosing to ignore? (Practice Unite)
• This STEM bears fruit for two million students (Lexmark)
• Accurate Provider Data Plays an Important Role in Meeting Meaningful Use Objectives (Phynd Technologies)
• Messaging Must-Haves: What Features are Essential for a Great Messaging Product? (PMD)
• It pays to do your homework on hospital safety rankings! (Qpid Health)
• Meaningful Use Stage 3: A Brief History and What Lies Ahead for Healthcare IT (Sagacious Consultants)
• Readiness: The Precursor to Health IT Adoption in the Long-Term Care Setting (Surescripts)

Contacts

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

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EPtalk by Dr. Jayne 11/5/15

A shout-out to representative Steve King of Iowa for attempting to inject some Midwestern common sense into the Meaningful Use chaos. His “Putting Patients and Providers Ahead of Compressed Regulatory Timelines Act of 2015” would sunset meaningful use penalties and rebate 2015 penalties back to providers and hospitals. It doesn’t have a realistic chance of passing, but I applaud him for trying.

I mentioned last week that I’ll be attending the AMIA meeting. During my email cleanup, I happened to come across an invitation to a pre-symposium educational session and registered for it. It was lucky that I did my cleanup when I did because the session was the following morning. The late registration caused a couple of hitches in accessing the session, but the team at AMIA still got me connected in time.

I’ve attended a lot of conferences, but appreciated the ability to get some solid recommendations for first-time attendees. One of the pieces of advice that surprised me was their openness with attendees dropping in and out of sessions and following the “buzz” on social media.

One conference I attended last year required attendees to declare their intentions weeks in advance under the pretense of predicting room sizes. In reality, they were using the attendee information for target marketing in advance of the conference. They also had some pretty aggressive door-checkers who scolded attendees for leaving sessions or trying to enter ones already in progress. I understand minimizing disruptions, but I would rather people move to another session where they may learn something than to sit in a session where they don’t find value.

Now that I have more information on the meeting, I can spend my free time putting together my social schedule. There are several networking events planned, including one called WINE (Women in Informatics Networking Event). How can you go wrong with a draw like that? Unfortunately, a couple of my favorite San Francisco-area colleagues will be out of town while I’m there, but that gives me an excuse to look for new and exciting things to do in my free time.

Also in the email clean-up, I found a direct marketing piece from Pfizer about October being Gaucher Awareness Month. Although Gaucher disease only affects 50,000 – 100,000 people worldwide, it has a disproportionate impact on people of Ashkenazi Jewish heritage (one in 600) and medications are available for treatment that can make a dramatic difference for patients. Unfortunately, it’s extremely expensive (cost was $150,000 per patient per year when it first launched in 2012) despite its obvious benefit. I’ve never actually seen a patient with Gaucher Disease (treated or otherwise) as compared to other more prevalent conditions, so it seems an odd choice for a direct marketing piece.

I also found yet another email from Doximity asking me to review the residency program where I trained. I’ve been deleting these for several months. When it first launched in 2011, Doximity tried to brand itself as the LinkedIn for doctors. I’m not sure how successful they’ve been, but I suspect they’re somewhat struggling for relevancy.  I laughed, though, when I read the body of the most recent email, where they asked me to review the program because “choosing a residency program is one of the biggest decisions new physicians face in their careers” and “reviews help medical students find the right training program.” Thankfully, the program where I trained bears no resemblance to what it looked like when I was there. There have been tremendous changes to graduate medical education in the last decade and frankly anything I write would be wholly irrelevant to anyone considering the program today. I’d think that a company that is supposed to understand physicians would have a better handle on this.

A reader contacted me about how hospitals handle Daylight Saving Time. “Our hospital claims that every hospital in the US that deals with Daylight Saving Time turns off their EHR from 1:00 to 2:00 a.m. so there are not duplicate orders, meds, notes out of order, etc. For 15 minutes prior and 15 minutes after — a total of 90 minutes — we have “Zombie Hour” every year for DST. No medical care happens in the system for one hour. Is this your experience? That if you are an unlucky soul that hits the ED from 1:00 a.m. to 2:00 a.m. on November 1 that you do not exist for 90 minutes? Isn’t there a better way? Use UTC or GMT time for meds and timestamps? I cannot imagine that EHR vendors and ONC did not think of this when it has come up before. Help me understand this.”

I was a bit puzzled by this because it hasn’t been a factor in any hospitals where I’ve worked. I double checked with one of my former hospital colleagues and our system handles timestamps in UTC but uses an adjustment for the display, whether regional standard time or regional daylight time. I polled a couple of colleagues at other systems, though, and several of them have Zombie Hour. The reader named a specific vendor in his email, which surprised me that they would not have a better solution than dropping to paper. I’d be interested to hear from vendors how they handle this issue. In the meantime, I found this NIST document on DST rules.

How does your facility handle DST? Email me.

Email Dr. Jayne.

Morning Headlines 11/5/15

Cerner Reports Third Quarter 2015 Results

Cerner stock closed down 6.75 percent today after missing revenue expectations in its Q3 financial results and projecting lower Q4 earnings than analysts had forecasted. Quarterly revenue rose 34 percent to $1.1 billion, adjusted EPS $0.54 vs. $0.42.

Prestigious medical journals rejected stunning study on deaths among middle-aged whites

Two Princeton economists, one a recent Nobel Laureate, have discovered that mortality rates for whites in the US between the ages of 45 and 54 rose dramatically from 1999 to 2013. The findings, which are unseen elsewhere in the developed world, were rejected for publication by both JAMA and NEJM, before being accepted by the Proceedings of the National Academy of Sciences.

Better Together: High Tech and High Touch

A new study conducted by Nielsen Strategic Health Perspectives surveyed 5,000 patients and 630 providers on consumer attitudes toward a wide variety of technologies used in healthcare, including EHRs in the exam room, telehealth services, and text-based appointment reminders.

Many patients ok linking social media to medical records

In a study published in BMJ Quality and Safety, researchers ask adult ED patients if they would be willing to link their social media accounts to their EHR for medical research purposes, to which 71 percent of the patients agreed.

Readers Write: All Aboard the Analytics Train! Next Stop, ROI!

All Aboard the Analytics Train! Next Stop, ROI!
By Jeff Wu

HIStalk-ers may be familiar with Zubin Damania, MD (aka ZDoggMD), a primary care physician turned health pop star. ZDoggMD has been featured on TED and produces parody videos on YouTube of our dysfunctional healthcare system.

Dr. Damania’s videos are loaded with hilarious and witty lyrics with often deep and powerful commentary on what it’s like to practice medicine in the US. His most recent video pokes fun at EHR implementation and highlights a laundry list of relevant complaints about what EHRs have done to negatively impact many providers’ care of patients. Dr. Damania’s criticisms aren’t so outlandish as to propose going back to paper, but he does make the case that we need a new and better EHR environment.

While he makes a valid argument, we also need to consider that the greatest value that EHRs provide has barely been touched.

As of September 2015, CMS’s Meaningful Use program has doled out approximately $31.6 billion in incentive payments for the adoption of Certified Electronic Health Record Technology (CEHRT). While EHR implementations have proven valuable immediate effects — such as reduction of adverse drug events and medical errors — it would be difficult to make the case that these benefits would provide the magnitude of ROI necessary to justify their costs. CMS’s own projections and several post-MU studies have demonstrated that the types of immediate benefits achieved from CEHRT will recoup only a fraction of the MU program’s cost.

What gives? Why would CMS knowingly implement a program that they knew would not provide the immediate ROI necessary to pay for its implementation?

The intention was never to achieve ROI purely on efficiency gains, optimized billing, or reductions in medical errors. What CEHRT provides is data – to an unprecedented degree.

The real value in CEHRT is the way we are getting insights into how disease and injuries progress and react to treatments. The vast volumes of data mean that we are seeing things in novel ways for the very first time. Advances in both hardware and software means that the old days of manual chart abstraction or fragmented tables in antiquated or siloed databases are being replaced with dynamic analytical platforms that can be leveraged cheaper and more effectively.

Analytics is the way to ROI and the industry is finally moving to embrace this. Several industry reports are already seeing an influx in investments into analytics. Big tech players including Google and Microsoft predict healthcare analytics to be a key area of growth over the next few years.

This is a logical next step in healthcare’s technology maturity that we’ve been talking about a lot, even here on HIStalk. While analytics is a hot topic, who it benefits is surprisingly overlooked.

Our discussions of ROI have to be with our end users in mind. Analytics offers us an important opportunity to re-engage our disenfranchised healthcare workers. Our doctors, nurses, pharmacists, and desk staff all have contributed to the data we now have. They should be the ones to chiefly benefit from the coming data harvest. I have yet to meet a doctor or nurse who didn’t have a dozen questions they knew could be answered from data within the EMR, but did not have the tools to do so. That simple fact should be both a mark of shame and a call to action to every health IT worker.

We are on the verge of shifts in practice that can be truly groundbreaking. The information revolution started by the dot-com boom in the 1990s paved the way for companies like Amazon and Zappos to transform whole industries. These adoptions of technology and analytics are being implemented by other sectors at an even faster rate (Uber, Airbnb, Square). If we in healthcare can embrace the power of analytics and purposefully drive their output to end users, we can start tapping an endless supply of ROI.

The optimism behind analytics does not diminish the challenges the next evolution in healthcare information technology will present. All the “big data” and “data governance” buzzwords are valid, but not insurmountable, and the insights we stand to gain are priceless.

The next buzzword is already circulating—closed-loop analytics. It’s the intentional, purpose-driven effort to get analytics to end users for decision making as near to real time as possible. It’s the attempt to engage end users to a degree that the outputs of our analytics serve purposeful functions in their actual practice rather than a retrospective review of what’s happened.

This progression in healthcare technology is the necessary (and hopefully welcome) change that can make the biggest difference in rejuvenating our staff and demonstrating some much-needed value.

Jeff Wu is a population health researcher with UW Health at the University of Wisconsin-Madison.