News 9/11/15

Top News

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

Reader Comments

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

HIStalk Announcements and Requests

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

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

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

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

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

Sales

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

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

People

Leidos Health promotes Tom Aikens to deputy group president.

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

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

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

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

Announcements and Implementations

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

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

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

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

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

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

Government and Politics

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

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

Innovation and Research

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

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

Technology

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

Other

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Contact us or send news tips online.

EPtalk by Dr. Jayne 9/10/15

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 9/10/15

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

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

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

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

GOP scores early win in ObamaCare lawsuit

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

2015 HIMSS Congressional Asks

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

HIStalk Interviews Sean Carroll, CEO, Arcadia Healthcare Solutions

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Is it common now to incorporate claims data?

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

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

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

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

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

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

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

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

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

How did the Sage Technologies acquisition change what you offer?

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

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

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

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

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

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

Do you have any final thoughts?

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

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

Morning Headlines 9/9/15

Recent patent infringement cases filed in the Eastern District of Texas

Preservation Wellness Technologies, LLC sues Allscripts, Athenahealth, Epic, and NextGen for patent infringement on its patent which generically describes a patient portal that “employs a server on which the health care records of participating patients are stored” and where “patients can review their own records via Internet and can edit them.”

Cerner Announces Share Repurchase Program

Cerner’s board of directors has approved a stock repurchase program authorizing the purchase of $245 million of its common stock, representing an estimated 1.2 percent of its outstanding shares. The stock will be repurchased in blocks over an undisclosed period of time.

Trends in Clinical Lab & Digital Pathology | 2015

Peer60 publishes analysis on the Clinical Lab and Pathology market, finding that Meditech (25 percent) and Cerner (22 percent) are the segment’s market share leaders, while replacement vendor mind share is closely split between Epic (33 percent) and Cerner (30 percent). 51 percent of respondents report that they are planning to move away from their current vendor.

PointClickCare Gears Up for IPO

Long-term care software vendor PointClickCare files its IPO with the SEC at an initial valuation of $100 million.

News 9/9/15

Top News

The New York Times profiles cost analysis work being done at the University of Utah Health Care, kicked off when the CEO found that nobody could tell her what it costs to operate an MRI or OR for an hour. Medical costs have declined 0.5 percent a year since the health system was able to compare costs with outcomes. Sixty seconds in the ED costs $0.82 vs. $12.00 for operating an OR for an orthopedics case, for example. Experts say the health system’s VDO database with 200 million rows makes it one of very few health systems that have any idea of their true costs. The health system saves $200,000 per year simply by requiring medical residents to justify each lab order that they otherwise were cranking out by habit. The depressing aspect is that it’s still novelty news when a health system actually wonders what its true costs are, much less does something about them, which is unfortunately not all that uncommon with non-profits who get to stick someone else with their overhead.

Here’s a video overview of University of Utah Health Care’s VDO (value-driven outcomes) project.

Reader Comments

From Slightly Jaded Epic CIO: “Re: UGM. I was overall underwhelmed by this year’s UGM experience. On the plus side, I continue to be amazed at the show and presentation Epic is able to put on, drawing almost entirely from the talents of their own employees. It is still an amazing group of people to be around at all levels. The new features they demo always have a few real whiz-bang moments, as well.The headlining Judy did regarding aggregating data for clinical research grabbed my attention, but it’s coming in the broader environment of a whole bunch of other services and ideas that have not been executed very well. Epic’s new consultancy service was mentioned, but we and every organization I talked to that had been interested in using it were told that there were no staff available. A program to help implement new features with every upgrade touched on several UGMs ago. Nothing happened until just recently, and my sense is that it doesn’t cover anywhere near the services originally advertised. Also mentioned several UGMs ago (I think originally in 2008) was a move towards a Web-based architecture that could replace Citrix. Several years later, this is still in limbo. It wasn’t even mentioned this year. What is not in limbo is all the money we’re paying to Citrix. I hope some of these big ideas come to pass, but it’s getting harder and harder to walk around all the opulence in Verona and not wonder if our money has been buying an illusion.”

From Former Epic CMIO: “Re: UGM. Someone committed suicide that the Marriott where all the CIOs and CMIOs were staying, apparently jumping from a high floor into the main atrium. Very sad.” The only mention I found confirmed that the suicide occurred on September 1 at the Marriott in Middleton. My first thought was that it must have been someone associated with the event given the number of hotel rooms the user group meeting requires.

From Clarity Disparity: “Re: Nordic. I followed your sponsor link to their site, which is clean and well presented, but it contains an error.” It does indeed, although the number of folks who misspell or mispronounce Epic’s analytics and reporting product Cogito Ergo Sum (“I think, therefore I am”) is in my experience quite high. I like the incorrect name Cognito, though – “incognito” means “unknown,” so “cognito” should mean “known” and is also easy to pronounce. I think Nordic (or is that Nordnic?) is on to something.

From Torn Ligament: “Re: Healthcare Tech Outlook magazine. I received an email that our company has been ‘shortlisted’ for an elite opportunity to sponsor the magazine for $3,000 (woo!) A magazine about healthcare technology that spells HIPAA wrong on its cover? Sign me up!” They also got creative in spelling “administration” as “admisidtration”  right above their “HIPPA” gaffe. I tried to figure out who publishes the magazine, but Google turns up nothing about the company, the editor isn’t on LinkedIn or anywhere I could find, and the owner of the web domain is hidden. The magazine’s address suggests that the publisher is SiliconIndia, a Bangalore-based community of Indian professionals that also publishes magazines, with a handful of people working from Fremont, CA and everybody else in India.

From Bamboozled Public Healther: “Re: Mitchell & McCormick EHR/PM for public health. It’s like going back to the 1980s – DOS-based, the company provides no training materials, there’s no MPI, it takes 25 minutes to register, and multiple family members share a single MRN. We’ve had multiple data breaches (of luckily a small number of records) since the system has only three roles – admin, clinician, and business ops – and both clinician users and business ops can see and access all records. According to ONC’s database, no a single health system or provider used this certified EHR to meet Meaningful Use.” Unverified, but this comment is from a system user. 

HIStalk Announcements and Requests

Three-quarters of poll respondents haven’t seen a “gag clause” in a vendor’s software contract. A CIO says the closest he’s seen is a clause requiring both parties to review public announcements or publications involving the other organization. New poll to your right or here, brought on my nostalgia for programming I’ve done: have you ever designed or written software that was used by clinicians?

I planned to write a Monday morning post as usual, but after I wrote up all the available news, it would have been a waste of reader time. I just retitled what little content I had and moved on from there.

Welcome to new HIStalk Platinum Sponsor Crossings Healthcare Solutions. The King of Prussia, PA company’s parent is Universal Health Services, which addressed workflow gaps it found in rolling out Cerner solutions to 25 of its hospitals. The Crossings development team optimized the EHR for clinician use by building many software components as mPages and Advisors, focusing a significant part of their effort on Cerner’s Dynamic Documentation solution to move physician documentation from dictation and paper in 11 hospitals in 2015, with 12 more scheduled in the next five months. Those hospitals have seen voluntary transcription reductions from 50 to 90 percent with good physician feedback from all specialties, earning the company Cerner’s “2015 Physician All Stars Award for Physician Documentation.” A CMIO of a large health system says, “You should be incredibly proud … the best client innovation I’ve seen in my 10 years working with Cerner.” Just released is TPN Advisor, which aggregates patient nutrition information on one Millennium chart, decreasing TPN ordering time and calculating compounding instructions that are sent electronically to the pharmacy (a pharmacist describes it as “the most sophisticated clinical decision support tool I have ever seen.”) Future releases include a CNO Dashboard, daily physician documentation with Core Measure advisors, a discharge package, and an DKA advisor. The company will exhibit at Cerner’s CHC15 in Kansas City, MO on October 11-14. Thanks to Crossings Healthcare Solutions for supporting HIStalk.

I found this YouTube video that describes and demonstrates  enhanced Dynamic Documentation from Crossings Healthcare Solutions.

Mrs. S sent photos of her Oklahoma third graders using the two iPad Minis bought via our DonorsChoose project, adding that they love playing educational games on them during listening and word study sessions.

Sites keep running new polls about ICD-10 readiness. Why? It’s happening no matter what, so just wait three weeks and we’ll find out who’s ready.

My latest grammar and usage peeve: people who say something such as, “I went to two different doctors,” inserting the pointless “different” to proactively address any misconception that they visited two of the same doctors.

Last Week’s Most Interesting News

• ONC revokes certification for the SkyCare EHR after the company appears to go belly up.
• Salesforce announces Health Cloud, its patient relationship management foray into healthcare.
• Voalte raises $17 million in funding with Cerner as one of its investors.
• Epic announces formation of a research network in which the information of its opt-in clients can be searched.
• MEA|NEA acquires The White Stone Group.
• Former BIDMC CEO Paul Levy calls for an attorney general anti-trust review of Epic in his blog.

Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services.

Acquisitions, Funding, Business, and Stock

Cerner announces that it will repurchase up to $245 million in shares of its common stock. Neal Patterson says that “the repurchase of our stock is a good use of funds,” although I’ve never understand how a company buying its own shares from investors does anything more than provide the market with reassurance that it thinks they are undervalued despite what shareholders might otherwise believe.

Craneware announces FY15 results: revenue up 5 percent, adjusted EPS $0.38 vs. $0.34.

Long-term care software vendor PointClickCare files its IPO forms with the SEC. In it, the company reports $102 million in 2014 revenue, up 24 percent even as its losses widened from $3.3 million to $11 million.

Preservation Wellness Technologies, of which no Internet trace exists except for lawsuit filings, sues Allscripts, Athenahealth, Epic, and NextGen for patent infringement. Its patent is summarized as, “A portable heath care records system employs a server on which the health care records of participating patients are stored. The patients may access the system using cards or CD-ROMS that are inserted into the patient’s computer. The patients can review their own records via Internet and can edit them.” The inventor appears to be a hairstyling salon owner.

Franklin, TN-based patient engagement technology vendor Relatient will move into larger office space to accommodate its 24 employees.

Post-acute care EHR vendor Netsmart acquires Trend Consulting Services, a Solon, OH-based IT outsourcing and infrastructure support services vendor.

Community Health Systems files the initial SEC paperwork to spin off 38 of its small-town hospitals and management consulting subsidiary Quorum Health Resources to form Quorum Health Corporation.

Sales

In China, Qingdao United Family Hospital will deploy the InterSystems TrakCare healthcare information system.

People

Dann Lemerand (Evariant) joins Infor as director of healthcare industry and solution strategy. He started the HIStalk Fan Club on LinkedIn many years ago, which has grown to 3,634 members. I should have a random drawing or something since it’s cool to have a fan club and it would be nice to give folks something for signing up.

Darthmouth-Hitchcock Medical Center (NH) Chief Innovation Officer Terry Carroll resigns. 

Chris Longhurst, MD, MS (Stanford Children’s Health) will join UC San Diego Health Sciences as CIO, replacing the retired Ed Babakanian on November 2. He will also serve as a faculty member in the Department of Biomedical Informatics. 

Surgical ICD-10 coding vendor Vincari hires Maqbool Patel, PhD (YourCareUniverse) as CTO and Hugh Lee (Perigen) as RVP of sales.

Todd Cozzens (Sequoia Capital) joins Leerink Capital Partners as managing director.

Announcements and Implementations

The Tucson paper tells the locals that Banner Health will replace its $115 million Epic system with Cerner in early 2018 at the former University of Arizona Health Network it acquired earlier this year. The article summarizes, “Installing the Epic system and training employees to use it was one of the key reasons the former University of Arizona Health Network, acquired by Phoenix-based Banner March 1, struggled financially throughout 2014 … The investment in Epic was so expensive that the UA Health Network experienced unprecedented operating losses in its 2014 fiscal year, including $32 million in unbudgeted costs.”

Versus announces VUE16, its third Versus User Experience, May 4-6, 2016 in Scottsdale, AZ. 

Peer60 releases “Trends in Clinical Lab & Digital Pathology,” which finds that the top LIS mind share leaders are Epic, Cerner, Orchard, and Meditech. Half of the respondents say they’ll switch LIS vendors, not surprising given that they scored their existing vendor an average of 5.2 on a 10-point scale (although that means they’ll most likely be switching to a different but equally low-ranked product). When asked what LIS vendors could do to retain clients, additional functionality and better support rose to the top, but about the same percentage said it wouldn’t really matter since the lab won’t get to make the decision. Half say they’ll never buy digital pathology, most because they don’t offer on-site pathology. Three-quarters say they’re seeing more requests for genetic testing, molecular testing, or both.

Vital Images licenses HeartIT’s zero-footprint patent portfolio.

Government and Politics

The CDC awards a four-year grant worth nearly $4 million to the Kentucky Injury Prevention and Research Center to integrate the state’s KASPER prescription drug monitoring database with EHRs.

The West Texas VA system, which was reporting 43 percent of its positions as vacant, admits that nobody had updated the national computer system for months. The actual vacancy rate was 22.3 percent, still the third-highest in the VA.

Privacy and Security

A Wired editorial on the Ashley Madison breach concludes,

There is a naiveté to how we use the Internet. We never read the small print. We scroll to the bottom, check the box and cross our fingers. We are still terrible at basic online security. The top two passwords used to access Ashley Madison were "123456" and "password", just like everywhere else on the Internet. We trust people we shouldn’t to look after the most personal information about ourselves. "There is no such thing as the cloud", the saying goes, "it’s just someone else’s computer." The data held by Ashley Madison, although embarrassing, was small fry. Every mobile phone in our pockets, every sat-nav in our cars, and every smart meter in our homes is recording something about our lives. We as humans are creating the richest source of information about ourselves in history. Unfortunately for social scientists and historians, that information is held securely by private corporations. Unfortunately for everyone, that information isn’t always held as securely as we might hope.

A Microsoft Research study finds that legacy-friendly database encryption systems such as CryptDB and Cipherbase aren’t very good at protecting EHR information, mostly because the encryption key is held in memory where it can be extracted by exploits. The researchers conclude that CryptDB shouldn’t be used to secure EHR databases.

Innovation and Research

Researchers at the Scripps Translational Science Institute enroll 4,000 people in the first clinical trial of the Scanadu Scout. The six-month study invites participants to use the Scout however they would like to measure heart rate, blood pressure, blood oxygen level, and temperature by touching the device to their temples for 10 seconds. Scanadu’s CEO describes the choice of Scripps for the trial by using one of my least-favorite expressions, calling it “a no-brainer.” The Scout doesn’t sound nearly as cool, useful, or innovative as the early Tricorder hype suggested.

Technology

Dell will sell Microsoft Surface Pro tablets and services to enterprises starting next month.

This is both brilliant and life-changing for some people. The Brightly wearable abdominal belt monitors bladder conductivity to alert incontinent wearers via their smartphone that they need to find a restroom. A similar product in Japan provides the same service for people with fecal incontinence. In either case, wearers suffer less embarrassment and dependence on external pads.

A hospital in England installs an arrhythmia scanner at its visitor entrance, with the palm-scanning technology looking specifically for atrial fibrillation that can cause strokes. Results from the 30-second test are emailed to the hospital’s cardiology department, which can offer a same-day EKG. The hospital wrote the software that uses RhythmPad system of Cardiocity, which was formed in 2011 to use car racing telemetry for mobile health.

Other

The mother of a Penn student who committed suicide sues Amazon for selling her daughter cyanide, which is banned for sale in the US. Amazon stopped sales of a cyanide-containing product from Thailand in early 2013, but the lawsuit claims 52 customers had purchased it by then and 11 of them died shortly after receiving their order.

Monadnock Community Hospital (NH) turned patients away, diverted ED patients, and cancelled surgeries last week during a four-day computer outage caused by a failed network upgrade.

An independent panel hired by Texas Health Resources to assess the 2014 death of Ebola patient Thomas Duncan and the infection of two of its nurses finds that (a) THR employees were overly reliant on Epic to convey critical information; (b) the hospital’s Epic configuration didn’t place the patient’s travel history on the standard patient assessment screen; (c) caregivers failed to monitor the patient’s clinical information; (d) the hospital worried too much about patient satisfaction instead of outcomes; and (e) the hospital didn’t get Ebola treatment information into the right hands quickly. The committee suggested that all hospitals be prepared to react as THR did in quickly reconfiguring Epic to improve caregiver communication. It also notes that the care team was presented with an electronic warning via Systemic Inflammatory Response Syndrome Score, but either didn’t understand it or ignored it as the patient was discharged with a temperature of 101.4 degrees. Another problem is that nobody understood CDC’s role in managing the patients or suggesting caregiver protection, which is advisory only.

A law review journal suggests that medical malpractice attorneys scour the defendant’s EHR to find a single data element that is incorrect or falsified, then have their entire medical record dismissed as being untrustworthy.

Weird News Andy says the subject of this story hasn’t showered for three years, with WNA adding that he hasn’t either because his typically last around five minutes. An MIT-trained engineer creates Mother Dirt, a spray that contains live bacteria intended to replace baths and showers. He theorizes that humans have killed off good skin bacteria due to over-cleaning, with his company’s GM adding, “We’ve confused clean with sterile.” A single bottle contains 3.4 fluid ounces, which lasts about a month and costs $49.00.

Sponsor Updates

• Dimmit County Memorial Hospital (TX) documents its love of T-Systems in video and song.
• VisionWare and ZeOmega will exhibit at the Accountable Care & Health IT Strategies Summit September 10-11 in Chicago.
• VitalWare will exhibit at the QHR Vendor Fair September 10 in Orlando.
• ZirMed will exhibit at the California Ambulatory Surgery Association conference through September 11 in Huntington Beach, CA.

Blog Posts

• Lab Goes Social: Using Social Media to Inspire Innovation (Sunquest Information Systems)
• Interview with Andi Dewes, VP of Clinical Strategy, Surgical Information Systems (Surgical Information Systems)
• Hospital CFOs Focus – Integration, Efficiency, Outcomes (TeleTracking)
• Workplace Wellness Goes Digital (Validic)
• How to Play as a Team to Fight Fraud (Verisk Health)
• Flip the Script: Delivering the Unexpected (Visage Imaging)
• Back to School (Voalte)
• Meaningful Care Coordination (Zynx Health)
• PainCareOS Software Leverages SyTrue Inc. Artificial Intelligence (Natural Language Processing) Platform to Automate Incoming Referrals (SyTrue)

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 9/8/15

What Are a Hospital’s Costs? Utah System Is Trying to Learn

The New York Times covers efforts by the University of Utah Health Care to use data analytics to calculate the cost of the care per minute in each care area, as well as across various procedures and conditions. The team has already cut $200,000 per year in unnecessary lab tests and reduced costs associated with bypass surgeries by 30 percent.

Care.data on hold again

In England, the NHS’s electronic patient data sharing program Care.data has been suspended just ahead of its pilot program launch. Concerns over the wording used on the patient consent and opt out form was the reason for the delay.

Kentucky receives nearly $1m a year for next four years to combat prescription drug abuse, heroin

The CDC issues a four-year, $4 million grant to Kentucky to help it integrate its prescription drug monitoring program with EHRs being used by hospitals in the state.

Morning Headlines 9/7/15

Banner scrapping $115M UA Health records system

A local Tucson paper reports that Banner Health will replace the University of Arizona Health Network’s $115 million Epic platform with Cerner by early 2018.

Medicaid ICD-10 workarounds in California, three other states worry providers

Medicaid programs in California, Louisiana, Maryland, and Montana have been granted permission from CMS to continue using ICD-9 codes after the October 1 switchover because their systems are not fully capable of supporting ICD-10. The state offices will convert submitted ICD-10 codes into ICD-9 codes and then use those codes to calculate payments.

New service to manage cyber security threats in health and care

England will create a national cyber security center to support the NHS and other healthcare organizations, providing “expert advice and guidance on cyber security threats and best practice.”  The new service will be launch in phases between January and autumn 2016.

Electronic Health Record Incentive Program-Stage 3 and Modifications to Meaningful Use in 2015 through 2017

ONC has submitted the Meaningful Use Stage 3 Final Rule to the OMB for review ahead of its public release.

Morning Headlines 9/4/15

Salesforce Health Cloud: Putting Patients at the Center of Their Care

Salesforce announces the launch of its new Health Cloud platform, a CRM platform optimized to help healthcare organizations manage patient relationships.

athenahealth and Epic Are Only Vendors with Growth and No Losses in Acute Care EMR Market Share

A new KLAS report finds that Epic, Cerner, and Athenahealth are the only vendors that were able to expand their acute EHR market share in 2014. While only two vendors, Epic and Athena, recorded no customer losses through the year.

Veterans Health Administration: Review of Alleged Mismanagement at the Health Eligibility Center

The VA OIG publishes a report concluding that more than 300,000 of the VA’s 889,000 pending healthcare applications were for patients that have died, while an additional 50,000 applications were either erroneously deleted or otherwise left unprocessed for more than three years. The errors are being attributed to substandard IT processes.

NIH grants seek best ways to combine genomic information and EHRs

The NIH awards $35 million in funding to 10 organizations working to integrate genetics data into EHR systems. Recipients include Mayo Clinic, Geisinger Health System, and Brigham and Women’s Hospital, among others.

News 9/4/15

Top News

ONC revokes certification for Platinum Health Information System’s SkyCare EHR (the former PlatinumMD) after the apparently defunct company ignores information requests, forcing the 48 SkyCare users who attested to Meaningful Use Stage 1 to either replace the system or drop out of the MU program. I’m guessing the company has gone out of business since its website is down and several Ripoff Reports say it closed its doors in March, leaving customers in a lurch right after it threatened to sue users for $10,000 if they stopped paying their monthly fees that were financed through external lenders as five-year contracts. The company was apparently owned by UBcare, a huge South Korean holding company. The complaints of users seem to revolve around the company’s squeaking by on MU Stage 1 certification with unfulfilled promises to develop MU Stage 2 enhancements. That, unfortunately, is a business rather than a certification issue and small practices are notorious for being naive in letting major decisions be made by inexperienced and minimally educated office managers (often chosen from a pool of candidates consisting of the spouse or other relative of the solo physician).

Here’s a January 2015 snip from someone claiming to be a customer of SkyCare, although it misspells the name of SkyCare President and CEO Alex Chang.

Reader Comments

From Red Corvette: “Re: Salesforce interview. They have ambitious plans and have brought on a team that understands the industry’s big players, but I think they will struggle for traction. I assume their new product is a healthcare-optimized version of their Force Platform, which requires third-party developers to flesh out features and functions. Those potential developers will want to know how many healthcare organizations have deployed Salesforce, just as prospects will want to know how many third-party applications are available immediately. This will be a difficult cycle for Salesforce to break. The Saleseforce exec team will need patience to wait for their healthcare vertical to gain traction, which will take much, much longer than they think. Salesforce needs to make a strategic acquisition to give them a customer base and to fast-track third-party developers.” I’m always wary of big companies suddenly barging into healthcare as their latest lust interest, but Salesforce has chosen a good time to address the new need for providers to engage with consumers. They have a highly recognized name, thrive on an open ecosystem, are already working with big-name sites, and make sensible arguments as to why patient relationship management is more their domain as a customer relationship management technology vendor than for traditional healthcare-only software vendors.

On the other hand, Salesforce has to figure out how to play nice with Cerner, Epic, and Meditech, and leading off the launch by calling out their closed walls and dated technologies probably wasn’t the best way to start cultivating those relationships. Their main problem, however, will be getting in front of provider decision-makers who have a million other problems to worry about, keeping the sales plates spinning through infinitely long sales cycles, and giving providers the hand-holding they’re accustomed to. Still, what they’re offering is just a healthcare-tweaked version of their existing products, so it’s not a huge leap into the abyss. I’ll be interested to see whether they appeal only to the marketing function of health systems instead of the much more interesting and lucrative clinical outreach and patient engagement side of the house. The track record of outsiders barging into healthcare with guns blazing is abysmal – nearly all of them end up whimpering away quietly with their tails between their legs. But for yet another counterpoint, health systems are starting to look more like health plans in dealing with large numbers of consumers who aren’t necessarily regular patients, and for that kind of marketing, EHRs aren’t going to cut it.

Speaking of the Salesforce announcement, clueless writers suggested that Health Cloud: (a) solves interoperability; (b) competes with Athenahealth; (c) is an EHR; (d) is a personal health record; and (e) might required FDA approval. Others spat out unrelated old news from other health IT companies in adding confusion while struggling to say something original that wasn’t already contained in the press release. It’s depressing to think that someone might believe some of this misinformed but confidently presented drivel.

From Kitty Carr: “Re: St. Luke’s, Idaho anti-trust case. Epic finding itself in the eye of an anti-trust spat isn’t new to Partners or the Northeast.” The US district judge agreed with the plaintiffs (competitors of St. Luke’s) that its acquisition of a big medical practice would give it a near monopoly since even without St. Luke’s expressly mandating practices to send them all their business. One aspect of that is encouraging practices to use the same EHR as the health system to make referrals to it easier and to prevent “leakage.”

From EpicUGM: “Re: TV clips played in the Cool Stuff Ahead and executive address sessions. Did Epic license those from Gilligan’s Island and Batman? If so, that must have been one really expensive show.”

From Lookie Here: “Re: contributed articles. I thought you don’t post articles that have appeared elsewhere, but ‘Can We Create a Market for Health Tech?’ comes right from the contributor’s blog.” Thanks for catching that since I didn’t. I’ve deleted that article and notified the author that he’s banned from submitting future posts. You only get one strike when it comes to sending me something claimed to be unpublished anywhere.

From FlyOnTheWall: “Re: Emdeon. Announced today that they are becoming Change Healthcare.” Verified. Emdeon acquired consumer engagement technology vendor Change Healthcare in November 2014 and will now adopt its name.

HIStalk Announcements and Requests

I’m reminiscing about my early days as a hospital software analyst, thinking about how I viewed (and still do) programming as a personal form of art. I would look at thousands of lines of intricate code that handled extraordinarily complicated clinical and billing functions, marveling at how much thought went into figuring out how the program should work and making sure that every weird thing a user might do was corralled by carefully defined exceptions. Programmers characterize each other by how they code – do they favor elegant, brilliant analysis and clean and well-documented programming, or do they just jam in brute force changes to handle a specific problem without really understanding it? Programmers sit alone, immersed in the artificial world a program creates and mentally turning dry lines of code into a visual picture of what the program does and should do. I think that’s the mark of an exceptional analyst – not necessarily their code-slinging proficiency, but their ability to understand and then visualize what the user needs the program to do. I think the proudest moments of my career were in working solo to create occasionally ingenious programs that helped people do their jobs or helped patients to get out of the hospital unharmed.

This week on HIStalk Practice: MGMA calls on CMS to extend Meaningful Use reporting deadlines for medical groups. BCBS of Minnesota picks Doctor on Demand as its preferred telemedicine provider. Wisconsin looks to join the Interstate Medical Licensure Compact. CenturyLink sees telemedicine potential thanks to $500 million FCC grant. HHS makes an example out of Cancer Care Group’s HIPAA violations. The Independence Blue Cross Foundation invests in healthcare tech for safety net health centers in Pennsylvania.

This week on HIStalk Connect: Google announces a strategic partnership with French pharmaceutical giant Sanofi focused on developing a platform of Bluetooth enabled insulin pens and glucometers. The American Society of Clinical Oncologists updates its statement on the use of genetic testing in cancer screening and care delivery. Voalte raises a $17 million Series D that it will use to ramp up as demand for its point-of-care communications platform grows. Providence, RI-based digital health startup Sproutel launches Jerry the Bear, a diabetic patient education tool for children built in the form of a stuffed bear.

I admit that I ignore the instructions and don’t stir frozen dinners when microwaving then – I just set the timer for the total number of minutes and figure it won’t make that much difference.

Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day. We get a lot of webinar page views and registrations from interested readers.

Acquisitions, Funding, Business, and Stock

Analytics vendor MedeAnalytics sells a majority interest in the company to Thoma Bravo.

Healthcare communications platform vendor Voalte raises $17 million in a Series D funding round, increasing its total to $60 million. Investors are Ascension Ventures, Cerner Capital, and Bedford Funding. The company reported Q2 YOY growth of 250 percent with 44 new sites signed last year. Founder and CEO Trey Lauderdale told me that the health systems that created the industry were academic medical centers and pediatric hospitals and the capital infusion will help Voalte reach the big health systems as demand shifts to enterprise standardization in replacing pagers and legacy smart phones. Cerner will get a Voalte board seat as part o the investment.

Shareable Ink will change its name to Shareable following the departure this year of CEO Laurie McGraw and founder/CTO Stephen Hau.

Leidos covered its DoD EHR contract award in a Wednesday investor webcast. It was mostly a glossy overview with some details on how the company will recognize revenue as it completes task orders. The go-lives won’t start until summer 2017 and will take six years to finish. Leidos says it earns $50-$75 million per year in revenue supporting the current AHLTA system, which will wind down as it implements the new system. The company says profit margins will be at or slightly above its usual margins, but declined to explain further. Leidos says that it expects the contract to be worth the awarded $4.3 billion despite rumored higher numbers, saying those higher dollar estimates include internal government costs that won’t be paid to contractors. The company declined to say how the money will be divided among the subcontractors.

Sales

Holyoke Medical Center (MA) chooses QPID Health to identity behavioral health patients at risk for ED visits and readmissions.

Cerner announces its much-discussed replacement of Epic ambulatory at Glens Falls Hospitals (NY), which also uses Cerner’s ITWorks.

People

Medecision promotes Kathy D’Amario to SVP/CTO.

The Greater Houston Healthconnect HIE hires Deepak Chaudhry (Nexus Health Systems) as CTO.

Peter Schmitt (Nomacorc) joins release of information vendor MRO as president/COO/CFO.

Hunt Blair, former Vermont health IT coordinator and consultant to ONC, has died.

Announcements and Implementations

Salesforce launches Health Cloud, a patient relationship management solution that was designed with the help of UCSF and Centura Health. I interviewed Salesforce Chief Medical Officer Josh Newman, MD this week, who described the new application as:

What we want to do for healthcare is what we’ve done for business, which is to enable those relationships. Service Cloud is our product name. It’s like a call center app, but customized for healthcare so that everyone can have that same relationship with the patient wherever they are, on any device, to support healthcare. Not the stuff the EMR does — not medication ordering, laboratory ordering and resulting, or procedure ordering or notes — but the interpersonal communication that supports the success of those other things.

The FDA clears the $199 Eko Core digital add-on for stethoscopes following completion of clinical trials at UCSF. Stanford University Department of Medicine will issue the devices to its internal medicine residents. The device provides amplification, background noise filters, and Bluetooth connection to its app that powers its dashboard and can send recordings to EHRs. 

Government and Politics

A VA OIG report commissioned by the House Committee on Veterans’ Affairs finds that the agency’s poor recordkeeping and sloppy IT processes makes it impossible to accurately report the rumored extent of backlogged healthcare applications, the number of veterans who died while their claims were pending, and suspicions that the VA intentionally deleted records. The report states, “Enrollment program data were generally unreliable for monitoring, reporting on the status of health care enrollments, and making decisions regarding overall processing timeliness, in spite of the costs to collect the data and maintain ES [enrollment system].”

NIH awards 10 grants of around $3.5 million each to researchers studying how to add DNA sequence information into EHRs. Receiving awards were Group Health Research Institute/University of Washington, Brigham and Women’s Hospital, Vanderbilt University School of Medicine (two grants), Cincinnati Children’s Medical Center, Mayo Clinic, Geisinger Health System, Columbia University, Children’s Hospital of Philadelphia, and Northwestern University. Brigham and Women’s and Baylor College of Medicine already received $8.4 million each in funding.

Privacy and Security

A jury throws out the $1.25 million data breach lawsuit brought against UCLA Health System by a woman whose sexually transmitted disease diagnosis was sent to to her former boyfriend by a UCLA temp (who also happened to be the former boyfriend’s current girlfriend).

In England, an NHS clinic sends out its HIV patient newsletter by using Outlook’s CC function instead of BCC, exposing the names of all 780 people to each other. The clinic tried using Outlook’s recall feature, then sent another email containing an apology and an urgent plea for everybody to delete the original.

Sony Pictures settles the proposed class action lawsuit filed by employees whose medical information was exposed in last year’s data breach.

Other

In South Australia, a hospital radiologist who complained that administrators were deleting his notes and entering orders under his name is vindicated by state investigators who find that four employees tried unsuccessfully to delete a  patient’s record from the imaging system.

The Madison paper covers the kickoff of Epic’s UGM, which is themed around classic (meaning off the air for decades) TV shows. A new offering, Cosmos Research Network, was apparently announced that involves commingling the information participating Epic clients for clinical research. CEO Judy Faulkner told attendees that Epic is talking to Congress about telehealth and cybersecurity.

The call for an anti-trust investigation into Epic was one of the last healthcare-related posts on the blog of former BIDMC CEO Paul Levy, who says he’s finished writing about healthcare and will instead focus future articles on his current interest — negotiation.

I don’t recall having heard of the provider-led, non-profit Healthcare Services Platform Consortium that is working on interoperability, but it announces founding members Intermountain Healthcare and LSU Health Care Services Division.

Speaking of BIDMC, the health system is rumored to be talking again with Lahey Health about a merger to compete with Partners HealthCare.

A KLAS report finds that only Epic, Cerner, and Athenahealth gained inpatient EHR market share in 2014. Athenahealth (the former RazorInsights) and Epic were the only vendors who didn’t lost customers last year. Epic’s customer count increased the most, but Cerner’s market share is larger following its acquisition of Siemens Healthcare Solutions.

The United Auto Works suggests that Detroit car manufacturers form a single healthcare purchasing group to increase their bargaining power in providing health benefits to 1 million people.

In England, a few newspaper-contacted doctors and organizations express unhappiness with the plans of Health Secretary Jeremy Hunt to give patients access to their entire medical record by 2018 and to allow them to read and update their records by smartphone within a year. Most interesting is the response by the chair of the Royal College of GPs, who says, “GPs are under incredible pressure, seeing more patients than ever before, and we simply do not have the resources to analyze data that patients upload to their records as a matter of course.” Articles like this suggest that all doctors are unhappy with the announcement even though the writer didn’t contact any practicing physicians, a method quite a few publications use to stir up emotion without having to expend effort in doing real research that proves the headline’s pre-digested conclusion.

An interesting analysis of episodes of “Grey’s Anatomy” and “House” finds that TV patients survived CPR at twice the rate of real-life patients, which might unduly influence anyone making Do Not Resuscitate decisions.

PhantomAlert, a competitor to Waze (the GPS and directions service Google bought for $1 billion in 2013) sues Google, claiming the pre-acquisition company stole its mapping information. PhantomAlert says it can prove it because it placed fake locations in its databases just to catch copycats, adding that Waze needed to steal its information in its desperation to find a buyer that turned out to be Google.

Sponsor Updates

• Impact Advisors is named to Modern Healthcare’s “Largest Healthcare Management Consulting Firms” list.
• Forward Health Group creates an overview video called “Population Health Management for the Real World.”
• TransFirst will provide payment processing solutions that integrate with PatientPay.
• Medicomp announces Medcin U North America and New Asia conferences.
• Nordic brews up an EHR IPA to raise funds for veterans and the unemployed during Epic’s UGM in Madison.
• NTT Data partners with the City of Plano, Texas in its Food 4 Kids program.
• Experian Health/Passport will exhibit at the North Carolina Association of Healthcare Access Management
• PerfectServe releases a new case study featuring IPC Healthcare’s Memorial City practice.
• Impact Advisors releases a white paper titled “Realizing Value from an Enteprise EHR Investment.”
• PMD makes the Inc. 5000 list of fastest-growing private companies in the U.S. for the fourth consecutive year.
• RelayHealth is named a leader in clinical data exchange in IDC’s latest MarketScape report.

Blog Posts

• Flip the Script: Delivering the Unexpected (Visage Imaging)
• 4 Ways Front Desk Staff Impact Your Revenue Cycle (Hayes Management Consulting)
• Securing Critical Patient Data and Closing the Gaps in Communication Processes across the Continuum of Care (MEA|NEA)
• How “Patient-Focused” Drives MedData’s Operational Philosophy (MedData)
• Traveling the Path to Population Health: Data Acquisition (Orion Health)
• Patient Financial Engagement: Grinnell Regional’s Practice Experience (Patientco)
• The Future Will be so Bright That We Will Have to Wear Shades! (Phynd Technologies)
• Edward Tufte’s Powerful Message for Healthcare Analytics (Sagacious Consultants)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

EPtalk by Dr. Jayne 9/3/15

CMS is pushing their “ABCs of ICD-10.” Although this week’s focus is on “B,” I hadn’t seen the campaign before. As a physician, I couldn’t help but think of the fact that when we hear “ABCs” we immediately tend to think “Airway, Breathing, and Circulation” as we’re trying to resuscitate patients. Based on some of what I’m seeing in the community, I think we’re going to be resuscitating more than a few providers and billing supervisors as their practices are decidedly not ready for the transition.

I was on the phone with a client today who has decided not to take its vendor’s mandatory ICD-10 patch and instead will try to customize the system on their own. They plan some brute force workarounds if that doesn’t work. At this point in the game, I just don’t have the stomach for working with people in that mindset. I told them that if they agree to take their vendor’s patch I’ll be happy to assist, but if not, they’re on their own. It’s just too risky when there are fewer than 30 days on the clock and there are tested solutions available.

Interestingly, the “B” campaign stands for “Be sure your systems are ready.” They recommend practices test to make sure they can generate and submit claims, schedule appointments and procedures, verify eligibility and benefits, submit quality data, update patient histories and encounters, and code encounters. If you’re just thinking about testing these items now, you have a lot of work in front of you.

Speaking of the October 1 date, I’ve seen an uptick in requests for last-minute locum tenens placements spanning the go-live date. I am not sure if people are thinking the system will grind to a halt and want to staff up or if small practice providers are deciding to take vacation during the transition and return to practice when things are stable. I see more specific EHR information in the listings than I have seen in the past.

I had to laugh though at one of them, which was not only trying to recruit a “Physican,” but also said the small-town practice includes “tell a med.” I can only infer that telemedicine is involved, but there were enough problems with the listing to make me worry about what one might be walking into (including spelling the name of the EHR wrong and failing to capitalize “September.”) The one site only sees 6-10 patients a day and that’s certainly tempting, but I doubt the locum agency’s ability to handle professional liability coverage and credentialing when they can’t spell.

My former hospital made me chuckle today by announcing (at 11:30 a.m.) that they would be taking the hospital system down from noon to five for a scheduled upgrade. Seriously, who performs upgrades in the middle of the work day? They’re offering a special support line from 5-7 p.m. then going back to regular support hours. I suppose they assume all bugs will present themselves in the first two hours after the upgrade. There was no mention of what the upgrades would bring or how users should anticipate their workflows might change. Needless to say, I’m feeling pretty good about having jumped ship when I did. I just hope they keep me on the distribution list because it’s been amusing.

I’m always happy to feature companies that are giving back to the community. While the Epic User Group Meeting is in full swing, Nordic Consulting is partnering with local organizations to make the world a better place. Monday night at their open house, Nordic served a custom-brewed Nordic EHR IPA. For every pint poured, they donated $1 to The Road Home program at Rush University Medical Center, which helps veterans return to civilian life.

For beer connoisseurs, the EHR IPA contains Equinox, Hallertau, and Rakau hops. It’s also on tap at more than a dozen bars and restaurants in Madison, so grab a glass if you can. Their open house also featured cookies from The River Bakery, which provides job training and placement in the baking industry. Everyone knows how much I love pastry, so this made me smile.

From Eager Reader: “Re: keeping up. I’m working on an informatics project and wanted your take on something. How do physicians with extremely busy schedules keep up with new scientific data? Do you rely on certain sources now, or do you have to grunt through the medical journals on your own?”

That’s a great question. The short answer is that it’s hard to keep up, especially if you’re really in the trenches. I have a few key journals that I read. Unfortunately, I don’t read them regularly, but rather stack them up (I’m still a paper girl at heart), and when the pile gets so tall, then I curl up and read the articles that are pertinent to my practice and my clients. In addition to new articles and reviews, several also have “tips from other journals” sections that may lead me to read parts of other journals.

I’m also a big fan of the Wolters Kluwer Health UpToDate product as far as researching the most current thinking on a given condition, especially when you have someone in front of you with a condition you may not have seen in years. In my clinical setting, I’m often working alone and don’t have a colleague I can grab between patients and bounce ideas off of them. I do have clinical decision support in my EHR that links to the literature, but I rarely use the links. With my current vendor, I trust that the physician informaticists on staff did the right thing when it was built, but I’ve seen some crazy bugs in previous systems.

How do other physician readers keep up? Email me.

Email Dr. Jayne.

Morning Headlines 9/3/15

Electronic health record product certifications terminated

ONC strips Platinum Health Information System’s SkyCare 4.2 EHR of its MU certification after it failed to participate in routine surveillance requests. Prior to the decision, only one other vendor, EHRMagic, has ever had their certification revoked.

Healthcare Organization ICD-10 Readiness Survey: Key Survey Findings and Action Items

An August 2015 Navicure survey of practice billers, administrators, and executives finds that 15 percent of respondents have not started planning for their ICD-10 transition yet, while an additional 14 percent report that they are not on track to meet the deadline.

Radiation oncology practice settles with HHS over data breach

Cancer Care Group, a oncology practice in Indiana, will pay $750,000 to settle a 55,000 patient data breach with the OCR.

CIO Unplugged 9/2/15

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Barren

I am often asked what the difference is between a manager and leader. In simple terms, it comes down to this. Leaders replicate themselves; managers don’t.

This may seem offensive because many who would consider themselves leaders are actually barren in a professional sense. They have not replicated themselves to cultivate children in leadership. They are managers. There is nothing wrong with being a manager — you just have to be honest about it.

If you think you are a leader but no one follows in your footsteps, you are a manager. But the greatest joy of a leader is to raise someone up and see him or her succeed.

I have been blessed with two children. We were deliberate in how we raised them. From an early age, they were taught to be independent adults who would add value to society. Parenting success was largely based on our ability to mentor and model how to be an adult. I am thankful that both children are of upright character and morals, graduated from college, have noble professions, and moreover, are adding value to society in numerous other ways.

That is what leaders do — replicate. They serve as models. They mentor. They call forth the seeds of leadership within their teams, nurture them, and protect them until they can protect themselves. Then they let them go. Yes! Let them go.

I learned this early on as I observed leadership roles in my classrooms, on the playground, in Cub Scouts and Webelos, on the soccer pitch, and as an altar boy. It was all about identifying potential leaders, nurturing them, and helping them grow and—eventually—letting go.

I learned last week that another one of my former direct reports became a CIO. I cried just like I did when I let my kids go. We invested so much energy and resources into Brandon and Talitha over the years, and as hard as it was, we let them go.

Oh the pain and joy. I feel it fresh as I write. But that is what leaders do — replicate themselves. Joey was my 12th CIO. Most of the 12 serve in healthcare today, but I had one who left for the Cleveland Zoo. He said that there were many similarities with academic medicine. I believed him. Like a proud papa, I let him go.

If you are not barren, then perhaps you’ve got it down and can add fresh ideas in the comments section that might help others.

If you are barren but want to start producing children in leadership, here are some ideas that may help:

• Self-reflection. Ouch. Yes it starts with you. Are you worthy to be replicated? Do people seek you out and want to serve you ? If not, be honest about it and figure out why. I self-reflect constantly and sometimes, I don’t like what I see.
• Mentor. Establish a mentoring program. These can be formal or informal. You will have more success if you develop a formal program and enlist others to help.
• Hand-offs. I still recall an Army mission where we were on patrol for three days straight. The company commander approached me early one morning and said, “Congratulations Marx, you are in charge. Take us back safely.” No time to prepare or rest. Man, I grew on that mission. My boss knew how to force me to grow. Throw surprises at your team. That is how you accelerate growth.
• Commission. Speak life into your people. Most are beat down by the circumstances of life. Stuff happens and life and career can be hard. Counteract the negativity with an opposing spirit by encouraging those you serve. Tell them what they need to hear, but don’t believe about themselves and their abilities – that they are leaders and have what it takes. That they can be CIO. That they are better than you. That their lives matter.
• Listen. The biggest compliment you can give is to ask for input, listen to those you serve, and take action on it. Insecure leaders are afraid and don’t listen, but doing so builds the confidence of those around you. Confident subordinates are future CIOs.
• Model. Always lead the way. Don’t just talk about rounding floors—actually do it and take people with you. Grab them spontaneously and say, “Let’s go visit with some of our team” or “Let’s go to our hospitals and talk to clinicians directly.”
• Opportunity. Look for opportunities for your team and pass them along. Kick them out of the nest. If you hear of a great opportunity, tell them about it and help them prepare. Leaders help locate opportunities for those they lead.
• Legacy. Look, we should all ask ourselves what on earth are we here for. We ask ourselves those deathbed questions about legacy and if our life mattered now. What better way to leave a legacy than to have dozens of leaders out there you helped develop who are saving lives? Wow. That is something to live and work for.
• Time. Your time is not yours. You owe everything to your team. Spend social and work time with them. Laugh, cry, reflect, vent. The reason my kids are successful adults is directly proportional to the time we gave them. If you don’t give yourself to your team, they will never escape adolescence and grow into the leaders they have the ability to be.

What are you going to do with this challenge? Are you a leader with offspring … or are you a manager? What will you do to move from manager to leader? What will you do to increase your impact in this world?

One is too small a number for greatness (Maxwell). You need to multiply yourself if you desire to be a leader. Let’s do this.

Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.

HIStalk Interviews Joshua Newman, MD, Chief Medical Officer, Salesforce

Joshua Newman, MD, MSHS is chief medical officer and GM of healthcare and life sciences at Salesforce.

Most healthcare IT systems involve back office functions that are, to patients at least, invisible at best or intrusive at worst. Do you see that changing?

We do. The proof point is that we’ve been doing it already. We’ve been doing it for five or six years. But we also see it changing because the current needs of healthcare seem to be much more around that kind of end-user experience and less about the back office stuff.

If you look at where the reimbursement’s going, if you look at value-based care, or if you just want to look at the competition that’s being caused by the ACA and all the new people with insurance and so on, you see that it’s around patient experience. It’s around consumer expectations. It’s around value-based reimbursement and outcomes. It’s about helping people take care of themselves at home, responding to their text messages, being able to send a message of support, and so on.

Johns Hopkins posted a study saying if you have a relationship with a doctor, you lose more weight. It’s just one example of how relationships, patient outreach, devices, mobility, all of those kinds of things are starting to be the coin of the realm. What I mean by that is not only are they they right thing to do for health, but they’re also being reimbursed.

What are Salesforce’s major efforts in healthcare?

You may know we’re the number one CRM company. We’ve got this very broad platform that does a lot of things. Outside of healthcare, it’s marketing, sales, and service. There’s a Communities app, which is like a portal. We have analytics and an app development platform.

What we want to do for healthcare is what we’ve done for business, which is to enable those relationships. Service Cloud is our product name. It’s like a call center app, but customized for healthcare so that everyone can have that same relationship with the patient wherever they are, on any device, to support healthcare. Not the stuff the EMR does — not medication ordering, laboratory ordering and resulting, or procedure ordering or notes — but the interpersonal communication that supports the success of those other things.

Will it be difficult for providers to make the transition from one-time billed episodes to developing ongoing, health-encouraging relationships with consumers?

It’s funny you ask that question, saying it’s the new thing. The reality is it’s the old thing. It’s the original thing we were doing before we had any technology or anything.

I was trained as a family doc. I had other faculty members, like the wise old family docs, who used to tell me not that long ago, "Write in the margins of the paper record the patient’s occupation, their kids’ names, their pets’ names.” All those things. That was the beginning of my exposure to CRM. Understand who this person really is so you can build a connection and have an impact on them.

I think because the EMRs are so focused on those kinds of fee-per-service, episodic elements, it took away a lot of that. Frankly, those systems weren’t that flexible, so it made it harder to do those things. I think now with this and with the reimbursement that’s facing it and the value of it, people are amenable to it.

The second part of your question, though, are people going to be able to do it? That’s going to be a hard thing to solve. Work flow changes in healthcare, new innovations even when they’re proven … even a medication that’s proven to be great with no side effects still takes five years to diffuse. Something like this that’s a little more complicated, that takes new jobs and new training, is going to be a little harder. Our thought is the technology is going to be able to help people do it.

What we’ve seen outside of healthcare is that when people have really good tools that make it easy to use and to succeed, they’re a little more willing to change. In fact, we see that all the time.

Just so you know, I’m not under any kind of false hope that it’s going to be simple. Healthcare changes slowly.

In healthcare we individually feel that we have a relationship from our providers and caregivers when we’re receiving care, but in that 99 percent of the time we’re not in the ED, an exam room, or a hospital bed, the faceless bureaucracy doesn’t care about us. If hospitals turn this relationship function over to the marketing department, will it feel genuine to patients or will it be like receiving unwanted calls from an aggressive telemarketer?

I’m not seeing this as like cold calls or marketing. I’m seeing this more as when you’re on your bank website, you can’t figure out what to do, and all of a sudden the chat window comes up and there’s someone who can answer your question. It feels really good.

I use an application called TripIt that brings together all my travel plans in one place. I don’t feel like I’m in a herd of cattle running through the airport. I know where I’m going to go. When I land at the airport, if there’s been a delay, I get this alert automatically sent to me saying the gate’s over here, the gate’s been changed, or you’re late, so go here or do that.

Those simple kinds of tools are available. The data is available, although the systems that own it aren’t flexible. But if you put it in something like Salesforce or any kind of modern tool, the possibility exists to make people at least feel like the system is understanding them.

That’s from the technology side, a little more of the impersonal side. Then when you want to add the idea of, if I ever have a question, I can text message a care coordinator. If I ever have a problem, I know who to call and they have instant visibility into my clinical systems; who my informal caregiver is; what language I like to speak; or what my preferences are for communications, whether it’s mobile or email or phone. Even those simple, simple things would be profound in healthcare because they don’t really exist.

It’s going to enable the kind of change of change from where I only care about my doctor and I only relate to my doctor to there’s a whole team that’s willing to talk to me, and by the way Nurse Sally is really sweet and really great and she’s the one I ask questions to because she’s willing to listen.

Salesforce and a lot of other non-healthcare technology companies scaled themselves up by opening up their systems to partners and even competitors to create an ecosystem that benefited everybody. Healthcare hasn’t embraced that concept. Do you see that changing?

Yes. I see it hugely changing. What I see in the marketplace, and what a lot of us think about is, imagine the gates or the walls that have been erected by Epic. There are throngs of companies and experts and innovators and entrepreneurs who are banging on those walls trying to get in in every single healthcare organization in every single market everywhere. They just can’t do it. Sometimes because there’s not enough patients that are using a certain service. Sometimes because the CIOs are afraid of the risk and the cost of building an EMR connection and all that. We’ve already seen it in some cases. We’ve got a use case with UCSF where they’re using a third-party decision support tool to get data collected into Salesforce to make a risk score and have it come back.

The old days of decision support tools were that you put a CD that comes from someone and you put it in your EMR. It’s usually for drug-drug interaction or drug-allergy interactions. You know about the Framingham Study, I’m sure. There’s a guy in UCSF named Jeff Olgin who’s head of the cardiology department. He’s doing an e-heart study, which is going to be a million-person Framingham Study. Gone will be the days when the cardiologist has to remember the journal article that said this or that. They’re going to start using databases of hugely valuable decision support tools. We see it at the National Cancer Institute with some of their cancer data or even this breast cancer study.

We’re moving to a time when people are realizing that a single doc with some information in their head is not enough. Allowing them to take the time to go to different journal articles and figure out what the best treatment isn’t also the best.

We look at mortgage bankers. We see that they use impressive calculations to figure out where people’s risks are. We don’t really have that in healthcare yet and I think we’re going to have it more. Then you include the device managers, you include the rehab centers and the home health agencies, and all the different people that have to collaborate.

There’s no way that’s going to happen unless there is an open system, an ecosystem, and some friendliness between parties who all want the same thing. Fortunately, the money is there and the bundled payments are going to make it a little more likely.

We really have only three large inpatient EHR vendors in Cerner, Epic, and Meditech. Does that make it easier or harder for a company like Salesforce to come in and try to open things up and collaborate outside their walls?

The irony, and it’s a little bit controversial, is the fact that there are three almost makes it like an Irish potato farm. I don’t like that analogy so much because it makes us all look like we’re going to hurt those, but we’re really not. We want to connect to them.

It makes a certain kind of standardization, and to be frank, I think the closed histories of a lot of those vendors … their strengths and weaknesses are all different, but the fact that an organization like Epic has such a mind share among the very top hospitals and yet they don’t have the flexibility to open up gives us a great opportunity to extend what they do, to connect to what they do, and to bring these organizations into a modern technology space.

By the way, we don’t have to worry about working with them directly because middleware solutions are making it easier than ever to get data out and in some cases get data back in, even if it’s in the form of unstructured text or something like that.

I suppose for CRM-type purposes, you wouldn’t need real-time EHR access or for the vendor to provide APIs to everything. You could work around that.

We can start with just an ADT feed just to identify who the person is. You’re right, we can start small. But what’s cool is at a place like UCSF, for example, they started with the ADT feed. Just tell us who they are, who’s taking care of them, and some demographic information. But then they add more data to that pipe and they’re including prescriptions and diagnoses.

It doesn’t take much. We don’t need everything. We certainly don’t need the notes. We don’t need the medication administration record. Between diagnoses and medications and maybe some lab tests, we can do a ton.

That’s how Salesforce works. We’re not like Epic where we’re going to make someone write a $200 million check or a $1 billion check. We’ll start small. We’ll solve problems with the simplest of connections and then we can move on. Frankly, there are some folks who are doing it without an EMR connection. They just use it as their engagement engine, and then over time they grow those kinds of connections to the legacy systems.

Would a typical health system CIO look to Salesforce for solutions? Is it hard to get in front of them since you’re not a traditional healthcare vendor?

If you ask me in a year, I’ll say absolutely yes. I think we’re in a transition period. There are a bunch of CIOs that I talk to who say, "Wow, I had no idea you did healthcare." Frankly that’s our job and that’s one of the reasons why we’re doing this the way we are. But there are a bunch that do know us.

It’s interesting because our pioneering customers, the people that gave us credibility and confidence that what we have is of value in the marketplace, have been organizations that say, I’ve heard of Salesforce,or I know Salesforce, or I used to be a CIO of an insurance company and now I’m the CIO of this big hospital system, I know what you guys can do and relating to my patients is very similar to relating to customers.

There’s a great quote from an academic medical center CMIO friend. He says, "We’ve got to treat our patients like customers. They’re consumers and we may treat them better than we treated them when they were patients." They know we’re useful for this and they want to customize what we have to make it work for them.

Our new product is around making those customizations built into the product so that it’s credible and relevant to healthcare. I think with the new announcement, there’s going to be a real excitement for this because people know we’ve figured out how to do a lot of this stuff.

Salesforce offers the Chatter application. Do large health systems and practices use collaboration tools as well as they should?

They don’t because they don’t have them. They know what the inbox is. One CMIO says, "We keep getting older and the residents keep getting younger. It’s really funny. My residents ask me, where’s the feed? Why do I have to use email? Why do I have to use pagers? We’re the only occupation that still uses pagers. The drug dealers don’t even use pagers."

What’s happened is a lot of these hospital systems and residents have adopted these systems just because they want to. We see the proliferation of a lot of these things that were ground-up or viral and people started using them. Then the CIO will say, "Holy smoke, what can I do here?” They use them because they just work better.

In Salesforce, we’ve gotten rid of like 40 percent of our emails using Chatter. I actually wasn’t that big of a fan of it because I use email and I’m sort of an older guy, but I’ve been convinced by what we’ve seen in Salesforce. Now we’re starting to see people in hospital systems take this up.

When we show it to them, everyone gets it because it looks like Facebook. All these kids know how to do it. They know how to do @ mentions to include other people on the feed. They know how to do other kinds of things from that feed post. Marc Benioff, our CEO, did a lot of work to make Chatter not only something that’s good for communication, but you can do links, polls, forms, fill out all kinds of stuff, and actually do your work in it.

The more helpful it is and the more it saves people time, the more they’re going to use it. We know it’s something people cotton to as an interface. To the extent that it’s helpful for their business, the uptake is going to be significant.

Where do you hope to see healthcare in the next five or 10 years?

The cues or the things that inform my answer are every other industry in the world, on one hand, and then my oath to make health better. What we see in every industry is fluid data. We see open APIs. We see hybrid information systems. We see things coming together in all kinds of ways to solve problems flexibly. If there’s a new genetics test, it should come in there. If there’s a new partner you want to work with, it should go there. If you want to get a coupon for your home health needs. If you want to have someone deliver your bandages by drone. 

Healthcare is still stuck in an earlier era because they’re stuck in this client-server technology that’s not open, that’s not flexible, and that doesn’t give people the confidence that they can safely open up to partners. I see a future where hospital systems are as open and as nimble as Amazon, Gmail, or Salesforce.

Morning Headlines 9/2/15

MEA|NEA Acquires The White Stone Group

MEA|NEA, a health information exchange platform vendor, acquires The White Stone Group whose HIPAA-compliant communications platform will be integrated into MEA|NEA’s existing platform to create a single communication and data sharing solution designed to connect patients, providers, payers, and health plans.

New technology allows Cincinnati VA to give care across US

The Cincinnati VA Medical Center’s Tele-ICU program is profiled by a local paper after expanding its initial capacity of overseeing 72 beds, to its current role overseeing 213-beds in VA Medical Centers across the US.

Cincinnati hospital slashes ICU costs in GE software test

Jewish Hospital (OH) reduces its ICU length of stay by 28 percent and cuts costs by $9,000 per patient by incorporating nutrition-monitoring software by GE.

Fresh from new product launch, Medfusion raises $3M capital infusion

Patient portal vendor Medfusion raises $3 million in fresh funding after introducing a new “patient encounter journey” feature to its platform that allows patients to pre-register for appointments and submit co-pays online.

News 9/2/15

Top News

MEA|NEA, whose platform allows providers and payers to securely exchange payment-related electronic documents, acquires The White Stone Group, whose Trace communication tools connect voice, fax, and electronic communication to the patient’s record. With the acquisition, MEA|NEA will create separate business units for its medical and dental customers.

Reader Comments

From Limoncello: “Re: receiving files from patients. Patients of our dermatology practice want to email us their records or use Dropbox. We can’t figure out how to receive them without violating HIPAA or threatening our electronic security. Our Top Five EHR vendor patient portal doesn’t allow patients to upload or attach files. We tried Carebox, but it appears they don’t participate in Direct Trust since test messages in either direction won’t go through. Does any company that’s willing to sign a BAA offer a HIPAA-compliant patient upload file site that scans for malware and accepts image files? We’re also interested whether practices have been able to get their local VA facilities to use Direct messaging instead of faxes. Our biggest barriers to using Direct messaging has been lack of a standard Direct address directory and eClinicalWorks requiring community health centers to buy an interface if they want to use Direct Trust-compliant messages instead of eCW’s Direct web portal. There’s definitely a bias against Direct messaging and towards expensive one-off interfaces at most vendors.”

From Woodpecker: “Re: McKesson. Will announce that its Horizon Clinicals product will not support Meaningful Use Stage 3.”

From Boisterous Lad: “Re: Capsule Tech. Good sources tell me it’s been acquired by Qualcomm Life, which is expanding its 2Net device and sensor connectivity platform beyond sensors and home medical devices.” Unverified. I didn’t see any SEC filings from Qualcomm.

From UGMer Roasting Weenies: “Re: Eskenazi Health (formerly Wishard) in Indianapolis. Going with Epic. Seems like a big deal as they are one of the last holdouts using the self-developed system of Regenstrief.”

From Creative Differences: “Re: Partners and Epic. I’m on the Partners ambulatory rollout team. We offer practices three options: (a) stick with your current EHR, in which case we’ll integrate as necessary which includes billing for some through our Epic Resolute system; (b) use MyPractice, aka Epic Lite, a slimmed down version that I’ve hear is not fun to use although I’ve not seen it; or (c) go full Epic. This is happening in every city in America where the larger organization buys Epic. A great comment to Paul Levy’s original post reflects my thoughts: what do you suggest the AG tell Epic? Interoperability is better when all parties are on the same vendor no matter who the vendor is. This looks like capitalism at its best. Should the the AG tell Epic they can’t tell prospects about how they can improve interoperability between them and their partners? Should she tell Epic they need to change their product?”

Meanwhile, @Farzad_MD posts a reminder of Jonathan Bush’s Athenahealth earnings call comments about Epic at Yale-New Haven, which I ran in May 2013. Recall that Paul Levy is apparently doing work for Athenahealth these days, Athena is commercializing BIDMC’s WebOMR system, and Bush can’t seem to decide if Epic is evil incarnate or an admired competitor. 

I think we are seeing — particularly the folks who got pregnant with Epic — they’re going to this sort of desperate burn-bright tactics. We heard where Yale-New Haven has told all the doctors that have privileges that they will either buy this piece of shit Epic that none of them want or do you have their privileges revoked. So there’s that kind of tactic going on. “Oh, we can’t interface.” I’m like, “What you mean? Epic interfaces all the time. They actually do it really well.” So there’s a lot of sort of how are we going to pay for this thing? How are we going to make this thing drive more referrals, more high-profit diagnostics to our hospital? … The folks that have gone off and laid down more money than they have on Epic have, in the back of their mind, that they are going to make a real impact on referral patterns by getting doctors on to Epic that don’t want to be on it.

From Payer Watcher: “Re: Optum Exec Forum. UHG CEO Steve Helmsley declared that unlike Aetna, UHG will not purse the acquisition of other payers. Less important, it was puzzling to see both Colin Powell and Dr. Atul Gawande there.”

HIStalk Announcements and Requests

The family of a reader who wishes to remain anonymous personally donated $1,000 to my DonorsChoose classroom grants project, triggering matching funds from another anonymous reader as well as other matching funds from specific classroom projects I funded. That means the family’s donation put at least $3,000 into classrooms in need. The donation and matching funds paid for these projects in their entirety.

• Math activity stations for a low-income elementary school in Oklahoma City, OK in which many students were affected by a tornado last year.
• STEM materials for a kindergarten class in Chicago, IL.
• Two Amazon Fire tablets for STEM time exercises for an elementary school class in Tulsa, OK.
• Ten Android tablets with pre-installed apps for an elementary school class in Mobile, AL that will meet the Bring Your Own Device policy for the children whose families can’t afford to buy them.
• Hands-on STEM technology (Ozbot, green screen, Makey Makey kit, and Sphero) for Genius Time and MakerSpace activities in an elementary school class in Pensacola, FL.
• Estes rocket kits and supplies for an elementary school class in Okeechobee, FL.
• A listening center for an elementary school class in Mobile, AL.

I’ve already received emails from several of the teachers above. Ms. S said, “The math centers that you have funded will allow my students to be provided an interactive approach to the math standards that we are studying in depth this year. The ability for these students to not only hear about, but to apply themselves into a deeper level of learning through a variety of activities is so much more meaningful than sitting and being taught to. You have enabled my students to involve themselves in the teaching of these daily lessons.” Ms. S from Tulsa emailed to say, “Thank you so much for your generous donation! The impact of these items will be huge! I can’t wait to see the look on my students’ faces when they get their new Kindles for the classroom! We will be using these so much during science, accessing digital science materials. The students will have the opportunity to access so many things they wouldn’t have been able to access before. The fact that they’ll also be able to use them to read during their independent reading time is icing on the cake. Thank you so much!! You have made this Teacher’s day and maybe even the whole year!”

I also received an email from Mr. H at Maynard Jackson High School in Atlanta, to which we earlier donated furniture to create a broadcasting studio news set. He says, “My students use the new resources every day to broadcast the school news. Last year, broadcasting the news was a dream but with our new resources, we are about reach our student population and the community through broadcasting. The new furniture gives students a clear understanding of the layout of a television studio, but at the same time, it allows us to compete with other schools in our district. I can honestly say that the learning levels in my class is at an all-time high and we have over 260 students in the program!”

I noticed that HIStalk page views hit 190,000 in August even though I slacked off a bit this past month given less news. That’s 2.3 million page views in 1.8 million visits in the past 12 months. I appreciate everyone who reads and sponsors HIStalk for making it fun every day for the past 12 years. I have quite a few new sponsors to announce thanks to our usual once-yearly back-to-school new sponsor special offer that Lorre can describe for interested companies, including for former sponsors interested in coming back. Then we buckle down for the always-busy Labor Day to Thanksgiving health IT rush.

I’m watching “Narcos” on Netflix, which I like even though I’m distracted by the cheesy 1970s mustaches and the fact that Pablo Escobar looks like Andy Kaufman.

Note to providers: I’m perfectly aware that I should call 911 if this is a medical emergency, that my call may be recorded, and that the menu options have changed. You don’t have to waste 20 seconds of my time telling me that every time I call and then get put on hold.

How to Do a Webinar

We get asked a lot about doing webinars. Sometimes companies take our advice, sometimes not.  Here are some tips as requested by a reader.

• Present a webinar to educate without obsessing about getting sales leads. A webinar that is mostly a company promo piece or demo is going to draw as attendees only people who want to buy your product. Don’t be surprised when only eight people register and none of those are prospects. It’s like a timeshare pitch without the free Chili’s gift certificate.
• Nobody wants to hear a company’s marketing VP deliver a webinar, or for that matter, anyone from the company as a primary speaker. You earn a lot more credibility letting a happy customer do the talking about their real-life experience, assuming you have one.
• Make sure the presenters have seen the slides and understand the topic ahead of time. The fact that I have to even say this tells you how poorly planned some webinars are.
• Choose a snappy title that succinctly describes what the webinar will cover.
• Don’t provide insultingly obvious background about the state of the industry in the abstract. Ditch the flowery language and just say what you’re going to cover and why people should attend.
• Don’t include a roster of every hospital job description in the “who should attend” section. Sure you don’t want to turn people away, but your in-depth technical overview isn’t really going to appeal to most CEOs and floor nurses.
• Don’t pitch the company or product for more than two minutes. We get a lot of complaints from attendees who are annoyed that the presented ignored our advice to keep the sales job at a minimum.
• Don’t require a bunch of registration information. I’ve done polls here before and people are like me in refusing to give a bunch of information (phone number, job title, etc.) to nosy companies who will lose signups or just encourage to enter fake information to avoid the inevitable cold calls.
• Record the video for later review. Our webinars get a lot more views on YouTube than they did in the live session. That’s why we do it.
• Presenters, don’t read your presentation.
• Don’t include slide transitions or animations, which may indeed look super cute when viewing locally but are painful to watch in a slowed-down live webinar.
• Don’t fall into the trap of making PowerPoint a teleprompter. You already have your talking head, so add graphics or other visual to make what they say clearer and more memorable. If your slide contains full sentences, you don’t know what you’re doing.
• Spread material over multiple slides so that no single slide is on the screen for more than 1-2 minutes. The attention of attendees wander when someone just drones endlessly with no visual break.
• Lock down the title, presenters, and abstract at least 2-3 weeks before live day to give people time to sign up.
• Deliver a presentation of no more than 30-40 minutes to leave time at the end for questions.
• Have attendees submit their questions via the webinar platform’s chat box to allow the moderator to choose the best ones and to avoid having an attendee hijack the presentation with self-indulgent prattling.

Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

We’re doing a September 22 webinar with The Breakaway Group, who filmed a commercial for “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements using Simple but Predictive Adoption Metrics.”

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Acquisitions, Funding, Business, and Stock

Ivenix secures $42 million in funding to continue rollout of its next-generation smart infusion pump.

Cardiopulmonary Corp., which offers the Bernoulli medical device integration, alarm management, and virtual ICU applications, will merge with medical device integration vendor Nuvon.

Patient portal vendor Medfusion raises $3 million in venture funding after announcing new patient responsibility collection tools.

Sales

Western Connecticut Health Network chooses Cerner’s Millennium EHR, will upgrade its Soarian revenue cycle applications, and implement Cerner’s HealtheIntent population health management system.

People

Alexander Eroe (LinkEHR) joins Health Data Specialists as business development executive of the Cerner/Siemens practice in the Western region.

Announcements and Implementations

A Nuance survey finds that Millennials (ages 18-24) are more likely to choose a PCP based on the recommendations of friends and family members, are quicker to tell friends about their doctor experiences, and are more likely to look up doctors on online review sites.

Craig Hospital (CO) implements a clinical communications and mobile alerts solution that integrates its Draeger and Connexall alarm systems with the mobile network of PatientSafe Solutions, allowing clinicians to access alerts, secure messages, voice communications, and patient information from a single device.

Mayo Clinic Center for Social Media will offer a “Social Media Basics for Healthcare” online certificate program for healthcare professionals that includes CME credits. The four-hour course is free for members ($495 per year) or $400 otherwise.

Tenet, Dignity Health, and Ascension will take over management of Carondelet Health Network and connect it with the Arizona Care Network in the turbulent  Southern Arizona market.

InterSystems will release a next-generation laboratory business management system in early 2016.

Government and Politics

The Dayton, OH newspaper profiles the Cincinnati VA’s tele-ICU service, which has expanded from monitoring 72 Ohio beds to 213 beds in several states.

Technology

Google unveils its new logo (old on the left, new on the right). The font veers dangerously close to Comic Sans territory.

Other

Jewish Hospital (OH) reduced ICU length of stay by 28 percent in a pilot that used GE Healthcare’s nutrition monitoring software that works with its ICU ventilators and sends nutrition measurements to the EHR. The software was being used in other countries and earned FDA approve in June.

UC Health (OH) will run a six-month pilot in which patients can get free video consultations with physicians after scheduling a time slot in advance.

Research Implications of the Conversion to ICD-10

I spoke with Andrew Boyd, MD, assistant professor in the Department of Biomedical and Health Information Sciences at the University of Illinois at Chicago, who has published several articles about the impact of the conversion to ICD-10 on medical research. He predicts problems when researchers conduct studies spanning the October 1, 2015 switch, as researchers miss patients because the code logic has changed. He even speculates that some researchers may avoid performing historical studies because they may fear that the pre-October 1 codes are unreliable or because they won’t want to invest the time required to double check the codes and data queries.

Andy says researchers are generally aware of the upcoming ICD-10 problem, but haven’t necessarily grasped its significance or the effort and uncertainty required to use information originally entered as ICD-9 codes. He’s also concerned that analytics vendors are underestimating what will be lost if they just perform simple one-to-one ICD mappings.

ICD-10 mixes concepts that were separate under ICD-9. He gives as an example “sickle cell crisis,” which maps to the ICD-10 code for “sickle cell disease with crisis unspecified.” That looks fine on paper, but there were two associate ICD-9 codes that mapped backwards to it. Some researchers might want to look at all sickle cell crisis patients and would therefor have searched for all three codes, while others might only care about sickle cell crisis with acute chest, for example. Every data query will need to be analyzed by a researcher who knows what they’re looking for, not a junior analyst who only knows the old and new codes.

I asked Andy if he thought new studies might reach incorrect conclusions because of either researcher ICD mistakes or improperly converted data. He said he wouldn’t be surprised.

There’s also the issue that the US version of ICD-10 (ICD-10-CM) is more complex than the versions the rest of the world has used for years. For instance, Canada has 20,000 ICD-10 codes while our ICD-10-CM has 68,000. It will be easier in some ways to graduate to the same ICD level as the rest of the world, but anyone performing international studies will have to do their ICD mappings all over again.

Andy also points out that the ways hospitals code under ICD-10 may make them appear safer than they really are, unintentionally or otherwise.

Andy concludes that in a few years we’ll wonder how we got along without ICD-10, but the transition will be rough for researchers and medical research may temporarily suffer.

Some of Andy’s articles covered:

Cohort discovery in ICD-10-CM
Patient Safety Indicators in ICD-10-CM
Discriminatory cost of ICD-10-CM transition between clinical specialties

Sponsor Updates

• CTG is ranked as one of the largest healthcare management consulting firms.
• Orion Health is named the “New Zealand Healthcare IT Company of the Year.”
• Santa Rosa Consulting is named as one of the “Best Places to Work in Healthcare.”
• AdvancedMD announces the six winners of its video contest.
• Eric Venn-Watson of AirStrip Technologies is featured in a San Diego Source profile of tech innovations.
• CapsuleTech receives the Surgical Information Systems Partner of the Year award for its DataCaptor and SmartLinx Medical Device Information System solutions.
• Extension Healthcare wins the Indiana Innovation Award.
• Anthelio is included as a sample vendor in two Gartner hype cycle reports in the legacy decommissioning category.
• CitiusTech will exhibit at the Smart Healthcare Technology Summit 2015 September 9-10 in Dubai.
• Surescripts announces that 20 Epic health systems have implemented its CompletEPA electronic prior authorization service.
• CoverMyMeds will exhibit at the EpicRx Annual Stockholders Meeting & Trade Show September 11-13 in Fort Lauderdale.
• The Tennessean features Cumberland Consulting Group in its profile of workplace culture at local healthcare technology companies.
• MedCPU CMO Yoni Ben-Yehuda is featured in an IBM/CMO Club marketing study.

Blog Posts

• “Shaping HIE Success” (Sandlot Solutions)
• “Readmission Reduction Strategies” (Besler Consulting)
• “Patient Portals: Wrong Target or Broken Arrows?” (Iatric Systems)

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 9/1/15

CMS continues ICD-10 education, names “ombudsman”

CMS names Williams Rogers, MD as the ICD-10 ombudsman. Rogers currently leads the Physician Regulatory Issues Team for CMS.

Vermont becomes final state to legalize e-prescribing of controlled substances

Five years after the DEA legalized e-prescribing of Schedule II through V drugs, Vermont becomes the 50th state to change its prescribing regulations and adopt e-prescribing of controlled substances.

Sanofi To Collaborate With Google Life Sciences To Improve Diabetes Health Outcomes

Google’s Life Sciences unit announces yet another diabetes-related business partnership, this time with the world’s leading insulin manufacturer, Sanofi. The team will co-develop Web-enabled insulin injectors and glucometers.

DoD Announces Award of New Flexible Hybrid Electronics Manufacturing Innovation Hub in Silicon Valley

The DoD will partner with private industry and academia to fund a new Silicon Valley-based innovation center focused on developing “flexible hybrid electronics,” including advanced sensors for use in new wearable devices and health monitoring technologies.