News 10/16/15

Top News

Personal genome testing vendor 23andMe raises a $115 million Series E on a $1.1 billion valuation. The company nearly shut down in 2013 after the FDA shut down its direct-to-consumer sales and marketing efforts, but has pivoted and now generates its revenue supporting drug discovery. Lt. Dan takes a closer look on HIStalk Connect.

HIStalk Announcements and Requests

This week on HIStalk Connect: Philips partners with Amazon to bring HIPAA-compliant IoT connectivity to its population health platform. Microsoft co-founder Paul Allen invests $500 million in artificial intelligence research. Berlin-based reproductive health app Clue raises a $7 million Series A to grow its user base and expand functionality within its app.

This week on HIStalk Practice: MGMA15 updates from Sunday, Monday, and Tuesday. AdvancedMD launches new interoperability and benchmarking tools. AMA’s new Telehealth Services Group convenes to discuss expanding CPT codes. Heart and Vascular Center of Lake County goes with Allscripts for chronic-care management. AAFP takes ONC to task for its weak interoperability roadmap. Primary care and mental health clinicians discover integrating data can be painful.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Glytec’s patent for its mobile diabetes management app, which offers patients real-time insulin-dosing guidance, receives approval from the US Patent and Trademark Office . 

DrFirst firms up $25 million in equity financing from Goldman Sachs, bringing its total financing over the last year to $42 million. The company announced last week the integration of its medication management software and secure communications with the Rx30 Pharmacy Management System.

Sunnyvale, CA-based Health Gorilla secures a $2.4 million Series A led by Data Collective. The company has also expanded its diagnostic test automation platform to include electronic ordering and secure messaging.

Theranos fires back after the Wall Street Journal publishes an exposé-like piece by Pulitzer prize-winning investigative journalist John Carreyrou highlighting the fact that company uses its proprietary testing equipment on only 15 of the 200-plus tests it performs, and that many of those tests require large samples rather than the “few drops of blood” the company claims. Theranos asserts that, “Stories like this come along when you threaten to change things, seeded by entrenched interests that will do anything to prevent change, but in the end nothing will deter us from making our tests the best and of the highest integrity for the people we serve, and continuing to fight for transformative change in health care.”

Sales

Seattle Children’s Hospital signs a three-year contract with Wellcentive to implement its population health management and value-based care solutions. The hospital will use the tools within its Seattle Children’s Care Network and Pediatric Partners in Care program.

Steward Health Care System (MA) moves forward with Meditech 6.1. Implementation across its nine hospitals is slated to begin next month, with a go-live date set for 2017.

Technology

Philips partners with Nuance to offer Nuance PowerScribe 360 users the ability to import radiology dosimetry data from its DoseWise Portal.

Medhost implements ExtraHop’s wire data analytics platform to gain insight into how providers use and experience its software. It’s also signed up for the Seattle-based company’s HL7 analytics to improve the troubleshooting process when HL7 interface problems crop up.

People

Validic Chief Marketing Officer Chris Edwards wins the CMO Growth Award from The CMO Club.

Pam Stampen (American Family Insurance) joins Nordic as vice president of human resources.

Eric Topol, MD (Scripps) joins the MyoKardio Board of Directors, and becomes chair of its science and technology committee.

Hackensack University Medical Center (NJ) Vice President and CIO Shafiq Rab, MD receives CHIME’s 2015 Innovator of the Year award.

Miles Snowden, MD (TeamHealth) and Linde Wilson (L.E.K. Consulting) join the Oxehealth advisory board.

Announcements and Implementations

LBJ Tropical Medical Center and 17 outpatient clinics in American Samoa go live on Medsphere’s OpenVista EHR. Four more clinics will roll out the technology in the coming months. Providers in the unincorporated US territory are eligible for Meaningful Use, and are in the process of qualifying for Stage 1.

Hospice Buffalo (NY) implements e-prescribing technology and services from Delta Care Rx.

Baystate Health selects Kyruus ProviderMatch software to streamline and standardize referral processes across its integrated network in Springfield, MA.

Holy Family Memorial (WI) rolls out telemedicine services via the Zipnosis platform. The vendor inked a deal with Michigan-based multispecialty provider group IHA earlier this month.

Mayo Clinic (MN) implements the Viewics Health Insighter analytics platform across several divisions within its Dept. of Laboratory Medicine and Pathology, including Mayo Medical Laboratories.

Government and Politics

The VA and Indian Health Service receive accreditation from EHNAC and DirectTrust, making them the first federal agencies to gain interoperability via the Direct exchange network.

Privacy and Security

Accenture reports that cyberattacks over the next five years will cost US health systems $305 billion in lifetime revenue. Adding insult to injury is the company’s estimate that one in 13 patients will have personal data stolen from technology systems within that same timeframe, leading 6 million people to become victims of medical identity theft. 

Innovation and Research

University of Wisconsin-Whitewater researchers determine that Hawaii, Wisconsin, and Iowa have the most efficient healthcare systems based on a five-year look at patient satisfaction scores and access trends, as well as financial and human resource data. The study, sponsored by the Wisconsin Hospital Association, was designed to give employers more insight into employee healthcare ROI across the country.

Other

The Georgia Partnership for Telehealth collaborates with Appling HealthCare System (GA) and WellCare Health Plans to open two new telemedicine-equipped health centers at schools in Appling County.

Epic’s “triple harvest” solar installation in Verona ranks as one of the largest in the area, with two arrays totaling 2.2 megawatts. The company grows alfalfa underneath its largest array, and has installed a network of 2,500 ground-source heat pumps under the alfalfa to heat and cool the campus. It’s somewhat ironic to compare the company’s attempts to go green with the impact its employment boom is taking on Madison’s public transportation system. Ridership on the city’s two routes to the Verona campus has increased by more than 25 percent annually since 2012. The company kicked in $26,000 to help run an extra route starting last month.

Sponsor Updates

•  Intelligent Medical Objects and Navicure will exhibit at the EClinicalWorks 2015 National Conference October 16-19 in Nashville.
• Leidos Health and Obix will exhibit at the Georgia HIMSS annual conference and tradeshow October 23 in Atlanta.
• Liaison Technologies covers 100 percent of health insurance premiums for its US-based employees and their dependents.
• LifeImage highlights the latest in image-sharing solutions at the 2015 Cerner health conference this week.
• Medecision Senior Clinical Content Specialist Lois Morris shares her most memorable case manager story.
• Netsmart will exhibit at the Providers Council Conference October 19 in Boston.
• Xerox will exhibit at the Midwest Fall Technology Conference October 25-26 in Detroit.

Blog Posts

• Horcruxes in Healthcare: Who Owns Your Medical Identity? (ID Experts)
• Endless Health IT Capabilities (Impact Advisors)
• Unless We Care a Whole Awful Lot (MedData)
• Epic MyChart patient engagement strategies: Buy-in, special challenges and Meaningful Use (Nordic)

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 10/15/15

Both the American Hospital Association and the American Academy of Family Physicians have publicly weighed in on ONC’s revised Interoperability Roadmap. Both organizations believe it doesn’t go far enough or fast enough.

Although quite a few stakeholders accuse the EHR vendors of being the villains with regards to data blocking, my personal experience has been that health systems and hospital-controlled physician networks are really behind it. Not to mention that ACOs naturally create barriers to interoperability as they encourage physicians to keep patients within a well-defined (often narrowly so) network.

I had the adventure of standing up a private HIE seven or eight years ago. The sponsoring health system’s express purpose was to share data only within our referral network. Providers affiliated with other hospitals were not invited to join.

At least in my metropolitan area, I haven’t seen that philosophy change across the years. While the AAFP calls for “increased accountability on industry and decreased accountability on those who are using their inadequate products,” I think we need to focus the microscope on some of the other interested parties.

Let’s hold health systems accountable. When their vendors provide interoperable products, they need to be using them in an interoperable fashion. They need to force their owned hospitals and employed physicians to accept and integrate electronic health data brought by patients. And they need to release the data electronically when patients request it. Mr. H’s story of his inability to get his records electronically is just one of thousands out there.

Let’s also bring the non-provider technology stakeholders into the business of being regulated in the same way that providers and hospitals are. For example, reference laboratories. The fact that there are still numerous laboratories who cannot (or will not) send LOINC codes with their results is appalling.

Let’s also start regulating the pharmacies, getting their information systems under control. One of my local pharmacies sends scads of duplicate prescription refill requests all the time. This leads our practice to have to spend time determining if they’re really duplicates or not. When we call the pharmacy to complain, we’re told that it happens due to limitations in their computer systems and the inability to match refill responses to the original requests in an accurate manner.

Since all patients and physicians depend on pharmacies and labs, why shouldn’t this be part of the solution? What about standardizing all the other systems we have to interact with, such as home health systems and those used by nursing homes and other extended care facilities? Many patients that we used to hospitalize for care are instead receiving services through home health agencies. It doesn’t do me much good to interoperate with the hospital if the patients aren’t in it.

I started reading the Roadmap essentially to have a break from reading the Meaningful Use final rules. I’ve been jumping around in it rather than reading it through, however. I was pleased that they called out “Authentication and Identity Proofing” early in the paper (page 11 if you’re interested). They admit that lack of standard approaches has hampered information sharing. They mention that Direct was intended to “work much like email and lower the barrier to exchange for providers and hospitals.”

In my market, however, Direct has added all kinds of confusion, especially for providers like me who have multiple practice situations. I have different addresses for the different urgent care groups I work with on different EHR platforms. If a PCP is looking for me to send a follow-up, how do they know where to send it? Other health organizations have created additional complexity. One organization created separate addresses for each location for each provider, so a cardiologist who sees patients at six physical locations has six addresses. Although I understand their original reasoning for doing it, it’s untenable in reality.

Page 36 addresses individual data matching. They point out that although HIPAA required creation of national identifiers for patients in 1996 and Congress blocked appropriations, there is no prohibition against private or non-HHS governmental agencies creating their own. They note that the Department of Veterans Affairs and the Department of Defense assign unique identifiers for service members. Although I understand the arguments against it, I’d volunteer to test drive a national ID myself even if it’s private and voluntary.

I’ve had too many bad experiences with using existing primary data elements (name, DOB, sex, phone number), both personally and professionally. Even existing non-healthcare governmental systems don’t always handle the data in the same manner.

Here’s an example. Due to my southern roots, my actual legal name has a compound first name. My legal middle name is actually a family name, which looks like a last name to most people. Then I have my actual last name. Let’s work with “Peggy Sue Herrington Mitchell” as our example. My original birth certificate was completed on a typewriter, with “Sue” landing squarely on the line between the caption for “first” and “middle” names.

When I was in medical school, I had to get a certified copy of my birth certificate to prove identity for licensure. My birth county had computerized, and the person keying the data had made “Peggy” my first name and “Sue Herrington” as my middle name. It also truncated the “Herrington” by a few letters since there weren’t enough characters in the middle name field. With the layout and truncation issues, the computerized copy didn’t match my college transcript or my medical school transcript or my passport, which had my legal name listed correctly. The authorities refused to accept my identity proofing. I had to petition the county to pull a microfiche copy of the original and certify it.

When I complained about the truncation issue as the reason for needing the original, they said that they were limited by their systems. I pointed out that it was good that George Herbert Walker Bush wasn’t born in my county because his middle names wouldn’t have fit either. The county clerk didn’t find that amusing.

Fast forward a number of years to last year when I applied for TSA PreCheck status. Guess what? TSA in 2014 had surprising character issues. I was told that if I wanted to continue through the application process, I needed to formally shift Sue into my middle name or they couldn’t process my application since “space” was considered a special character and wasn’t allowable in the first name field and they couldn’t run PeggySue all together because it wouldn’t match my passport. This meant changing my name on all my frequent flyer profiles.

Additionally I’ve had hundreds of issues with patient matching during system migrations and data cleanups, not to mention the HIE project. How many people with either longer names or those that are more complex than mine will look like different people depending on how the data was entered? Of course there will be other matching criteria, but it’s going to take a lot of work to meet their stated goals of reducing system duplicate record rates from 2 percent in 2017 to 0.5 percent in 2020 and 0.01 percent in 2024. It should be interesting to see where already strapped (or cheap, as the case may be) organizations find the resources to get it all done.

I still have more to read, but at least it’s more interesting than MU rules. What’s your take on the Interoperability Roadmap? Email me.

Email Dr. Jayne.

Morning Headlines 10/15/15

How Jeb Bush’s health plan overhauls IT: 5 things to know

Jeb Bush, cousin of Athenahealth CEO Jonathan Bush, publishes his alternative to Obamacare this week, calling for an end to the Meaningful Use program, or as the proposal states “eliminating government mandates and penalties for healthcare providers who do not use government-approved electronic health records."

Statewide Patient Engagement Campaign Underway

Louisiana launches a statewide patient engagement campaign to teach its residents about the health IT tools at their disposal, such as patient portals and the state’s HIE.

AAFP Letter To Karen DeSalvo, MD

The American Academy of Family Physicians argues that ONC’s recent Interoperability Roadmap is not aggressive enough and fails to hold parties accountable for future delays or failures, noting “The AAFP helped create a standard for the exchange of clinical summaries in 2007 – the Continuity of Care Record. Eight years and billions of dollars later, our members and their practices continue to experience the dismal failure with the current certified EHR technology in supporting clinical summary exchange.”

23andMe Raises $115 Million in Series E Financing Led by Fidelity Management & Research Company

Personal genome testing vendor 23andMe raises a $115 million Series E on a $1.1 billion valuation. 23andMe nearly shut down in 2013, after the FDA shut its direct-to-consumer sales and marketing efforts down, but the company has pivoted and now generates its revenue supporting drug discovery.

Morning Headlines 10/14/15

Verisk Analytics hires Morgan Stanley to sell healthcare business

Morgan Stanley has been hired to sell the healthcare division of Verisk Analytics, a deal that is projected to be worth between $900 million and $1.1 billion.

GPs’ diagnostic skills could be obsolete within 20 years’ time, says Hunt

In the UK, health secretary Jeremy Hunt predicts that within 20 years computers will be used to diagnose conditions rather than doctors, pledging to ensure the NHS is ready when this technology becomes available.

Trends & Insights in Ambulatory EHR

Peer60 publishes a report on the ambulatory EHR market. Epic and Cerner are leading in both market share and mindshare. NextGen holds a strong market share but virtually no mindshare among independent providers and, similarly, Meditech has a strong market share but virtually no mindshare among hospital-owned facilities.

Xerox Provides Update on Government Healthcare Business Strategy

Xerox will walk away from the failed implementations of its Health Enterprise Medicaid platform in California and Montana, writing off $385 million, or $0.22 cents per share, on its third quarter results.

News 10/14/15

Top News

Verisk Analytics is rumored to have retained Morgan Stanley to sell its Verisk Health business in what should be a billion-dollar deal.

Reader Comments

From Laura: “Re: EHRs. Thanks for highlighting that the problems with EHRs aren’t (just) design and usability. They also relate to the major new spate of inane and arcane, bureaucratic, insane regs and new rules that keep HIT tools from being efficient (or even sufficient). If we could cut loose all of Meaningful Use and all E&M codes, we could open new modes of treatment and care and improve everywhere.” Laura is an informatics-certified physician and professor. I suggest this exercise for those who blame their EHR for excessive clicks and documentation collection. Make a list of every piece of information the EHR requires to inboard and treat a new patient, then map it back to who demands or uses that data element. I’m pretty sure EHR vendors aren’t just adding required fields for their personal enjoyment – the provider has agreed to collect that information for some approved purpose, internal or external, most likely as a condition of getting paid. Usability factors aren’t all that important when your users, by the nature of their jobs, are required several times each day to enter the same 200 codified data elements on the the same screen for each new patient. Clinical employees of EHR vendors dream of a fantasy world in which their products are designed strictly for doctors, nurses, and patients. In the mean time, blaming the vendor for operationalizing the sad current state of healthcare is like blaming fast food restaurants for obesity – those who created the market demand refuse to accept responsibility and instead complain about those they pay to supply their needs.

HIStalk Announcements and Requests

Jenn is filing daily reports from the MGMA conference in Nashville. Want to know how ICD-10 turned out for practices or what’s being discussed in the exhibit hall? Check out her recaps from Sunday and Monday.

Ms. Byrd-Johnson sent photos of her Alabama class using the 10 Android tablets we purchased via the DonorsChoose project. The school district implemented a “bring your own device” policy and we bought the tablets for students who don’t have a device to bring. Also checking in was Mrs. Clark from Tennessee, whose students used the STEM kit we provided to study engineering design and then collaborate to design, discuss, and improve their projects.

Good or bad, the conference season is back. People are endlessly live-tweeting quotes from anyone with a PowerPoint behind them. I don’t get anything (except annoyed) from reading out-of-context, 140-character quotes pulled randomly by tweet-seekers compensated either by ego strokes or paychecks. I’ll be interested to see how conferences handle Periscope and other live video apps whose tech-obsessed users stream low-quality video from presentations and exhibit halls.

I’m also always reminded at this time of year at just how some healthcare people seem to spend every free minute attending conferences at the expense of their employers (and thus patients), reminding me of undergraduates who embrace the undemanding college life so much that they just hang around taking classes forever courtesy of their indulgent parents. I’m also amused that attendees flock to conferences devoted to mobile and tele-anything services, apparently not appreciating the irony of traveling great distances to physically watch someone talking about the huge benefits driven by online collaboration.

Welcome to new HIStalk Platinum Sponsor Clinical Computer Systems, which offers the Obix perinatal data system. The employee-owned, Elgin, IL-based company, which was founded in 1997, has been a labor and delivery technology leader, earning 10 consecutive KLAS rankings. It’s a CommonWell member, a member of the Allscripts developer program, and an Epic collaborator. Obix offers charting modules for intrapartum, recovery, post-partum, strip annotations, care plans, newborn, SCN, and remote provider access. It provides clinical decision support for fetal heart rate assessment and monitoring with automatic charting into the intrapartum charting module. Obix is certified as an EHR module and its products are approved as medical devices by the FDA. Thanks to Clinical Computer Systems for supporting HIStalk.

I found this Obix overview video on YouTube.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

IT solutions provider UST Global makes a $5 million stock investment in Sandlot Solutions.

I mentioned this weekend that Dell was rumored to be acquiring EMC. The deal was announced Monday, with Dell paying $67 billion for the storage vendor, a 28 percent premium to the share price before word of the acquisition leaked out. Dell will take on another $50 billion in debt and use its VMware equity to finance the deal as it anxiously tries to find something to sell other than low-demand commodity PCs. EMC is lucky that someone with access to capital also is in a business that makes enterprise storage look sexy.

Xerox announces that it has decided not to complete implementation of its overdue Health Enterprise Medicaid processing systems in California and Montana and will write off $385 million in settlement costs in Q3.

Sales

In the UK, University Hospital of South Manchester NHS Foundation Trust chooses Allscripts Sunrise.

People

XG Health Solutions names Mike Bertrand (HealthWyse) as SVP of EHR application development.

ZeOmega hires Chris Brown (Cardinal Health Specialty Solutions) as SVP of sales and marketing.

University of Vermont Health Network promotes CMIO and interim CIO Adam Buckley, MD to the permanent CIO position.

Divurgent promotes Paul Anderson to VP of advisory services.

Announcements and Implementations

Two hospitals of Centegra (IL) go live on T-System’s EV EDIS, with Centegra-McHenry’s LWBS (left without being seen) count dropping to zero on go-live day.

AdvancedMD announces new benchmarking and interoperability solutions at MGMA, where the company is also highlighting its patient engagement and iOS-powered point-of-care solution.

Voalte announces Voalte Platform, which includes collaboration, management, analytics, and integration solutions.

Technology

British Health Secretary Jeremy Hunt says that computers rather than physicians will diagnose medical conditions within 20 years, adding, “You can get 300,000 biomarkers from a single drop of blood, so why would you depend on a human brain to calculate what that means when a computer can do it for you? I think it’s really important that we’re ready in the NHS to harness the power of data to give us more accurate diagnoses, in particular with that example.”

Other

A study finds minimal improvement from the Choosing Wisely program that addresses unnecessary tests and procedures. The authors conclude that the program needs a wider rollout.

Farzad Mostashari, MD tweeted out this photo of a page from Saving Gotham, a just-released book by former NYC Health Commissioner Tom Farley, MD, MPH that describes the public health efforts by former Mayor Michael Bloomberg and former NYHHC Commissioner Tom Frieden, MD, MPH (now CDC director). It sounds like a great read as the rest of the country starts catching on that there’s no such thing as health without public health no matter what intervention-obsessed hospitals and doctors would have you believe.

Peer60’s new standalone ambulatory facility EHR report (not ambulatory EHRs in general as other sites misinterpreted) finds that Epic and Cerner are tied for mind share leadership, with Epic holding a big market share lead. Meditech and Allscripts have decent market share in hospital-owned facilities, but zero mind share, meaning their customers are at risk for defecting. NextGen is also at risk since it has the highest market share among independently owned facilities, but also zero mind share in which Cerner, Epic, and eClinicalWorks dominate. Respondents said vendors should make their product easier to use, improve reporting, and improve practice management capabilities, although 32 percent say it won’t matter since the hospital dictates the EHR used.

The Kansas City paper covers Neal Patterson’s address at the Cerner Health Conference. He called on Epic to join CommonWell’s “open architecture” and announced that Epic-using Geisinger Health System will implement Cerner’s HealtheIntent population health management system. Karen DeSalvo looks like she’s passing Neal a happy stuffed bear in the photo.

Texting-obsessed teens are like compulsive gamblers who can’t stop even as they miss sleep, lose their attention spans, and lie about the time they spend texting, a new study finds. It recommends that parents set screen-free times, which doesn’t give me a lot of hope since many adults are just as phone-zombified as their kids. One opiate of the masses was probably enough.

Weird News Andy finds this story “selfieish,” in which selfie-obsessed millennials, convinced that they are celebrities basking in the exhilarating glow of their own limelight, are flocking to “the shallow end of the value pool” in trying to look better and market themselves more effectively by having plastic surgery.

Sponsor Updates

• AirStrip will exhibit at the HMA CEO Forum October 14-18 in Deer Valley, Utah.
• Aprima will exhibit at the Oklahoma Primary Care Association event October 14-16 in Oklahoma City.
• Wellsoft will exhibit at ACEP15 in Boston October 26-28.
• Hospital Sisters Health System writes about their reduction in medication alert fatigue using First Databank’s AlertSpace in Patient Safety & Quality Healthcare.
• Cardiopulmonary Corp. (Bernoulli) will host a focus group session October 16 during the CHIME15 Fall CIO Forum October 14-17 in Orlando.
• Bottomline Technologies will exhibit at Health Informatics New Zealand October 19-22 in South Island.
• PatientKeeper will exhibit at Becker’s ASC 22nd Annual Meeting in Chicago October 22-23 and will sponsor HFMA’s Revenue Cycle Conference in Fort Lauderdale October 25-27.
• CapsuleTech will exhibit at Salon Infirmier October 14-16 in Paris.
• HealthLoop Chairman Jordan Shlain, MD will present at London Business School’s Driving Innovation in Healthcare Delivery on October 20.
• Culbert Healthcare Solutions will partner with ConnexaHealth for consulting.
• Verisk Health and ZeOmega will exhibit at AHIP’s National Conference on Medicare and Medicaid & Dual Eligibles Summit October 18-22 in Washington, DC.
• Huron Consulting hosts a Coverage Analysis & Billing Compliance Workshop October 16 in Washington, DC. 
• EClinicalWorks will exhibit at The National Conference on Correctional Healthcare October 17-21 in Dallas.
• Fujifilm Medical Systems will exhibit at the Annual Scientific Meeting of the ACG October 16-21 in Honolulu.

Blog Posts

• Aventura and Brian Madden Talk Virtualization in Healthcare (Aventura)
• Preserving Appeal Rights on Your Cost Report (Besler Consulting)
• How New Technologies are Expanding Care (Billian’s HealthData)
• Designing Clinical Communications – Part 1 (PatientSafe Solutions)
• Big Data? How About Right-Sized Data? (Forward Health Group)
• Four Steps to Make Population Health Analytics Actionable (Caradigm)
• #IHeartHIT – Proactive Continuity of Care with ChartMaxx (ChartMaxx)
• Leading with Passion: There’s No Button for That (T-System)
• A Growing Trend: Centralized Referral Management (TeleTracking)
• 7 Facts About Cyber Security and Phishing (TransUnion)
• How can UltraLinq Help with Mobile Imaging? (UltraLinq)
• Strategic Thinking. (Voalte)
• Opioid Addiction: A Prescription for Disaster (Xerox)
• Predictive modeling and the elusive 1-2 percent (ZirMed)
• HIT Hiring Managers Want 70% Technical and 30% Traits (Direct Consulting Associates)
• Final Ruling is in … Meaningful Use 3 is Upon Us (Divurgent)
• Why I Love Health IT (Extension Healthcare)
• Final Meaningful Use ruling has arrived! What stays and what goes? (Galen Healthcare Solutions)
• ICD-10 Applying Lessons from Implementation (Greenway Health)
• A Shift to Service Lines in Hospital Service Delivery (Hayes Management Consulting)
• McKesson Horizon: Why Way Now? Part 3 (The HCI Group)
• How Will the Final Rules for Meaningful Use Impact You? (HDS)
• 6 Steps to Building Your Own Plain-Language Glossary (Healthwise)

The following HIStalk sponsors are exhibiting at the Cerner Health Conference October 11-14 in Kansas City, MO:

• Access
• AirWatch
• CoverMyMeds
• Crossings Healthcare Solutions
• Divurgent
• Elsevier
• Experian Health/Passport
• Fujitsu
• Zynx Health
• GE Healthcare
• Healthwise
• Imprivata
• Intelligent Medical Objects
• Leidos Health
• Lexmark Healthcare
• LifeImage
• MedCPU
• Merge Healthcare
• Nuance
• Summit Healthcare
• Surescripts
• The SSI Group
• Versus Technology
• VMware
• Wolters Kluwer

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.

Curbside Consult with Dr. Jayne 10/12/15

All’s still relatively quiet on the ICD-10 front, so I’m catching up on other projects that have been pushed to the side during the transition. Most of my clients are seeing some sporadic claims issues, but nothing that is going to cause a major cash flow disruption. As long as practices have processes in place to monitor the revenue cycle and take action as soon as they see patterns forming, they should be fine, although it will take a good month to see how things are really working.

Some practices still haven’t sent a large volume of claims. I continue to be surprised when I see practices that don’t bill every night or don’t have requirements for their providers to complete charts in a timely manner. I don’t have a lot of visibility into how ICD-10 is going on the hospital space, so I look forward to hearing from readers.

I’m working on a lab project for a client. It’s the kind of project I enjoy – extremely detail-oriented, beneficial to end users and patients, but something that practices don’t seem to have time to deal with. Essentially it’s an analysis of their lab ordering patterns with an eye towards redoing their primary ordering screen and some order sets. The practice set up their orders when they went live on EHR in 2010 and haven’t touched it since. A lot has changed in the last five years. They’ve added vendors. Vendors have changed test codes. The community standard of care has changed. Professional organization recommendations have changed.

I’ve pulled all their ordering data and can manipulate it by provider, specialty, location, and time. Right now I’m working on the tedious (yet oddly satisfying) task of updating the vendor order codes to make sure they’re all correct. Luckily they’re using two national reference labs that were happy to provide me digital versions of their orders master. Unluckily, they’re also using a hospital lab where all the knowledgeable lab staff seem to be out of the office on an ongoing basis. They won’t give me their order master (citing “intellectual property”), so I’m at a bit of a disadvantage. I’m not sure how having a copy of the orders master is going to cause them harm since they have an online directory for providers to reference.

Their level of cooperation may also explain why the practice sends such a small portion of its business to the hospital lab. If their day-to-day service is anything like what I’ve experienced, I’d steer clear. One would think it was in their best interest to assist customers in cleaning up their orders, because every time they receive an invalid one, they have to call the office for a clarification. But I guess it’s like everything else with being short staffed. Additionally, I’m sure it didn’t occur to them to plan for the eventuality that if all their customers go to EHR, eventually they’re all going to have to update their orders masters. Interoperability seems like a great idea until you realize you don’t have the resources to support it.

Keeping vendor codes in sync can be a full-time job. Some of the national reference labs change codes as often as weekly. Some are better than others at telling you what codes have been retired or replaced. Others leave you guessing somewhat. I’m seeing some challenges, though, with the various vendors coming up with proprietary tests which can make it hard on the end users. Say a user wants to order a serum porcelain level (a common med school/residency joke). In many cases, the physician doesn’t care whether the test is run via liquid chromatography or liquid chromatography and mass spectrometry – they just want the value. For a large number of tests, the methodology doesn’t make that much of a difference.

Of course there are tests where it makes a tremendous difference and I would expect to see the methodology specified in the name of the test to make it clear. Labs, however, seem to be trademarking various methodologies – perhaps one calls it “PorcelainPure” and the other calls it “TruPorcelain.” It’s impossible for the end user to figure out what they’re ordering without going to websites and comparing. This becomes more of an issue when patients are switching insurance or employers (and therefore lab providers) and end up having serial tests done at different facilities. It’s also a problem when the tests really are equivalent but the labs have trademarked them as a marketing strategy. It’s getting to the point where we almost need generic and branded labs like we have for drugs. I’ve seen it become more complex even over the last two to three years, so I can’t imagine what the next decade will bring.

Once I get all the codes up to speed, I’ll provide them with a program to help keep the codes up to date. Usually I suggest monthly, but a lot of organizations aren’t staffed to keep up with that. They may elect to do it quarterly or twice a year. I stress that it should at least be done every six months or more often if the lab provides clear information on the nature of changes to its orders master. After that, I’ll start reviewing the data based on ordering patterns and we’ll really start doing some clinical transformation.

In midsize practices, it’s interesting to see how different providers order even when they share a specialty. I see a lot of variation in ordering of metabolic test panels. Some habitually order more comprehensive panels whether they’re indicated or not. There is also a lot of variation in cholesterol testing and pap testing. These are conditions where the indications are well identified in national recommendations and guidelines, so you can imagine what it looks like when we analyze ordering on less-common conditions and diagnostic workups.

There can be emotional minefields associated with analyzing ordering patterns. What do you do with your senior partner who is ordering tests based on outdated recommendations? Many groups are unwilling to deal with those kinds of issues head-on, so I end up creating educational programs where everyone in the group gets re-educated as to the current standard of care. Although it’s good to make sure everyone is following guidelines, it’s a tremendous waste of resources when everyone else is already in line and you could just deal with an individual directly.

There are a lot of people out there who never want to ruffle anyone’s feathers, which makes it easy to see why they’re having challenges delivering the kind of care they want to deliver and that patients expect. As the old saying goes, sometimes you have to break some eggs to make an omelet.

Once we analyze the ordering patterns, I’ll make suggestions on updates to the main orders screen and the order sets. We want to get the most commonly ordered tests in prime position for ease and speed of selection. There’s an art to it, though, because if you make too dramatic of changes, it can cause issues with muscle memory and the staff getting back up to speed.

We also have to figure out the timing and how we’ll train users, etc. There’s a lot more to it than just updating templates, and often my role is to help an IT team understand that. We need to give the users time to practice so they’re not hunting around when they’re patient-facing.

I’ll be working on this for a while, so I’m interested to hear how readers approach similar projects. Do you like your eggs over easy or sunny side up? Email me.

Email Dr. Jayne.

HIStalk Interviews Mike Nelson, CIO, Universal Health Services

Michael Nelson is CIO of Universal Health Services, a publicly traded, Fortune 500 hospital management company in King of Prussia, PA that is also the parent company of Crossings Healthcare Solutions, which offers advanced clinical decision support software for Cerner Millennium users.

Tell me about yourself and the company.

I’ve been with UHS for eight and a half years as a chief information officer. In those eight years, the company has doubled in size from $4 billion to $8 billion in revenue. We’re a healthcare provider-based organization with roughly 25 acute care hospitals and $4 billion in revenue for that division and 215 behavioral health facilities with roughly $4 billion in revenue for that organization.

UHS is the parent company of Crossings Healthcare Solutions. Crossings is where we’ve had the most clinical innovations that we sell to the market, but that functionality was all created and embedded for UHS use. We’re not trying to make a material profit with our Crossings subsidiary, but rather subsidize having a lot of clinicians involved in IT. That’s the real purpose.

You’ve worked for both non-profit health systems and now a publicly traded, for-profit one. How are those settings different?

Prior to working at UHS, I worked for the Carolinas Healthcare System in Charlotte, North Carolina, a well-run, large integrated healthcare delivery system of hospitals, physician practices, etc. They are a well-run not for profit. As I transitioned into the for-profit sector, I had curiosity as to what the differences may be.

The founder of UHS is still here 35 years later, Mr. Alan Miller. I think UHS is a little different from your standard for-profit company in that it has been established and it operates for the long haul. We insource and operate the majority of our IT. We pay Cerner to host our EMR platform, but we run our own help desk. We run our own help desk for the Cerner platform. The PC tech team is ours and not outsourced. We look to operate efficiently and effectively, providing good services from an IT perspective.

Even though we’re for-profit and publicly traded, we are operated for the long haul. In my eight years, I was never asked to decrease staffing due to a challenging financial market. If you think back to 2008 and 2009 when times were tough, we did not reduce head count because we’re very careful in what we add. We want to operate efficiently and continue to serve the customers and the physicians well.

I think UHS is a little different in that regard in the for-profit world. I’ve found that our goals are substantially the same — quality, patient safety, and have IT deliver effective services to the customers. A lot of those themes are exactly the same in the for-profit world, even though I would say there’s an incremental focus on expense management.

For-profit healthcare IT technology deployments seem to have been selective, with less investment in clinical and patient-facing systems. Did you find that to be the case at UHS?

When I got to UHS, they had a best-of-breed focus, as did many organizations  back in the early 2000s. We had an opportunity to reconsider that approach.

As I joined the company, the revenue cycle was stable and effective. There had been a major investment in what used to be the Siemens Invision platform, which is now owned by Cerner. The corporation needed an improved clinical IT, so we went down and determined our strategy was going to be a more innovative approach.

As we started the Cerner EMR implementation, I advocated for – and the president of the company, Mark Miller, supported — adding a chief medical information officer. Until we started our Cerner deployment, we didn’t have that. We added that one physician. Then that physician was so effective for us that we added three other full-time physicians in IT.

As far as I know, we’re the only for-profit that has four physicians full-time embedded in IT that sit across from my informaticists and my programmers on the same floor in our building. Our cycle times to make modifications, customizations, and enhancements is reduced because of the close physical proximity and the alignment with IT.

I think your characterization of for-profits is generally accurate. Between the work that Tenet and Community and we at UHS have done in the last four or five years across those organizations, there has been a huge focus on clinicals. We added clinicians into IT and I think that’s the secret sauce to having enhancements that we’re able to sell to other people.

You mentioned that you have a lot of behavioral facilities. Is the technology deployment different there as it usually is outside of the hospital setting?

We have different IT in the two divisions. We run different registration and clinicals in behavioral health as opposed to our acute.

In the behavioral health division, we have been piloting a couple of different EMRs that are better adapted to that environment. They have some documentation requirements and clinical processes that are materially different than acute care. A standard acute care EMR has not worked well in the behavioral health division. Lately, we found a vendor that’s a pharmacy IT vendor that has CPOE, etc. and leveraging that specialty system into our behavioral health has produced the best result so far.

They’re not running ORs, typically. They don’t have a lab. They’re not running radiology. Finding a good niche pharmacy system that has a CPOE component that allows the behavioral health to be effective with patient medication management — that’s really been the right piece for them. But we do have EMRs in select facilities. Then our acute care division is very standard with the rest of the acute industry.

There is separation differentiation at some of our large acutes. We have behavioral health pavilions, large inpatient units. At those locations, they use Cerner. We’ve worked to enhance Cerner so that it can meet the majority of their needs. We’ll continue to do it as we go forward.

What can you do with Cerner’s MPages and Advisors?

We can aggregate data that are on multiple screens within the system into one unified view. Instead of a physician having to go through seven clicks to renew a medication order that’s about to expire, we can have an MPage that displays all the med orders or any other orders, such as restraints, that are going to expire. Basically in one click to two clicks, they can renew all those orders when typically they would have to navigate to the orders page, review all the orders, determine which ones might expire, select those individual ones, and approve them.

Our goal using the Cerner tools has been to reduce the clicks for the physician and present information that they can take immediate action on and solve the conundrum of "Yes, the EMR has what needs to be done, but it’s not easy to get to it, it’s not easy to take that action, and IT, you guys aren’t providing me any value with the out-of-the-box EMR."

Do inpatient EHR vendors offer enough tools and technologies to allow users or third parties to extend or modify their basic functionality?

I can speak from my experience with the Cerner EMR, having implemented that at the Carolinas and at UHS. The MPages functionality, the Cerner Command Language CCL Programming tool set, has allowed us to extend the functionality of Cerner and address workflow issues that we see. That’s been good technology that when properly leveraged, adds real value.

Other vendors might not have been flexible enough early, but you’ve seen Epic adapt to that. They’ve rolled out equivalent functionality from what I understand, but I haven’t used it directly. How much or little Meditech does, I don’t know.

A lot of vendors that are smart realized that healthcare is not one size fits all. You don’t want to just let them have configuration choices — you want to let them enhance the tool. The direction is more positive as opposed to less. I’m pleased with Cerner. We’ve been able to get real value from that.

Are you hungry for additional capabilities to the point that you’re asking Cerner for more openness or APIs? Do they see that as competitive with what they want to offer the market in general?

We are actively working with them on some technical tools that are going to provide better alerting and information from a technology perspective.

I worry about end-to-end response time. Our end users in the hospitals are on a PC. They’re going through a Citrix session. They’re connecting across our wide area network to the Cerner data center. There’s an application set of functionality and  there’s a database server. I care about that end-to-end response time. Cerner has got great tools to manage the database and tell us what the database response is, but they can’t tell us Citrix session response times front to end in our facilities. We’re working on trying to get them to allow us to do some different things and installing tool sets in their managed services environment.

We’re pushing and advocating for the things that we need from an IT service delivery perspective and I think they’ll react to that. It will take a while. There’s still continued tools that we need, but it’s a step at a time. It’s a journey with the EMR stuff. Nothing is ever done overnight. if you think about client-server, that was the rage, but eventually people wanted to push everything to the cloud. You go through technical changes, but what you want is effective IT delivery for your end users.

Was it different to have to take a vendor mindset when developing something new that could be used, hopefully in shrink-wrapped fashion, by another health system?

Absolutely. We added several technical staff members to help package up code sets so that it would be deployable to other organizations. Cerner’s EMR and other vendor EMRs have configuration choices. Based on those configuration choices, our enhancements may work more straightforward –out of the box, if you will — or we may have to modify those enhancements to meet the configuration choices that a customer made.

We invested resources and time to package up the enhancements so that they were more readily usable. We worked to add some user admin tool sets so that they could modify some functionality without having it have to be hard coded and programmed into those solutions.

Absolutely, you cannot just take an enhancement we’ve made and plug and play it somewhere else. You need to think through that commercialization and how do you package that up and get it ready with release notes, etc. We went into with a mindset that we would have to, for our Crossings subsidiary, invest in commercializing the software, which meant packaging it up, making it ready for deployment, and usable. We’ve worked hard to make that effective at our first customers.

Vendors are announcing customer partnerships, like the Cerner-Intermountain one, where they’ll work together to develop intellectual property that will be added to the vendor’s base product. Is that a growing practice? How will it affect the industry?

Through the years, you’ve seen an increase in that. Cerner previously had a relationship, I believe, with the Chicago Institute of Rehabilitation. They had a rehab-specific module that Cerner customers could purchase. Other vendors have had different types of announcements with third-party organizations. I think that will continue in a limited fashion, where that third party can help the vendor create functionality that would have otherwise taken the vendor too long or they might not have gotten to and lost a market opportunity.

Cerner has worked with Advocate on the population health side. I think that’s helped  Cerner move more rapidly than perhaps they could have on their own. I think it’s a smart move from the vendors. They’ve got to pick the right organization that has similar business needs to other possible customers to create products that offer real viability in the market. It makes sense on a limited basis where they can control and manage the scope. It keeps them ahead of what customers are demanding.

I think it’s in my personal best interest that Cerner has as many products as I might want. It’s my personal opinion. Some of it will apply to us, others of it may not, but I think you’ve definitely seen a continued trend to do that in a focused manner.

It’s disillusioning to a clinician who moves to the vendor side to realize that what’s holding innovative functionality back isn’t always a shortage of good ideas, but rather navigating through convoluted internal development, testing, and release processes. Have technologies changed so that a good idea be turned into a software enhancement quickly and reliably?

Technology has given us capabilities to decrease the time for that development cycle. But there is still idea generation and requirements definition and modification that still takes time. That human side of coming up with a better idea, working through how it could function, going from a verbal design discussion to a technical set of specifications that you can program for. I think there’s still real time in that. 

Once you get to the programming side of the house, there are some tool sets, testing tools, testing environments, and repeatable test data. That technology has shrunk down that total development time, but I don’t think it can necessarily eat into that timeframe that’s on a front end, to come with the idea and create something that’s viable that then you can handle the technical life cycle on. I think we’ve made some progress.

Within our organization, there are more good ideas than we have people. Most IT shops probably have that problem. You prioritize them and work through them in as smart a manner as you can.

What will be most important for you to accomplish for UHS in the next five years?

For IT, I want us to be flexible and responsive to the organization, which everybody certainly wants. But where I see our business and clinical priorities are increasing are focused on population health. We as an organization purchased an insurance plan. We are offering Medicare Advantage plans. We are working to provide narrow networks. 

As we in the IT realm move from having an EMR deployed that we believe is relatively effective and physicians inside the four walls of our hospital using that relatively well, we need to then look outside of those four walls to the post-acute world. We need to look to managing that population health, providing the quality, and having the data and information to do all those things.

I don’t believe that’s necessarily materially different than other large providers. Working to align IT and making sure that we can effectively support good decision-making, quality improvement, and quality patient care delivery. Those are probably the most important things at the top of our list while continuing to be effective inside the four walls of the hospital.

Do you have any final thoughts?

I’ve enjoyed reading HIStalk for a long time. I think you bring a nice breadth of practical and honest information-sharing across the healthcare IT space. I appreciate what you’ve done. We hire kids out of college. We work to train them and grow them and try to create their interest in healthcare IT and you are a great source of information for that. I know a lot of others read what you  have. You know I’m a long-term reader and I appreciate what you’ve done. You’ve made it very practical for people and cut through the BS, which is great.

Morning Headlines 10/13/15

Dell buys EMC in largest tech deal ever

As rumored on HIStalk over the weekend, Dell will acquire EMC for $67 billion, paying EMC shareholders with cash and stock worth a combined $33.15 per share, a 28-percent premium over EMC’s closing stock price Friday.

Cerner conference will focus on health care information technology

A local paper covers Cerner’s annual conference, which will draw an estimated 14,000 visitors to the Kansas City area this week.

HealthCare.gov to Get Major Changes to Ease Shopping for Coverage

Healthcare.gov will get new enhancements ahead of this years open enrollment period that will let users search for plans that include their primary care doctor, preferred hospital, and coverage for their prescription medications. Security enhancements include a “Do Not Track” option and other data exchange enhancements that will help safeguard personal information.

Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records

The National Institute of Standards and Technology publishes recommended guidelines on EHR design based on a patient safety-focused usability study.

Morning Headlines 10/12/15

Philips strengthens collaboration with Amazon Web Services to expand digital health solutions in the cloud

Philips announces that it will integrate its HealthSuite platform with Amazon Web Services’ new Internet of Things platform, allowing it to wirelessly and securely exchange data with a variety of medical devices and sensors.

Dell to use VMware to help pay for EMC deal: sources

Dell will acquire EMC Corp for $55 billion in cash and stock options, according to anonymous insiders. An announcement is expected as early as this week.

Time To Implement IOM Health IT Recommendations For Improving Diagnosis

Hardeep Singh, MD, MPH, and Dean Sittig, PhD and professor of biomedical informatics at the University of Texas, publish a Health Affairs post outlining recommended changes that could help EHRs better support diagnosis.

Fitch Rates Banner Health Series 2015A Rev Bonds ‘AA-‘; Outlook Stable

Fitch affirms Banner Health’s AA- bond rating after its $733 million acquisition of University of Arizona Health Network, concluding that integrating UAHN into Banner is already ahead of schedule and under budget, and noting that UAHN will be joining a health system with 21 HIMSS stage 7 facilities, plans of migrating to a value-based reimbursement model, and a solid financial profile.

Monday Morning Update 10/12/15

Top News

Philips will use the just-announced Amazon Web Services Internet of Things connectivity platform to expand its AWS-powered HealthSuite digital platform in connecting to devices and sensors.

Reader Comments

From Bum Steer: “Re: inpatient EHR vendors. Do you really want a market with only a handful of choices, or even worse, just Epic?” The market itself does that voting with its dollars, not me with my keyboard. The fact that the only vendors with significant market share are Cerner, Epic, and Meditech reflects the fact that they offer customers the broad, integrated, proven systems they want. Other companies fell by the wayside for a variety of reasons: lack of anticipation of the need for a single patient record, corporate bumbling, focusing on the small-hospital market as bigger companies moved down into their customer base, and stubbornly following a best-of-breed product strategy despite ample evidence that it was no longer valid. The next big test, the one where Cerner holds the clear lead, is turnkey systems hosting that frees hospitals from spending capital on hardware and hiring hard-to-find experts willing to relocate. One might hope for new entrants that will challenge the status quo in terms of innovation and value, but imagine the time and money required to design, develop, test, and roll out a full healthcare IT system with zero income until it’s done and then trying to sell it to risk-averse hospitals that have already invested millions in one of the Big Three’s products. The only real question is whether Meditech can challenge Cerner and Epic, who are moving into its market as big health systems offer hosted systems to smaller hospitals or acquire them outright. The health system EHR war has been won and smart companies will focus on how to work with rather than against the victors.

HIStalk Announcements and Requests

It’s a 60-40 poll respondent split on whether consumers should be allowed to order their own lab tests. All Hat No Cattle worries that the general population won’t understand the significant number of false positive results, while Don thinks it’s OK that people will test themselves as an adjunct to medical services or between visits. Bar Code says lab people need to reform reference ranges since many labs simply flag the top and bottom 2.5 percent of the population as abnormal without having any evidence-based cutoff. Mak votes a resounding yes from the personal experience of being denied coverage of certain tests by insurance but confirming his/her suspected diagnosis after paying for the test directly to discover a treatable genetic condition that could affect children and grandchildren as well. DZAMD says with tongue in cheek that while preventing people from practicing medicine without a license is a patronizing vestigial concept, it’s legal to represent oneself in court without a lawyer, to which he says, “expect a similar result.” New poll to your right or here:  what is your level of personal interest in the revised Meaningful Use requirements?

Mrs. Beasley from Georgia says her elementary class is intrigued by the Makey Makey kits we provided via DonorsChoose. She will add them to the school-wide “Hour of Code” programming activities that start in December.

Mrs. Eaton, a speech-language pathologist, says she has never received financial assistance to purchase materials for the 50 special education students she serves in her high-poverty, budget-strapped Georgia school, adding that they “were able to begin this school year with great enthusiasm and thankfulness when they saw our recently purchased essentials.”

Last Week’s Most Interesting News

• Cerner announces that its SMART on FHIR API is ready for client testing.
• CMS releases the pre-publication version of its modified Meaningful Use Stage 2 and Stage rules, with the Stage 3 dates unchanged.
• ONC publishes its Interoperability Roadmap.
• The US Coast Guard declines to renew its contract with Epic.
• Two HELP Committee senators introduce a bill that would require ONC to publish an EHR star rating, fine vendors or providers up to $10,000 for information blocking, and reimburse providers for replacing their EHRs that have been decertified.
• John Halamka reports that all the major EHR vendor CEOs have agreed to commissioning an independent third party to publish objective measures of interoperability.
• Mercy Health opens a $54 million virtual care center.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

In a fascinating example of how virtual companies can succeed while using contractors instead of employees, a one-employee, home-based biotechnology research company is acquired by drug manufacturer Roche in a deal worth up to $580 million. 

Dell will acquire EMC in a deal that values the storage vendor at $55 billion and will use some of EMC’s majority ownership position in VMware to finance the deal. 

Sales

University of Texas MD Anderson Cancer Center engages Santa Rosa Consulting to support its scheduling appointment conversion to Epic early next year.

People

Accreon hires Kimberly Post, CPA (Beacon Partners) as CFO.

Announcements and Implementations

Retail pharmacy software vendor Rx30 will incorporate DrFirst’s secure texting, event notifications, content distribution, and care team collaboration functionality into its software.

Government and Politics

ONC posted the PowerPoint used in its Webinar last week covering the Health IT Certification 2015 Edition Final Rule.

Privacy and Security

Finally a stolen, PHI-containing laptop turns out to have been encrypted. A Humana employee’s vehicle is broken into in Wisconsin and a laptop and paper records for 2,800 Medicare Advantage members were stolen. The 2,500 laptop records should be fine since it was encrypted, but the 250 paper records are obviously freely readable. I was amused by the Milwaukee paper’s coverage, which in describing that the files contained name, date of birth, and clinic name, stated, “… a Humana spokesman would not explain what the term ‘clinic name’ meant.”

Innovation and Research

Microsoft co-founder Paul Allen launches a $500 million project to build an artificial brain that can pass a high school science test.

A study finds that asking a cancer patient’s oncologist “would you be surprised if this patient died within the next year” was more accurate at predicting mortality than other screening methods. It would be interesting to repeat the study but asking the patients themselves that same question.

Other

Blue Cross Blue Shield of Illinois eliminates its most popular medical insurance plan three weeks before the November 1 open enrollment begins, saying medical costs were so high the PPO plan’s price would have been unaffordable. It will automatically switch members to a plan that’s similar but includes only 78 hospitals rather than all 209 Illinois hospitals.

HIMSS is apparently justifying the celebrity-pandering choice of Peyton Manning as a conference keynote presenter because he has something to do with NFL player safety, which I’m sure will resonate with a bunch of hospital IT people.

A Castlight Health study finds, to the surprise of no one, that prices for a given procedure vary wildly even within the same city, with an example being a cholesterol test that is priced from $14 to $1,070 in New York City. I assume it reviewed claims information that reflects prices negotiated by individual payers, which might differ a lot from what a cash-paying, high-deductible insurance patient would find. I still don’t understand why providers shouldn’t be required to offer their lowest prices to everybody.

Bob Wachter tweeted a link to this video of Rachel Pearline, a UCSF hematology-oncology fellow, saying goodbye as she dies of cancer.

Dean Sittig, PhD and Hardeep Singh, MD, MPH pen a Health Affairs Blog post that describes how EHRs could improve diagnosis, as called out by the IOM’s recent report. Their suggestions:

• EHRs should provide better support for teamwork and communication.
• ONC’s EHR certification criteria should review usability, clinical workflow, clinical decision support, and timely information flow.
• EHR screens should be shared among all users, not with separate versions for physicians and nurses as was the case in the Texas Health Resources Ebola patient incident.
• EHR vendors should share their documentation templates for emergent situations such as the Ebola case, encouraging users to exchange screen shots and best practices.
• The Ebola patient luckily returned to the same THR ED, allowing them to finally recognize his diagnosis, but the authors point out that he could well have gone to a non-THR ED, where lack of interoperability would probably have left his new caregivers working blind.
• Congress should fund ONC’s proposed Health IT Safety Collaboratory to discover safety concerns and disseminate best practices.

A Commonwealth Fund study funds that the US spends the most by far among 13 high-income countries — mostly because of expensive technology and high prices – but delivers poor outcomes that include shorter life expectancy and more prevalent chronic conditions. The US also spends a smaller percentage of its economy on social services.

Fitch Ratings likes the $733 million takeover of University of Arizona Health Network by Banner Health, pointing out that Banner has made consistent IT investments that led it to achieve HIMSS EMRAM Stage 7 using Cerner.

Only in Silicon Valley: a self-driving Google car yielding for a pedestrian in a crosswalk is rear-ended by a Tesla.

Weird News Andy summarizes this story as “Hospital cafeteria food … meh.” An 800-pound-man who starred in a series of YouTube videos making fun of his weight is kicked out of a hospital weight loss program for having pizza delivered to his bed. He had hoped to lose 250 pounds so he could get gastric bypass surgery. WNA adds that even without this new quick and easy heart attack detection test, he can predict that the pizza man is at risk.

Sponsor Updates

• Experian Health and SSI Solutions will exhibit at AAHAM ANI October 14-16 in Orlando.
• PatientSafe Solutions will exhibit at the CHIME15 Fall CIO Forum October 14-17 in Orlando.
• The Wall Street Journal features PerfectServe’s latest round of funding in its Venture Capital Dispatch.
• PeriGen co-founders Emily Hamilton and Matthew Sappern are featured in the One by One Million blog.
• Influence Health will sponsor, exhibit, and present at the AHA’s Society for Healthcare Strategy & Market Development Conference in Washington, DC next week.

Blog Posts

• Beyond Best Practices – Accelerate the Hospital’s Revenue Cycle thru Business Process Automation (Recondo Technology)
• The Big Day is Finally Here (PatientKeeper)
• Vendor Neutral Archive liberates Piedmont Healthcare’s “island of misfit images” (Lexmark)
• A Picture is Worth a Thousand Words (Lexmark)
• Medicare Creates Experimental Pilot Incentive Program to Boost Medication Adherence (Point-of-Care Partners)
• National Health IT Week: Revenue Cycle Supports Mission of Care (Sagacious Consultants)
• SMART Label Tip (Sunquest Information Systems)
• 10 Years of Interoperability in Action: A Historical Look at E-Prescribing (Surescripts)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 10/9/15

Cerner Clients Test SMART on FHIR Apps Within EHR

Cerner unveils an HL7 FHIR-based API that will provide its customers a way to integrate EHR data with third-party apps and other health IT applications.

Project One transition ongoing at Phoebe Putney Health System

A local paper covers the October 1 go-live of Meditech at  640-bed Phoebe Putney Health System (GA). CIO Jesse Diaz reports that the switch over generated upwards of 1,000 calls a day in the command center initially, but that in the week since going live the system has stabilized and morale in the hospital is good.

FDA Launches Pilot to Standardize REMS Information for Easier Systems Integration

The FDA is launching a four-month pilot program aimed at integrating Risk Evaluation and Mitigation Strategies into EHR systems.

Social Security Administration joins CommonWell Health Alliance

The Social Security Administration partners with CommonWell to expedite access to medical records and improve disability claims processing wait times.

EPtalk by Dr. Jayne 10/8/15

It’s funny how you look at things differently when you’re a physician or healthcare provider. I’m always noticing automated external defibrillators (AEDs) when I’m in public places, especially now that they’re nearly everywhere. Most places have them prominently displayed with clear signage and the cases are either red or bright yellow so they’re easily seen. When I was recently on Capitol Hill, however, I noticed that the AED of Congress sits in a nondescript pedestal in a subdued black case. No matter where your politics lie, it’s somewhat ironic that Congress operates in a different world than what most of us know.

Since the Meaningful Use rules were published earlier this week, hundreds of health IT people were spending thousands of hours poring over them. Several of my colleagues lamented that it was a huge waste of time since there’s a high likelihood that Congress will create legislation to delay the start of Stage 3 beyond 2018. Without my crystal ball, though, to know if that will be true and when it will happen, I had to dig into all 1,300+ pages of goodness like everyone else. You know you’re an informatics geek when you’re joining your informatics friends in tweeting photos of the cocktails you’re drinking while you’re simultaneously reading federal regulations.

After a while, they became mind-numbing and I just had to quit and go to bed. When I woke up, I unfortunately did not discover that MU had all been a dream. I did discover invites to some CMS webinars, though, which helped provide an excuse to procrastinate the reading until I could listen to the highlight reel.

I tried to register for the webinar, but kept getting a Windows Live Meeting error. It finally registered me after trying multiple times over the next several hours. I started working some issues with my clients and discovered that one of them only sent out 70 claims for the first two days on ICD-10. Although they didn’t experience any unusual rejections, that’s a fraction of the number of claims that should have gone out with the average physician seeing 30 patients per day and this being an organization with more than 100 physicians.

My client is the IT department. They engaged me to figure out what’s going on. After entirely too many phone calls, we determined that apparently the operations team decided to switch to a system where 100 percent of patient visits receive review by a certified coder. Unfortunately, they didn’t let anyone on the IT side know, so IT has been chasing their tails trying to figure out what is going on.

Although 100 percent review certainly reduces your risk of miscoded claims, it’s not realistic in most organizations. I think these folks just gave themselves a self-inflicted cash flow problem. I gave the IT department some advice on how to quickly transition from 100 percent review to representative sampling, but I’m not sure they’re going to be able to get the operations management to listen.

Fast forward to Thursday, when I attended the CMS Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs Final Rule Overview webinar. I’m curious about the inclusion of an additional 60-day public comment period. Although HHS is “committed to working with stakeholders,” what are they really going to do with the information? The comment period is limited to Stage 3, so it sounds like they’re leaving the door open for further changes even if Congress doesn’t act.

Webinar pro tips from a seasoned trainer: when you do introductions, put up a slide that lists the name and credentials of the person speaking. The first speaker was introduced so quickly I barely caught her name. The entire time we were looking at the title slide for Elizabeth Holland, who was the second speaker. Her title, however, was not listed. Although many people know “everyone” in the MU community, not everyone knows exactly who you are and why you’re speaking. She did apologize for the overloaded webinar and that people that were turned away – it should have been something they could have anticipated based on the issues with the registration.

Due to the vastness of the 752-page rule, the webinar largely focused on modifications to Stage 2 and in particular what we need to know for 2015. Attendees were encouraged to read the entire document to find responses to their questions.

The highlight reel for MU Stage 2:

• No flexibility in using CEHRT certified to previous edition criteria. Providers must use 2014 Edition CEHRT in 2015 and subsequent years until they transition to 2015 Edition CEHRT, which is required for reporting in 2018.
• Much emphasis on aligning 2015-2017 Modified Stage 2 measures to Stage 3, which will be required for everyone in 2018.
• Alternate measures and exclusions remain largely unchanged from the proposed rule. These help providers who planned to attest for Stage 1 or Stage 2 to be able to meet Modified Stage 2. These were essential since the rule was released later than anticipated. They’re fairly detailed and were addressed as each measure was covered. I got lost in the details on a couple of them, so I’ll do like the presenter and refer you to the Final Rule for details.
• CPOE landed at 60 percent for medications, 30 percent for labs, and 30 percent for radiology.
• Hospitals are at 10 percent of discharge meds meeting the same criteria.
• Transition of care requires use of the CEHRT to create a summary of care record; more than 10 percent of transitions of care and referrals must be transmitted electronically.
• Patient education is 10 percent for EP unique patients seen during the reporting period and also 10 percent for EH patients admitted to the inpatient or ED places of service.
• Medication reconciliation remains at 50 percent of transitions of care to the EP or EH/CAH.
• Patient electronic access threshold is 50 percent to receive access within four days for unique patients seen during the reporting period. For 2015-15, only one patient seen during the reporting period must view, download, or transmit. This goes up to 5 percent in 2017. Hospitals must provide access within 36 hours of discharge for more than 50 percent of patients. The VDT thresholds are the same.
• Secure messaging has to be enabled for the reporting period in 2015 on a yes/no basis. For 2016, at least one patient must engage in secure messaging. For 2017, this goes up to 5 percent.
• Public health reporting has four measures and several nuances, so I’m going to refer you to the rule here as well. Frankly this was covered 45 minutes into the call, so I had glazed over a bit. I zoned back in when they were talking about a FAQ on this issue, so my advice is to read all the FAQs and act accordingly. (And by the way, they change all the time, so you might want to appoint someone to check them daily.)
• No changes to CQMs and the period is 90 continuous days.

For Stage 3:

• Removes redundant, duplicative, and topped out measures (no surprises here) and intended to reduce provider burden. Not sure it meets the mark on the latter.
• The presenter started talking about specific measures and their changes without a supporting slide. I got completely lost. They were not reviewed in detail.
• The comment period closes December 15.

Tips for 2015:

• Confirm your stage.
• Update your registration information through NPPES including email and payment information as well as surrogate users. Ensure your 2014 Edition EHR identification information is documented.
• Reporting periods are any continuous 90 days in the calendar year except for hospitals, which can go back to the last quarter of 2014.
• Attestation opens January 4, 2016 and runs through February 29, 2016.
• If users claim they can’t meet the requirements because the rule was so late, they should apply for a hardship exception. Expect the FAQ to be up shortly.

I didn’t really expect it, but I would have liked to have them at least acknowledge the fact that they put a 90-day reporting period in place for this year, yet announced the requirements after the last possible 90-day period had already started. I know that’s what all the exclusions are about, but it just seems overly complex when it’s supposed to be simplifying and consolidating things for us. Being able to acknowledge a mistake is also a good customer service move. Vendors still have to support multiple sets of reporting and performance criteria.

As a side note, I’ve never heard the CAH abbreviation for Critical Access Hospitals pronounced as “Caaaa,” so that was a bit jarring every time I heard it.

Please excuse any typos or errors in my summary. I’m frantically typing it after a long day of “real job” work so Mr. H can get it to press.

Have you finished the rule? What are your thoughts? Email me.

Email Dr. Jayne.

News 10/9/15

Top News

Cerner opens client testing of its SMART on FHIR standard that has been released to Millennium production. Demonstrating their SMART on FHIR solutions at CHC next week are VisualDX, xG Health, and Boston Children’s Hospital. The company is also calling for interested developers to become part of its ecosystem. This is what the market says it wants – an EHR vendor (one of only three big inpatient ones) that opens its system to third parties to give more choices to its users. It’s a pretty big deal if you ask me.

Reader Comments

From Light Brigade: “Re: Meaningful Use. Do I detect little interest in the new regulations?” You certainly do from me. The Meaningful Use program, not unexpectedly, has turned into just another government program administered by its own well-intentioned but self-preserving bureaucracy. It has wasted an immense amount of industry energy and taxpayer billions with questionable results. We would have been much better off, as I said when it was first announced as a stimulus program, letting the free market dictate the health IT market rather than bribing providers to either use products they already owned a bit differently or to buy EHRs that weren’t selling without Uncle Sam’s subsidy. I just don’t care any more. The government already sets our healthcare agenda as the largest healthcare payer and provider, getting providers to sell out to keep the Medicare and Medicaid payments flowing while complaining constantly, and MU has turned into one more carrot-then-stick distraction and providers unwittingly made possible by taking those early stimulus checks. The government should be involved in setting standards, but not dictating the terms of provider-patient relationships or mandating technology use. I’m not sure all that money and energy made much of a positive difference for patients whose concerns are more about the cost and availability of insurance and care delivery rather than what’s running on the computer in the exam room. We should be talking about how to fix our screwed up healthcare system rather than how to automate the existing mess using old IT systems that chase old incentives.

From Comfortably Numb: “Re: clicks. A nurse told the Health IT Standards Committee recently that it took her more than 500 clicks to admit a patient. That tells you all you need to know about EHR usability.” Actually, that tells you all you need to know about the US administrative requirements for delivering care and accepting insurance company payments. The number of clicks is a reflection rather than a cause of that complexity. Everybody loves shooting the EHR messenger (Epic in this case) instead of the endless requirements by cheap-seaters for clinicians to capture irrelevant, non-medically contributory patient information.

HIStalk Announcements and Requests

I’ve been playing around with some of the health insurance sites like Healthcare.gov and Stride Health (which seems to be loaded with technical problems related to removing/adding prescription drugs from the user’s profile) under various scenarios. It’s interesting to me that despite their high cost, most of the medical insurance plans those sites suggest don’t kick in at all until the member has paid a $6,000 deductible – the member pays the entire cost of visits, prescriptions, etc. before the plan starts paying 100 percent. The high cost of hospitalization and prescription drugs means that a lot of people will then incur the full $6,000 cost plus the annual premium of around $3,000. I’m not sure all that many Americans have an extra $9,000 lying around. It also strikes me that it’s a leap of faith anyway since you can’t see the fine print when signing up, like which providers are in the network, which ones are accepting new patients, and the cost of any specialty drugs that are covered minimally if at all. It seems to me this means:

• People may not bother to buy insurance since it only covers unpredictable catastrophic expenses.
• Even people who buy insurance may not be able to pay their high deductibles.
• Both of these scenarios, plus higher medical and insurance costs, may make it just as hard for providers to get paid as pre-ACA.
• Patients with more financial skin in the game will have incentive to shop around and ask more pointed financial questions of providers.
• The ridiculous out-of-network scam is getting worse. ED and hospitalized patients can ask everyone in sight whether they’re in-network providers and still be stuck with huge bill from a provider they didn’t choose. This continues to create hospital trust issues. Imagine if you took your car in for a $30 oil change and later received bills for hundreds of dollars from mechanics the oil change place called in without your knowledge.

Ms. Palmer says her Mississippi third grade students are enjoying the classroom library of 90 books we provided via a DonorsChoose grant, to the point that several students read more than 20 of the new books in the first two months after receiving them.

Listening: new hard rock from Brooklyn’s Highly Suspect, who sounds like Queens of the Stone Age at times. Also: new from Moon Taxi, a polished indie-progressive band from Nashville that’s quickly becoming one of my favorites. They’re on tour playing mostly small venues like the Orange Peel in Asheville and the Majestic Theater in Madison.

I say goodbye and thanks to TriZetto, an HIStalk and HIStalk Practice sponsor since 2011 who, now that they’ve been acquired by Cognizant, demanded brusquely that we cancel their months-overdue sponsorship in asserting that “nobody here has ever heard of HIStalk” (apparently not including the several dozen of its employees are on the email list and whoever manages their Twitter account since they follow me). They were great supporters as Gateway EDI, so-so ones as TriZetto, and non-existent ones as Cognizant. I should offer their spot to competitors like Infosys, Wipro, Tata, and Accenture who might have someone who is familiar with what I do.

This week on HIStalk Practice: Premier dives deeper into ambulatory market with InFlow Health acquisition. Doctors Administrative Solutions buys Spectra Healthcare. Dr. Gregg explains his fondness for ICD-10. Primary care performance metrics are in need of a strategic overhaul. Pulse System acquires Nightingale’s US-based PM business. Brad Boyd offers strategies to mitigate risk during physician practice onboarding. Physician love/hate relationships with technology get even murkier. Flight surgeon and family practice physician gets to the heart of practicing medicine in a time of heightened healthcare IT policy-making. The HIStalk Exhibitor Guide for MGMA 15 goes live.

This week on HIStalk Connect: Startup Health and Rock Health publish digital health funding reports confirming that the industry is maintaining pace with 2014’s investment levels. Mayo Clinic announces the winners of the Think Big Challenge, a developer contest soliciting disease management and general wellness solutions. Dātu Health raises a $10 million Series B invested by St. Joseph Health, an early investor and user of Dātu’s patient engagement platform. Advances in rapid genome sequencing show promise in the NICU.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Allscripts promotes CFO Rick Poulton to president and extends CEO Paul Black’s employment agreement for another three years through December 2018. The company has opened a search for a new CFO. Poulton’s pre-Allscripts experience was in the airline industry.

CareSync secures $18 million in series B funding, announcing that its user base has expanded 20-fold in the past four months. The company will hire 500 more employees in the next 18 months. I have to say I never saw that coming – it looked like a great service destined to be lost in a sea of mostly failing competitors who tainted the entire market with their lack of success and focus.

The SSI Group reports that sales for the first three quarters of 2015 exceed its 2014 numbers by 48 percent.

In England, Musgrove Park Hospital goes live on an EHR created as a customized version of open source IMS OpenMaxims software.

UK-based Cambridge Cognition, which offers a dementia detection app, licenses additional tests and a behavioral treatment app that trains people with aggressive behavior on how to better recognize facial cues.

Post-acute EHR vendor Netsmart and KC-based social provider Cornerstones of Care will collaborate on technology innovation.

Sales

WakeMed (NC) chooses Lexmark Accounts Payable Automation.

Hopkins-owned Sibley Memorial Hospital (DC) selects Versus RTLS for its new ED including a personal panic button, staff locator, and asset management.

Intermountain Healthcare chooses American Well to create a $49 video visit service that will launch in early 2016.

People

Barry Volin (Aetna Better Health New Jersey) joins WeiserMazars as healthcare consulting principal.

Valence Health hires W. Roy Smythe, MD (Avia) as chief medical officer.

Aurora Health Care (WI) names Preston Simons (Abbott Laboratories) as CIO.

Culbert Healthcare Solutions hires Randy Jones, DHA (UT Southwestern Medical Center at Dallas) as SVP of consulting services for the Western region.

Zest Health hires Ann Mond Johnson (ConnectedHealth) as CEO.

Announcements and Implementations

The National Association for Trusted Exchange (NATE) turns over administration of its Provider-to-Provider Trust Bundle to the California Association of Health Information Exchanges.

The Social Security Administration joins CommonWell Health Alliance.

Government and Politics

ONC opens a position for a pharmacist to perform policy, advisory, and liaison work.

FDA launches a four-month pilot program seeking to standardize drug company REMS information so that it can be incorporated into electronic systems such as EHRs.

Privacy and Security

In another mail-merge type mistake, Affinity Health Plan (NY) alerts patients that its renewal reminders for the state’s child insurance program contained a different patient’s information on the reverse side.

Valley Children’s Hospital (CA) sues two of its former pulmonologists for downloading records of 164 cystic fibrosis patients from its system in trying to recruit them to a competing practice. Valley Children’s Hospital reported the incident as a HIPAA breach, while the rival practice says doctors have a right to contact former patients to let them know they’ve moved.

Innovation and Research

Boston Scientific announces a remote patient monitoring innovation contest, with winners dividing “up to $25,000 of services in kind.”

Other

The Albany, GA paper shares interesting details of the October 1 Meditech go-live of Phoebe Putney Health System. VP/CIO Jesse Diaz says it was “very challenging” with 1,000 command center calls the first day and a NICU dosing problem, but things are settling down and more orders are being entered electronically than before with a 15-20 percent increase. The health system also opened up a $50 million line of credit to help cover the project’s cost and the potential revenue cycle impact of ICD-10.

St. Luke’s University Health Network (PA) publishes a price list for patients willing and able to pre-pay for bundles of services for common procedures, imaging studies, and ambulatory surgeries. An ACL repair costs $10,270, while most common X-rays run $100. The target market is the consumer I described above who has a high-deductible plan that requires them to pay every penny themselves until their insurance kicks in.

Pathologist Bruce Friedman, MD notes that investor darling lab provider Theranos — whose lobbyists successfully pushed an Arizona law to allow patients to order their own lab tests — now has competition in the state as Sonora Quest Laboratories launches similar cash-only services. I checked out Sonora Quest Laboratories, which turns out to be a Phoenix-based joint venture between Banner Health and Quest Diagnostics that has the largest laboratory testing market share in Arizona with 70 service locations. This is perhaps the first real face-off between Theranos and the established two-company lab market, competing on price in the only state where cash-paying consumers can take full control. Banner had $4.5 billion of revenue in 2013, of which it appears that Sonora Quest Laboratories generated $18 million and parent Laboratory Sciences of Arizona brought in another $80 million if I’m reading their tax forms correctly. The non-profit Banner, which had a $482 million “surplus” that I noticed while perusing their Form 990, paid their HR VP $900K, their CIO an annualized $560K, and their pharmacy director $553K.

Athenahealth’s Jonathan Bush tweeted this selfie with Karen DeSalvo, saying he’s disappointed to lose his perception that all government officials are stiff (maybe DeSalvo lost that same perception about vendor CEOs).

A New York City entrepreneurship site profiles ED wait time system and analytics vendor MedTimers. The company’s founder and CEO is an NYU undergrad.

Weird News Andy calls this story “Recycling Gone Wild.” Dozens of employees of a New Jersey drug company are being tested for HIV and hepatitis after a contract nurse from onsite flu clinic provider TotalWellness who was giving flu shots was caught using the same syringe for everyone.

Sponsor Updates

• ZirMed is ranked first for revenue cycle solutions among hospitals under 200 beds in a Black Book survey.
• Iatric Systems, Intelligent Medical Objects, Medecision will exhibit at the CHIME Fall CIO Forum 2015 October 14-17 in Orlando.
• Impact Advisors and Leidos Health participate in National Health IT Week.
• Influence Health will exhibit at SHSMD Connections October 11-14 in Washington, D.C.
• PDR wins the 2015 Trailblazer Award for Innovation for EMR/EHR provider-patient engagement.
• MedCPU releases a new case study, “Reducing Inappropriate CT Imaging in the ED.”

Blog Posts

• Embracing – and Igniting – Change (Medicity)
• NHIT Week: Close to the Heart – Electronic Medication Reconciliation (Impact Advisors)
• Revolutions in Healthcare Analytic (Part 1 of 6) (Optimum Healthcare IT)
• Overcoming Your EHR Optimization Challenges (Iatric systems)
• Everyone Sells (Ingenious Med)
• The ICD-10 Deadline has Passed! (InstaMed)
• Semantic Interoperability, or My Semester Living with an Undocumented Alien (InterSystems)
• In Honor of NHIT Week, 5 Trends Advancing the Cause of Health IT (Liaison Technologies)
• ICD-9, Finally a Thing of the Past! (MedAptus)
• Why We’re Excited to Join the MedData Team (MedData)
• Questions to Ask Your SaaS Provider (NTT Data)

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 10/8/15

Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap

ONC publishes the final draft of its 10-year interoperability roadmap, which calls on vendors to expand API support, asks providers to migrate to value-based reimbursement models faster, and encourages government agencies to clarify privacy and security policies that impact data sharing.

MU 3 is out: 5 reactions from industry leaders

Executives from CHIME, HIMSS, AHA, AMA, and Athenahealth weigh in on the MU3 final rule.

Allscripts Solidifies Management Team, Enhances Organizational Structure

Allscripts CFO Rick Poulton will be the next company president, assuming the role from current CEO Paul Black who has held dual positions as president and CEO since joining the company in December 2012. The company also announces that Black’s contract, which was set to expire at the end of 2015, has been extended through December 2018.

With E.U. striking down data-sharing pact, U.S. healthcare firms face challenges

An EU court has struck down the Safe Harbor Framework, a data sharing agreement that allows US-based companies to store the sensitive information of European citizens on US-based servers, a decision that could impact US health IT vendor operating in Europe.

Readers Write: Mission Impossible: Transitioning to Value-Based Care with Health IT Solutions

Mission Impossible: Transitioning to Value-Based Care with Health IT Solutions
By Victor Lee, MD

Your mission, should you choose to accept it, is to partake in the nation’s efforts to transition our healthcare system from volume-based care and fee-for-service (FFS) reimbursement models to value-based care.

If you are in clinical practice or hospital administration, chances are that you have accepted this mission. Like Ethan Hunt, what choice did you really have?

Earlier this year, the US Department of Health & Human Services (HHS) announced specific goals for shifting Medicare reimbursements from volume to value. Under this plan, 90 percent of all traditional FFS Medicare payments would be tied to quality or value and 50 percent would be tied to alternative payment models by the end of 2018. What does all this mean?

For background information, see this fact sheet which summarizes the payment taxonomy framework that HHS has adopted to categorize its payment reform programs. Briefly, Category 1 is traditional FFS with no link of payment to quality. Category 2 is FFS with a link to quality which includes pay-for-performance programs such as Hospital Value-Based Purchasing, Readmissions Reduction Program, and Hospital-Acquired Condition Reduction Program.

Categories 3 and 4 include alternative payment models, where the difference between them is that category 3 programs are built on top of an FFS architecture (e.g., accountable care organizations, medical homes, bundled payments), while category 4 programs completely move away from FFS and exclusively involve population-based payments (e.g., eligible Pioneer accountable care organizations in years 3-5).

Now that we’ve characterized the impossible mission, let’s look at some tools you can use along your journey. There are no spy trinkets, laser beams, toxin antidotes, or heavy artillery involved. Rather, I am referring to newer, innovative solutions proven to maximize clinical and financial outcomes such as clinical decision support (CDS) and mobile care coordination.

The Office of the National Coordinator for Health Information Technology (ONC) defines CDS as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” A classic example of CDS is a pop-up alert that provides guidance to clinicians at the point of care. However, the Centers for Medicare & Medicaid Services asserts that there are many other common forms of CDS in addition to alerts, all of which may be used to satisfy the CDS objective within its EHR Incentive Programs. Which ones have you used on your mission?

Admittedly, many providers have already successfully implemented a variety of CDS interventions in their EHR systems or are somewhere along that journey, so the concept of implementing CDS for quality improvement is not new. However, many organizations struggle with keeping CDS updated over time as new information from clinical trials, guidelines, and performance measures emerges.

Fortunately, there are solutions to help with this part of the impossible mission, including third-party evidence surveillance or software applications that analyze CDS from EHR systems to identify potential deviations from evidence-based best practices.

Care coordination has also been part of a national dialogue, with the Agency for Healthcare Research and Quality (AHRQ) including care coordination as one of its six National Quality Strategy priorities. Care coordination is also explicitly required in certain regulations such as Meaningful Use (mentioned earlier) and the Medicare Shared Savings Program, with the latter specifically requiring the use of “enabling technologies” to support care coordination. So clearly the impossible mission is less likely to be completed in the absence of care coordination, but what solutions are available?

A classic example of a care coordination solution is HIPAA-compliant text messaging. However, newer care coordination solutions take this a step further and incorporate person-centered and evidence-based approaches to ensuring safe and timely transitions of care across providers and venues. Some solutions embrace mobile platforms to ensure accessibility at every point of a person’s care journey.

In summary, our nation’s path toward healthcare reform may appear to be daunting if not nearly impossible. However, the HHS prescription for payment reform and its taxonomy for measuring progress toward its goals includes programs that are dependent on lowering costs, promoting care coordination, and optimizing quality of care. Fortunately, advanced solutions are at your disposal today that transform the mission from one that is seemingly impossible to one that is probable if not inevitable.

This message will self-destruct after we have completed the transition to value-based care.

Victor Lee, MD is vice president of clinical Informatics at Zynx Health of Los Angeles, CA.

CIO Unplugged 10/7/15

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

If It Ain’t Raining, It Ain’t Training

One week prior to the Duathlon Long Course World Championship this September, I meandered out for my last long training bike ride. I met with a group of cyclists with whom I share the same coach.

As we tuned our bikes to ride, it began to rain. No worries. I lowered my tire pressure, threw on rain gear, and was ready to roll.

As a member of TeamUSA, I finished in the top 100 at last year’s World’s. My goal was to stay there and help our team’s score. I needed this last ride before the long haul to Switzerland in what is the most difficult course on the circuit, a 150 km ride through the Alps with 16 percent grades and 5,000 feet of elevation change bookended by trail runs of 10K and 30K.

We began our training ride cautiously, given the rain and slick streets. My tires were new and that made the situation that much more risky. As we passed the two-mile mark, I began to feel increasingly comfortable, but wary. I thought about turning around and training indoors, but the words of my ROTC instructor, Sergeant Major Samuelsson, echoed in my mind as it had so many times prior:  “if it ain’t rainin’, it ain’t trainin’.” So there I rode near the front of the pack, confidence building.

Samuelsson’s exhortation served me well my entire life, especially as an Army combat engineer officer. When in training mode, it was so tempting to cancel or postpone construction, bivouacs, or drills whenever the weather turned dour. But we knew that could kill us. If we were called into combat, we needed to have trained under the worst possible conditions so we would be ready for anything.

The same principle applies in the civilian work place. If you avoid adversity, you won’t be ready to perform well when you find yourself in less than ideal circumstances. How often have we lost golden opportunities because something did not go as planned and we were unrehearsed in our response?

I am comfortable working through challenges in real-time and don’t panic because I know it makes my team and organization stronger. I have led through countless application and technical go-lives where we had success because we had persevered through adversity in the buildup. It is part of growing up.

That day in the rain, we were making a hairpin turn and our peloton slowed appropriately. Before I could react, I took my first cycling crash. Down. Hard. I braced myself for impact from riders behind me. Thankfully, everyone avoided or skidded around me.

I was pretty shaken as I listened to my body for damage and inspected my bike. We were both injured, but well enough that I limped back to my bike shop. My bike repaired and my body bandaged, I gave thanks that neither bike nor body were irreparable in time for World’s.

The weather forecast for Zofigen called for rain. While the days preceding the event were warm and sunny, race day was wet and cold. The first hour was mostly uphill, so the slick streets weren’t too much of a concern. Once we crested the highest point of the course, a steep, technical, narrow, alpine descent beckoned us.

While I questioned my judgment for riding in the rain one week prior to World’s, it all became clear. I was thankful for the experience, fall included. I was better prepared to handle my bike under extremely dangerous conditions. I was confident, albeit cautious, in my approach.

The rain dissipated in time for our second and third laps of this 50K loop and slick roads were no longer a factor. There were many accidents that day on this hill. I am convinced that without training in the rain, I would have ended up a statistic on the pavement and not have fared as well as I did. I fell out of the top 100 duathlete in the world category that day, but remained proud to help TeamUSA.

Whether in sport or profession, it is critical to train under all conditions. Don’t take the easy road and cancel or modify your path because circumstances are less than ideal. Just deal with it as is. You never know when the real world is going to throw you a storm or two, but when you’ve trained for it, you will remain confident. Dealing with adversity will be second nature. Not only will your odds of success increase exponentially, but you will build confidence in the people around you.

Raining? Awesome! I wouldn’t want it any other way!

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.

Morning Headlines 10/7/15

Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017

CMS publishes an update addressing both MU3 and its proposed modification to Meaningful Use in 2015 through 2017. The updated rules set the 2015 MU reporting period at 90-days, and makes MU3 optional in 2017, but mandatory in 2018.

The Joint HIT Standards and Policy Committee meeting

John Halamka, MD and CIO of BIDMC, reports that every major EHR vendor CEO met in Salt Lake City last week, where they discussed data sharing and agreed to  “objective measures we can use to quantify interoperability.” Halamka says that details of the meeting and the agreement will follow in the coming weeks.

Transparent Ratings on Usability and Security to Transform 8 Information Technology (TRUST IT) Act of 2015

HELP committee members Senators Bill Cassidy (R-LA) and Sheldon Whitehouse (D-RI) introduce legislation that would establish an EHR 5-star rating system and also require that EHR vendors file an attestation stating that they do not engage in information blocking.

Orion Health Awarded Defense Healthcare Management System Modernization Program Subcontract

Orion Health is added to the Leidos-Cerner DoD contract. Orion’s Rhapsody integration engine will be used to connect Cerner Millennium with civilian facilities.