News 8/21/15

Top News

Investors and genome sequencing company Illumina form Helix, an app store-like service that will sequence and store a user’s DNA for free, but then offer the user pay-as-you-go apps to access it in the future. A customer might pay $20 to see if they have a specific genetic variant, then Helix will additionally sequence all of their medically relevant variants at their own cost of $500, hoping to sell the customer other information they need later without requiring a second round of sequencing. Partners such as LabCorp and Mayo Clinic will be paid a royalty-type fee, both for getting customers to submit their initial DNA sample and for each app they sell.

San Diego-based Illumina sold $1.8 billion of DNA equipment and tests last year and is hoping to penetrate the market for consumers, who so far have shown little interest in having their DNA sequenced. The FDA may weigh in with regulatory requirements. As the excellent MIT Technology Review concludes, “With Helix, says Flatley, companies won’t have to invest in starting a laboratory any more. Instead, he says, any developer with a computer will be able to start a genomics company.”

Reader Comments

From Gotham Growler: “Re: NYHHC. Glen Tullman was right in the Allscripts lawsuit.” The 2012 Allscripts lawsuit had nothing to do with the current investigation into HHC’s payments to consultants or how it has managed (or mismanaged, depending on who you believe) its Epic project. Allscripts claimed that HHC’s choice of Epic over Allscripts was unfair because HHC incorrectly calculated the total cost of ownership of Allscripts, which the company says was $500 million less than the number HHC used to choose Epic. The Allscripts analysis from its lawsuit (above) shows that HHC pegged the cost of all three options (Epic, Allscripts, or doing nothing) at around $1.4 billion, which is where the project estimate stands today. The lawsuit backfired, with Allscripts earning negative publicity from an industry generally puzzled at what the company hoped to gain by suing a prospect after losing a selection — HHC responded publicly in stating that the Allscripts TCO claims were “absurd,” that Allscripts was getting beaten soundly in the market by Epic because it “lacks a truly integrated solution,” and that the lawsuit was “an ill-fated attempt to reassure investors and inflate its sagging stock price.” Allscripts filed the lawsuit on December 13, 2012. Six days later, the company announced that it had failed to find a buyer for itself and had instead hired Paul Black as CEO and fired its executive team of CEO Glen Tullman, President Lee Shapiro, Chief Client Officer Laurie McGraw, and EVP of Culture and Talent Diane Adams. Allscripts dropped the HHC lawsuit three months later. MDRX shares are up 30 percent since Black took over, although they significantly trail the Nasdaq’s 64 percent overall rise over that time.

I went back to my October 2012 post about HHC’s original Epic decision, where I now recall that the $1.4 billion project cost was clearly spelled out to documents prepared for HHC’s board. That suggests that newspaper reports that the project is running double the expected costs of $700 million are incorrect – HHC estimated $1.4 billion from the beginning. The most interesting aspect of the lawsuit is that it disclosed that Epic’s software license fees represented $303 million of the $1.4 billion project, which is pure profit to Epic since the software carries no incremental costs. People always observe that Epic gets only a small portion of a total project cost of $500 million or $1 billion as license fees, but the lawsuit indicates that it’s around 25 percent. The Epic financial magic is high license fees, billing out freshly graduated liberal arts majors at multiples of their $50 hourly salary, and charging a significant portion of the license fees as annual maintenance with rebates for behaving in ways that Epic likes (applying updates, not bad-mouthing the company, and following Epic’s consultant hiring processes, for example.) Not too much different than any other vendor except for using newbies and putting lots of restrictive clauses in the contracts.

From Quality is Job Open: “Re: Quality Systems/NextGen. They let CTO Steve Puckett go, but are also swapping out all of their development leadership to create an Office of the CTO with an SVP of engineering, chief architect, and chief product officer.” Unverified, but the recruiter’s email I ran across seems to confirm that newly appointed CEO Rusty Frantz is retooling the whole product development group.

From Fly on the Wall: “Re: MediGain. The CEO and chairman are gone after a series of lawsuits claiming financial improprieties. As reported on HIStalk on 10/29/14, MediGain received an investment of $38 million from Prudential Capital Group. The latest lawsuit was filed by MedVision in January 2015, claiming that MediGain failed to pay the founders the monies due them.” Unverified, but the bios of Greg Hackney and Dinesh Butani have been removed from the executive page of the coding and revenue cycle vendor’s site.

From Don: “Re: Theranos shout-out. I’ve used the service for nine months in Phoenix. No DMV type experience – draw stations are at Walgreens and have weekend hours. Great for people without insurance coverage, with PT/INR at $2.70 vs. $99.50 hospital bills Medicare, who pays $4.98. Fast turnaround and results are available via web, smartphone, app, and PDF download. Tests drawn at PCP are available in four hours and are available on his eClinicalWorks system and patient portal. No lab order required in Arizona. As long as Theranos meets CLIA-88, CAP, JCAHO, and other regulatory requirements, we will use them whenever possible. My only concern is that convenience and pricing could deteriorate as the company expands to meet financial viability.”

HIStalk Announcements and Requests

This week on HIStalk Practice: Circle Health launches new practice business model in San Francisco. Telemedicine comes to a pet near you. Urgent Clinics Medical Care implements DocuTap tech at Houston facilities. Millenials may not be as averse to primary care office visits as their addictions to devices would have you believe. HHS encourages health IT-savvy practices to submit nominations for the 2015 Million Hearts Hypertension Control Challenge. Palliative care via telemedicine makes a difference in rural California. Large group practices weigh in with favored vendors based on customer satisfaction.

This week on HIStalk Connect: Doctors working at Al-Shifa Hospital in the Gaza Strip have developed a 3D-printed stethoscope that can be produced for 30 cents and performs as well as modern commercial alternatives. Nutritional supplement startup WellPath announces new integration points with both Fitbit and 23andMe in an effort to enhance its ability to personalize nutritional supplements. Finnish designers have launched a Kickstarter campaign to fund the Oura Ring, a ring that tracks activity levels, caloric burn, heart rate, respiration rate, and sleep cycles.

Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience. 

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

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

Acquisitions, Funding, Business, and Stock

Physician-patient matching service Grand Rounds raises another $55 million in financing, increasing its total to $106 million. Companies provide the service to their employees, who can seek second opinions, find insurance-covered doctors and have appointments made for them, and ask for medical help while hospitalized. The company digitizes and stores the medical records of its users within its app. The co-founders are Owen Tripp (co-founder of Reputation.com) and Rusty Hoffman, MD (chief of interventional radiology at Stanford Hospital).

Doctor appointment booking app ZocDoc is valued at $1.8 billion from its most recent funding round, earning them the already-overused and annoying “unicorn” label by people whose lips are too busy to say “billion-dollar valuation.”

Sales

NeuroPsychiatric Hospitals (IN) chooses Medhost’s clinical and financial solutions.

People

Kennedy Health (NJ) promotes Tom Balcavage from VP/CIO to SVP of technology and program services, where he will oversee ambulatory, product line, dialysis, patient experience, and imaging as well as IT.

Consumer healthcare expense management system vendor CoPatient names Tom Torre (Alegeus Technologies) as CEO.

William Tierney, MD (Regenstrief Institute) is named inaugural chair of population health for Dell Medical School at the University of Texas at Austin.

Healthcare software vendor Ability Network names board chair Mark Pulido (BenefitPoint) as CEO. He was CEO of McKesson until the company fired him along most of the executives involved in its 1999 acquisition of book-cooking HBO & Company for $14 billion, with the June 1999 hit list including Pulido, Chairman Charlie McCall, CFO Richard Hawkins, Al Bergonzi, David Held, Jay Lapine, and Mike Smeraski.

Announcements and Implementations

Allscripts will use CoverMyMeds as its prescription electronic prior authorization (ePA) solution. That’s how I read this somewhat vague announcement, anyway – Allscripts announced in December 2014 that it had developed its eAuth product for Express Scripts patients, so perhaps this agreement expands its reach.

Cerner will integrate the CoverMyMeds ePA solution with Millennium.

Cancer diagnostic vendor Guardant Health and oncology IT vendor Flatiron Health will develop a cloud-based platform to integrate liquid biopsy-based genetic testing results from Guardant’s equipment with clinical treatments and outcomes information to improve the targeting of cancer therapies.

Privacy and Security

The health minister of the Netherlands will propose that doctors be forced to turn over the medical records of patients to disability fraud investigators, although planned European Union privacy legislation may override that requirement by giving individuals more control over information about them, especially their health records. That new EU regulation will impact England’s NHS, which is making the data of non-opt-out patients available to researchers, drug chains, and private companies.

Carilion Clinic (VA) reprimands or fires 14 employees in unspecified roles for accessing patient records without legitimate need.

A former Florida TV news anchor sues his former employer, claiming he was fired for covering a story about paper medical records found in an abandoned storage unit whose contents were auctioned off. Matthew Dougherty says the station’s news director ordered him to “kill the story” when he found that the owner of the records was his own family physician, threatening him with statements that he had violated HIPAA.

Other

The Kansas City paper writes a surprisingly insightful article on the lack of EHR interoperability, opening with a brilliant question: “Why, then, does a windowless office in Truman Medical Center need to scan 2.9 million pages of paper medical records that started out as electronic ones?” That’s pretty eloquent for a site that co-features the usual eyeball-pandering cute dog video right next to it. I like its term of “digital dead ends,” which it summarizes as, “All that scanning springs from institutional rivalries over control of your medical data. Records emerging from all that scanning give your doctor the digital age version of something pieced together with duct tape — and rendered less valuable in the process.”

It isn’t just a US problem that nobody likes taking a pay cut: China passes a law prohibiting doctors from selling drugs to patients at a markup, so to offset their loss of income, the doctors doubled the rate of inpatient care. As the abstract concludes, “The reform had an unintended consequence: China’s healthcare providers have sought new, potentially inappropriate forms of revenue.”

Cleveland Clinic kicks McDonald’s out of its food court after years of trying to cancel the company’s lease, apparently convinced that the people who eat there (many of whom its own clinical employees) can’t be trusted to choose their food wisely during the very few hours each lifetime they’re inside the hallowed Clinic’s food court walls rather than everywhere else in Cleveland, which has 25 surviving McDonald’s. They should have instead used their copy of the franchise as a living laboratory to learn how to shift consumption to the healthier options that McDonald’s offers and that nobody buys, like salads, apple slices, and non-sugary drinks. McDonald’s, like Walmart and drug dealers, meets consumer demand that won’t go away no matter how much finger-waggers try unsuccessfully to legislate away the supply.

Sponsor Updates

• MedData offers “The ABCs of ICD-10: Background and New Features.”
• Navicure will exhibit at the 2015 Community Health Institute & Expo August 23-25 in Orlando.
• ESD is included on the Inc. 500. Nordic also made the list, as did The HCI Group.
• Netsmart offers “Leading the Interoperability Charge with Local Health Departments.”
• Direct Consulting Associates opens its new exhibit in the Technology Showcase at the HIMSS Innovation center in Cleveland.
• Nordic will exhibit at NeXXpo August 25 in Madison, WI.
• SyTrue CEO Kyle Silvestro is featured in “Five Things You Never Suspected About Your Healthcare Data.”
• Park Place International offers “Approaching VDI.”
• Experian Health/Passport will exhibit at the National Association of Chain Drug Stores Total Store Expo August 22-25 in Denver.
• Patientco offers “Learn How a Meditech Hospital Boosted Patient Revenue 17% by Bringing Patient Payments In House.”
• QPID Health is identified as a sample vendor in the NLP-Clinical Enterprise category of Gartner’s Hype Cycle for healthcare technologies.
• PMD offers “The Many Faces of Android Devices.”
• Anthelio Healthcare Solutions is named to the HCI 100.
• Point-of-Care Partners offers a presentation on “Advancements in Technology to Streamline and Expedite Patient Access.”
• EClinicalWorks will exhibit at the Collaborative Care Summit 2015 August 20-21 in San Diego.
• Extension Healthcare offers “Imitation is the Sincerest Form of Flattery.”
• Galen Healthcare Solutions posts “Reducing Complexity in Healthcare IT: Part 2 … Preparing to move forward.”
• Greenway Health offers “Patient Engagement: Is Fear of Commitment Keeping Your Patients From Getting Engaged?”
• Healthfinch will exhibit at the NeXXpo: Business in Fast Forward event August 25 in Madison, WI.
• Healthgrades offers “A Day in the Life of a Web Developer.”
• HealthMedx will exhibit at the Missouri Health Care Association Annual Convention August 24-25 in Branson.
• Healthwise offers “Exploring the relationship between plain language and ethics.”
• Ingenious Med will exhibit at the HFMA Mid-America Summer Institute August 26-28 in Minneapolis.
• InstaMed offers “The Top 3 Essentials of Payment Security in Healthcare.”
• InterSystems publishes “Redefining Relationships: Information Sharing Among Frenemies.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

EPtalk by Dr. Jayne 8/20/15

ICD-10 is roughly six weeks away and CMS is launching an ICD-10 Clinical Concepts Series for specialties. Each guide contains specialty-specific information that can be shared with providers, including common ICD-10 codes and their counterparts. It also includes clinical scenarios for practice and links to case studies and other resources. If you’re looking for supplemental materials for your physicians, it’s worth a look. Specialties already released include Internal Medicine, Cardiology, Pediatrics, OB/GYN, Orthopedics, and Family Practice. They seem to be all on the website, but CMS is still sending out separate emails announcing their availability.

As a side note to CMS (rant alert) can we please come into the 21st century and start calling my specialty Family Medicine? There are still plenty of EHR vendors who can’t get the name of the specialty correct, either. The American Academy of General Practice was founded in 1947 and in 1971 became known as the American Academy of Family Physicians. We’ve never referred to ourselves as Family Practice. The MD certification board was originally called the American Board of Family Practice, but changed its name to Family Medicine in 2005. The DO board was originally the American Osteopathic Board of General Practitioners and changed its name to the American Osteopathic Board of Family Physicians in 1993.

CMS continues to use taxonomy codes that have not been updated to reflect the changes in specialty certification nomenclature that occurred up to two decades ago. CMS specialty code 08 (associated with provider taxonomy code 207Q00000X) still refers to us as “Family Practice.” With the increasing number of Nurse Practitioners (across many specialties), continuing to use outdated terminology is confusing. Physicians generally want to be referred to as such – for example, Internal Medicine physicians should not be referred to as “General Practitioners.”  Physicians who care for children are Pediatricians rather than pediatric practitioners. 

Thanks for putting up with my brief history lesson. It’s good information for those of you in the implementation trenches who may wind up on the receiving end of a physician’s unhappiness at finding the name of his or her specialty butchered in the EHR. It may seem like a small issue, but physician psychology is often complex. I’ve lost physicians at the beginning of a training session because they’re fixated on the idea that if the system can’t even get their specialty right, it can’t be that great of a system. It’s hard to overcome that kind of negativity if you run into one of those providers.

CMS isn’t the only governmental body that might be inadvertently offending physicians and other clinicians. I registered today for a meeting on laboratory data interoperability sponsored by FDA, CDC, and the National Library of Medicine. Although the registration form had checkboxes for MDs and PhDs, apparently DOs need not apply. I guess they don’t realize there literally dozens of disciplines that take part in the care and feeding of laboratory systems and interfaces. If they couldn’t provide a more comprehensive list, they should have just made it a free text field and let users enter whatever credential they feel is appropriate.

I had a near-miss in the office today as a result of another unexpected downtime. Usually the labs that are performed in-office are transcribed from the little analyzer printout slips to the EHR by the staff, which does a peer review to make sure there are no transcription errors. The EHR flags the results in different colors and bold type if they are out of range. I missed a significantly abnormal lab result at the time I reviewed it, only seeing it at the end of day after it had been loaded into the EHR and I was catching up on charts. Fortunately the patient had been admitted to the hospital for other reasons and the abnormality was addressed there, but that doesn’t make the experience any less horrifying for a physician.

In thinking through the event there were several potential causes:

1. General chaos in the office due to the downtime.
2. Trying to see a number of patients quickly to catch up from our initial delays.
3. Reviewing the data in an unfamiliar format.

Having the little cash register-type tape use color or having it in a more standard format that made the result stand out would certainly have helped, but it wouldn’t have countered the impact of general chaos or the fact that I was moving fast. I’m exceedingly thankful that the patient didn’t have any negative consequences. It’s a lesson learned for my next downtime experience, which based on the odds this week could happen at any minute.

This is the first time I’ve experienced system outages on a vendor-hosted system. In my past life, we’ve always been self-hosted and have been able to provide regular updates to the users. This week the practice’s owners have struggled with the vendor and it feels like the communication is not very good. In addition to system outages, the vendor’s telephone system went out today. I don’t know if it was related to the customer downtimes, but it’s adding up to be a perfect storm.

Speaking of outages, my former employer had to take down the EHR today at several hospitals for “urgent maintenance” at 9:30 in the morning. Despite my resignation, they haven’t removed me from the distribution lists, so I get all the notifications. The announcement came at 9:15 after the system apparently became so sluggish it was unusable. That’s not a lot of notice to give people in the swing of a busy hospital morning when you have hundreds of patients receiving procedures and treatments. It’s one of the peak times on the operating room schedules, so I can only imagine the magnified chaos going on there compared to my own downtime experience.

Do you agree that downtime is the gift that keeps on giving? Email me.

Email Dr. Jayne.

Morning Headlines 8/20/15

National patient identifier struggles for life

CIO.com covers the renewed public interest in establishing a national patient identifier, detailing several non-government efforts to establish an NPI infrastructure, including CHIME’s partnership with HeroX to back its National Patient ID Challenge with a $1 million prize.

$342B wasted each year due to government healthcare benefits data integration challenges

MeriTalk publishes a study estimating that $342 billion is lost each year due to poor integration between the benefits eligibility systems used by different HHS agencies.

Million Hearts Hypertension Control Challenge 2015

The CDC and HHS launch a competition among providers focused on improving hypertension control by recognizing organizations that demonstrate exceptional hypertension control rates achieved through the use of health IT, integrated team-based care delivery, and effective community outreach programs.

HIStalk Interviews Seth Blackley, President, Evolent Health

Seth Blackley is president and co-founder of Evolent Health of Arlington, VA.

Tell me about yourself and the company.

Evolent partners with health systems and providers to support their acceleration of value-based care, which we define as providers receiving some form of prepaid healthcare or other incentives that manage the total cost of care. Our customers are generally providers, like Indiana University Health; WakeMed in Raleigh, NC; Premier in Dayton, OH; and other organizations like that. Typically they’re pursuing prepaid healthcare because they think it’s the best way to meet their mission for their patients, but they also feel like it’s the best way to steward their finances.

We generally are either supporting them with a value or risk contract with a payer, CMS, or their own health plan. Evolent is providing our customers with both technology and services in an integrated way that helps them ensure they’re hitting their cost and quality targets.

Frank Williams, Tom Peterson, and I founded the company back in 2011 along with the Advisory Board and UPMC, which is the biggest provider-owned health plan in the country after Kaiser. We looked all around the country and saw lots of software companies, consulting companies, and health plans, but nobody providing an integrated solution to help providers accelerate in this direction. We’re about 1,000 people today, working in 25 organizations. We’re an independent company listed on the New York Stock Exchange.

Surveys suggest that even those providers who participate in an ACO aren’t sure if ACOs improve quality or cost. Will the model will work?

What is definitely proven is that integrated medicine does work. If you look at things that UPMC has done over the years, or that Kaiser has done, or many other systems where you have aligned incentives, it absolutely drives healthcare value — cost down and quality up. The issue that’s an open question is what ACO models will drive the right incentives to make those sorts of outcomes work.

There’s a spectrum of ACOs. There are ACOs that have more full upside and downside incentives for providers, where they make the full investments that they need to provide integrated medicine. There are ACOs in name only. They’ve got the C and the O right, but they don’t have the A — the accountable part. Lots of those want to migrate towards a type of ACO that really does drive value.

I think it proven that integrated care works and you can drive incredible value. That’s why the markets are pushing that way. Some people are on Phase One of that and haven’t yet migrated to an ACO model that is sustainable over time.

We’ve created a health system based on the premise that provider competition is good, but many of the hot issues such as interoperability and integrated care try to force those competitors to work together. Will the competitive pressure go away and allow those things to happen?

The direction that CMS and the buyers of healthcare are pushing for is to have healthy competition that will create alternatives for consumers and buyers to purchase networks and products that are higher value. That kind of competition is healthy. What it will cause at is providers and payers to look at each other differently and find out the right way to configure those networks.

The organizations that may have been competitive in the past may become partners and vice versa, but we have to continue letting that evolve such that we do have healthy competition of selection choices of different provider networks and different tiered networks. The buyers of healthcare will have options and the volume in healthcare flows to those payers and providers who are creating value. We’ll have more collaboration areas than we’ve had it in the past, but we still want the competition over time that’s set up around the right issue, which is the total cost and quality of healthcare.

You mentioned UPMC, which is a key player in the western Pennsylvania market where health systems bought insurance companies and vice versa trying to control the market. That may have been a preview of what we can expect as health systems and insurers try to maintain their business. Is it constructive for the big to get bigger?

Without speaking to Pittsburgh specifically, what will be constructive is if the buyers of healthcare — and CMS is really leading the way here with this 50 percent target by 2018 under true value-based care, but then also their value-based purchasing bundles, the doc fix — all lining up the structure where you really on the provider side will only get paid well if you’re creating value over time. If the market continues to move that way, whether you’re big or small, you’re going to have to create value in order to have a viable financial structure as a health system. That’s the biggest force that we see happen.

I do think that FTC and the DOJ and whatever markets will continue doing their work, both on the payer side and the provider side, which they need to do, but generally, the structure of value-based reimbursement is probably the most healthy thing we have to kind of make sure we end up with a cost and quality outcome that’s attractive to people who are buying healthcare.

What will hospitals look like in five to 10 years?

Our view, from an Evolent standpoint, is that there’s going to be some winners and some losers over the coming years in the health system space. We feel that progressive health systems will increasingly become entities that provide a very broad set of services and that ultimately take accountability for the total premium dollar all the way back to the buyer of healthcare. That includes acute inpatient, outpatient, and probably more primary care and more care management and population health services than they’ve had in the past.

We see a lot of those systems investing more heavily in those types of services that help manage the total cost of care then they do in new bricks and mortar. As an example, the things that are part of the premium, like pharmaceutical costs that we see health systems investing more around, “How do I manage the total cost of pharmaceuticals?" which traditionally hasn’t been part of their purview.

We think those many systems that are going to be the winners will continue to invest in that broad spectrum in ability to take all that, coordinate it, and offer something back to a buyer of healthcare that is attractive. We think that there will be a swath of systems that move that way. There are some systems that, if they don’t move as fast, may be boxed in a little bit more in terms of the spectrum of services they offer. Those will have a harder time financially than those that attempt to move upstream and take on a Triple Aim approach to healthcare.

Health systems haven’t had much interest in managing consumer health and haven’t done a good job holding down costs, and yet now they’re being appointed as the best hope for doing both. Will it be a challenge for health systems to move quickly away from transactions and filled beds to managing health and costs?

We do think it’s a big shift. It requires a lot of new competency and new capability. It’s the reason we created Evolent as an acceleration partner for those health systems as they build up their own talent and their own infrastructure around this. We think they can benefit from a partner like Evolent to provide the expertise in these areas where they’ve had less of it in the past. Things like our Identifi technology platform that is purpose built to help optimize their EMR investment in order to do this work and take an EMR investment which historically was more focused on the areas you asked about and make sure it’s optimized to do things that are going to be critical in this new world.

There are all kinds of issues. One example is risk adjustment, which is a really important issue for the exchanges or for Medicare Advantage that traditional health systems haven’t had as much exposure to. Or managing pharmaceutical costs. Just generally coordinating care and prioritizing outreach to a patient who may not be in their hospital or in their physician practice on any given day. Our Identifi platform is one example of what we bring to the table to help them make that pivot.

Your description is very accurate. It’s a big leap to go from here to there. That’s where we’re focused in supporting them.

The EMR is becoming less he center of the universe and is getting walled off by other technologies that are just as essential, just in different ways. Is there a market outside the core EMR business and are people paying enough attention to using them optimally rather than just buying them?

We’ve seen most of our health system partners betting deeply on the EMR as a critical part of their future. We’re spending a lot of time helping them make sure they’re getting the most out of that platform and leverage and identify to do that in concert with the EMR.

That said, most of our partners have networks that may be very broad. We have one partner that working with that has about 40 different EMRs that are relevant across their network. Being able to integrate and optimize population help across all those is critical. Having all the clinical content and knowledge about how to do population health is another thing that we’re bringing to the table through Identifi. We see other companies doing similar work.

In answer to your question, people are betting on the EMR but also realizing that they need to supplement it to be proficient at population health. We are trying to help them in both of those ways.

What are the most important characteristics of a provider that is well positioned to succeed under value-based care?

The things that we see that are critical are that the health system leadership has a vision that, over time, having a value-based structure is the best answer from a mission standpoint for their patients and is the best way to steward their financials. Those that get that and believe that or feel like the world’s headed that way is probably the most important thing.

After all, you can develop additional assets. You can develop your brand. You can develop more physician relationships if you start with that and you’re committed to do it. That’s probably the first and most important thing.

Obviously having a physician network, particularly primary care physicians, is, also a critical asset, so we look a lot at that. Many of the things that go beyond the leadership and the physician base can be developed over time.

One thing that we see a lot is that health systems, at times, need support in helping understand the full array of capabilities and competencies that they need to be successful. We do a lot of that in the Blueprint process. It’s not just about technology. It’s not just a consulting project. There’s a broad set of services and technologies that they need to make the pivot, as you articulated. It’s a new frontier for many of them. We try to bring that depth and understanding during the Blueprint as well.

Where do you want the company and the health system to be in five to 10 years?

Like many of the systems we’re working with today, I hope that there are systems in every market across the country that have a vision and a plan to execute on an approach to take the value-based model and make it a core part of their business. Not a pilot or initiative, but a core part of the business. That’s certainly where CMS and the payers are pushing.

We hope they have that in place. We hope that they’re the ones that do it and are the market leaders, able to gain market share and have a stronger financial position than they have today based on that strategy. You can see that happening today and a number of our partners are getting great outcomes out of the gate. We’re hopeful that that spreads and scales nationally and that they’re successful as part of it. As a result, the patients they’re taking care of are getting better care at a lower cost. That’s where our mission lies and where the missions of our customers lie as well.

Do you have any final thoughts?

We increasingly see that the future direction for payers and providers is pretty clear. CMS and the other payers are speaking clearly about where they want the market to head. We feel like that creates a huge opportunity or risk for the provider. If you can move and be a market leader, it’s a huge opportunity, and if not, it’s a risk.

Our experience with IU Health, WakeMed, Premier, and MedStar is showing, already over the last few years, that they can both do better financially and do better for their patients if they’ve got the right support. Evolent is uniquely set up, based on our heritage, to help them do that.

Morning Headlines 8/19/15

4th official leaves amid hospital system’s improper billing probe

NYC Health & Hospitals Corporation CTO Paul Contino becomes the fourth high-ranking IT official to leave since HHC started its now over budget and behind schedule Epic rollout.

U.S. Army Awards Leidos Medical Research Contract

Leidos wins a $900 million contract to support R&D efforts within the US Army’s Medical Research and Material Command.

American software developer to supply patient data system

In Finland, Epic has been selected as the replacement EHR vendor for the Hospital District of Helsinki and Uusimaa, in a $424 million contract that is budgeted to grow to $635 million in total project costs over 10-years.

How to Know Whether to Believe a Health Study

The New York Times dissects medical research studies, explaining in plain terms how to evaluate often confusing research methodologies and what characteristics to look for in a trustworthy study. The study also weighs the pros and cons of RCTs versus retrospective data analytics studies based on national datasets.  

News 8/19/15

Top News

CTO Paul Contino leaves NYC Health & Hospitals Corporation, the fourth high-ranking IT HHC official to depart following an investigation of its $764 million Epic implementation. HHC previously fired CIO Bert Robles, two other employees, and seven consultants. Several of the project’s top positions being filled in interim by Clinovations (acquired by The Advisory Board Company in February 2015), which was given a $4 million, 15-month contract to manage the project. HHC is investigating reports of consultant overbilling on the project that is 18 months behind schedule. Internal documents suggest an actual project cost of $1.4 billion, nearly double the announced cost. HHC chose Epic in January 2013 at an announced contract price of $302 million. It hopes to bring it live system-wide by 2018.

Reader Comments

From Former PF Employee: “Re: Practice Fusion’s interim CEO. Ryan Howard was never going to make it as CEO through an IPO. He had too many issues and wasn’t able to temper them enough. An IPO may happen but isn’t as imminent as the PR team says — that was a tactic to distract people from the need to change CEOs. It wasn’t supposed to be this sudden, but that’s how Ryan is and part of why this is a good decision overall. Side note: why does everyone think PF only generates revenue from ads and selling data? Ads are maybe 30 percent and data actually isn’t sold (while ‘insights’ from the data are sold, that’s less than five percent too).” Unverified.

From Duluth Dilettante: “Re: Practice Fusion’s interim CEO. I agree, you don’t put in an interim CEO to prepare for an IPO. A lot of venture money was poured into both Practice Fusion and CareCloud, both of which changed CEOs. The ‘broken’ healthcare space offers opportunities but is complicated, especially when competing with incumbent vendors like Epic and Cerner. Once you take VC money, the game changes to achieving lofty financial goals or getting kicked out by impatient investors.” I can’t imagine the learning that’s required of a startup CEO who faces a tough investor grade card at each revenue milestone. Think about Neal Patterson guiding Cerner from a picnic table conversation to a huge corporation and what he had to learn along the way. CEOs who are afraid of losing their job let boards convince them to maximize short-term profits even at the expense of long-term potential, so risky innovation isn’t encouraged, like Cerner spending a fortune developing Millennium in the late 1990s. One might postulate that every publicly traded company would have been better, but not necessarily bigger, if it had stayed private and stuck with a non-quarterly mindset like Epic, InterSystems, Meditech, and quite a few other health IT companies that are still run by their very successful founders after decades.

From Hospital Money Man: “Re: CMS. Cutting it awfully close for the 2015 MU modification / alignment rule. Reporting periods need to start no later than October 2 assuming the provision sticks. There’s no time for vendors to respond and QA is the first to get cut. Some vendors will hedge in assuming NPRM will pass as written, but there’s obvious risk. Just in case anyone wonders why we’re in the position we’re in with consensus that EHR functionality is in shambles and calls for program postponement.”

HIStalk Announcements and Requests

My latest gripe: referring to provider payments as noble-sounding “reimbursement,” an especially embarrassing euphemism when the reimbursee books an annual “surplus” of hundreds of millions of dollars. Also, publications that say Congress prohibits use of a National Patient Identifier, which isn’t exactly true – it only prohibits HHS spending government money to implement it.

Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience. 

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

Acquisitions, Funding, Business, and Stock

Wolters Kluwer will acquire physician CME provider Learners’ Digest International for $150 million in cash.

Denver-based predictive analytics vendor NextHealth Technologies raises $1 million in funding from investors that include Nuance Healthcare President Trace Devanny.

Medical coding services vendor Aviacode receives a $16 million investment to further develop its marketing and technology. David Jensen founded the company in 2000.

Rehab therapy software vendor WebPT acquires Therabill, which offers a Web-based practice management system for therapists.

Bold, insightful investment firms set a consensus target share price of $7.05 for Merge Healthcare, no doubt acting independently of the news that IBM will acquire the company for $7.13 per share.

Sales

Hospital District of Helsinki and Uusimaa in Finland chooses Epic’s $424 million bid to replace its patient care system. Epic outscored CGI based on price, functionality, usability, and interoperability. HUS has 21,000 employees and nearly 3,000 beds.

People

St. Jude Children’s Research Hospital (TN) names Keith Perry (University of Texas MD Anderson Cancer Center) as CIO.

Froedtert & the Medical College of Wisconsin hires William Showalter (Wellmont Health System) as SVP/CIO.

Steve Puckett, EVP/CTO of Quality Systems (NextGen), resigns “by mutual agreement with the company.” His duties will transition to COO Daniel Morefield.

Meg Aranow (The Advisory Board Company) joins SRG Technology as SVP of technology.

CareTech Solutions President and CEO Jim Giordano is appointed vice chairman of Ascension Michigan’s board.

RightCare Solutions names Jeff Edgin (Siemens Medical Solutions) as SVP of business development.

Announcements and Implementations

Peer60 publishes “IT Infrastructure Trends in Medical Imaging 2015.” It’s interesting that hospitals are nearly equally split between wanting to buy PACS or VNA hardware on their own vs. choosing a turnkey solution. Preferred hardware vendors were Dell and HP.

Clinical Architecture announces Content Cloud, a cloud-based terminology update service.

Novant Health (NC), which has the highest Epic MyChart engagement in the US with 50 percent of its users logging into the portal at least monthly, will integrate user wearable data into MyChart using Apple HealthKit.

Capital BlueCross (PA) announces that enrollees can start using its American Well-powered physician video visits on January 1, 2016.

Government and Politics

Leidos wins another big military medical contract, earning a 10-year, $900 million bid to support US Army medical research.

FDA, CDC, and NLM will convene a free public workshop on promoting semantic interoperability between diagnostic devices and EHRs/LISs on September 28, 2015 at the FDA’s Silver Spring, MD campus.

Privacy and Security

The State of Colorado apologizes for sending 1,600 PHI-containing letters intended for Medicaid recipients to the mailing addresses of other people due to a vendor’s programming error.

Innovation and Research

MIT researchers develop a cognitive assessment in which smart pens analyze the way a person draws a clock, automating a manually interpreted test and potentially allowing earlier detection of dementia.

Technology

An article about the Internet of Things says consumer and other light uses (some of them absurd, like refrigerator and trash can sensors) can’t be profitable since they communicate via expensive cellular networks.

Other

In England, local media get worked up after their Freedom of Information requests reveal that a hospital paid a cardiologist $17,000 to cover three, eight-hour holiday shifts, or compensation of $708 per hour.

UK investors complain that digital health innovation is stifled there by NHS, whose bureaucracy controls nearly all health-related spending even as NHS says its future success depends on innovative technology. A frustrated English startup CEO who moved his company to the US despite being named a NHS Innovation Accelerator Fellow says, “The NHS is optimized for people with large sales organizations and/or specific knowledge about how the system works. Although US healthcare has its problems and there are some messed-up incentives, at least there are incentives.” You can imagine a similar situation here if the federal government ran healthcare even more than it already does.

A study of 96 medical specialists in Massachusetts finds that most are unaware of the state’s 2012 medical transparency law that requires them to provide consumers with self-pay prices within two business days. Dentists were the most accommodating, presumably because they have many patients without insurance. One ophthalmology practice quoted $140 for an eyeglass exam, but raised the price to $327 when told the patient would be paying cash. Price estimates for a colonoscopy that includes facility and anesthesiology charges ranged from $1,300 to $10,000. Some practices told the surveyor that they weren’t allowed to give prices by phone, while others were “downright rude.” The president of the state medical society blames “the complexity of the payment system.”

The Kansas City paper digs back into Cerner history in comparing Amazon’s “brutal” workplace to Neal Patterson’s infamous 2001 threatening employee email that sent CERN shares down 20 percent after it went public. I’ve changed my opinion about the email over the years as several then-Cerner employees have said Neal was right – employees were taking advantage of the company’s management sloppiness and he had to skip those layers to get his point across directly and unequivocally. It must have worked since shares have increase somewhere around eightfold since then vs. the Nasdaq’s doubling. Still, it’s fun to run his spitting nails email every couple of years.

The New York Times publishes a great article called “How to Know Whether to Believe a Health Study.” It says the problem with randomized trials is that they focus on narrow populations of people who are most likely to benefit from the particular treatment, often also excluding older patients and children. However, it fails to mention what I see as the biggest problem – studies are often sponsored by companies that suppress publication of the negative or even inconclusive ones. The author likes observational studies in which large, existing databases are mined for new insights as long as they cover broad populations and not just people who chose to receive a particular treatment.

Lenny Robinson, who sold his cleaning business and made a full-time job of visiting hospitalized children in Maryland costumed as Batman, was killed Sunday when his stalled Batmobile was struck by another car on Interstate 70. He was 51.

Sponsor Updates

• Aprima announces attendance of 800 at its user conference earlier this month.
• Caradigm and iHT2 publish “12 Things You Need to Know About Value-Based Reimbursement.”
• MEA|NEA is named to the Inc. 5000.
• AdvancedMD offers a look at its new ICD-10 website.
• AirWatch becomes a founding sponsor of the new Center for the Development and Application of Internet-of-Things Technologies at Georgia Tech.
• Strata Decision Technology participates along with Costs of Care in a national story contest called “The Best Care, The Lowest Cost: One Idea at a Time.”
• Aventura offers “A Nurse’s Perspective: Shifting the Focus from the Computer to the Patient.”
• Awarepoint posts “Protect Patients, Cut Costs & Increase Compliance with Real-time Temp Monitoring.”
• Besler Consulting offers “Medical Necessity and Ambulance Services.”
• Cumberland Consulting Group and Divurgent are named to the Inc. 500 I 5000 list.
• Recondo Technology will exhibit at the HFMA Region 8 Mid-America Summer Institute August 26 in Minneapolis.
• Practice Unite offers “Achieving High Adoption of Patient Engagement Apps.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 8/18/15

Meaningful use of EHRs by doctors fell in 2014

The number of EPs who successfully attested in 2014 fell 13 percent compared to 2013 rates, with some specialties, like family medicine and internal medicine, seeing decreases as high as 40 percent. Steven Waldren, MD and director of the AAFP’s Alliance for eHealth Innovation, points to the cost of upgrading to a 2014 Edition EHR and Stage 2’s patient engagement requirements as the primary culprits for the drop off.

Why it’s time for the government to be part of the public conversation about health and health care

Susannah Fox outlines the philosophies she will rely on in her new role as HHS CTO.

How the NHS Is Locking Out Britain’s Digital-Health Startups

Bloomberg analyzes the negative impact England’s single-payer market is having on local digital health startups, citing the complex NHS procurement process as a key barrier to entry. UK-based entrepreneurs report that there are more opportunities to grow their companies if they move to the US.

Curbside Consult with Dr. Jayne 8/17/15

Dr. Jayne Does Downtime

Although I have a steady urgent care gig, I occasionally cover locum tenens assignments. It’s a great way to be able to use multiple EHR systems so I can see what vendors are doing for Meaningful Use and overall EHR usability.

I knew I was in trouble this week when I arrived at my assignment to find the EHR down. It’s a small practice with multiple locations and they have contracted IT support, which the staff had already called. With little chance of the system being up before patients arrived, we decided to activate the downtime procedures.

I was initially impressed. The staff knew where to find the downtime documents on the shared drive and started printing them out. They began to put packets together for each scheduled patient and started digging out a pile of clipboards. The front desk team pulled out an old-school credit card imprint machine and readied a cash log. Staff started rooming patients.

As I saw my first patient, I realized they had no way of accessing a patient summary. There was no local downtime solution. I couldn’t even get a medication list or problem list on the patients. Staff was asking them to summarize their histories, which was going to take a long time based on the number of geriatric patients on the schedule.

As I flipped through the downtime packet, I realized there wasn’t a SOAP template for the physicians to write their notes. There was a page that said “Findings” and “Plan,” but that was it. It had huge ruled lines on it that weren’t very practical for writing a patient care note. I divided it into virtual quadrants and started figuring out my own note format, while sending out a text to a physician working at one of the other locations asking for advice. All the locations were down so I figured he’d be in the same boat and may have a better idea.

I realized that the “Findings” sheet didn’t have a patient name or date of birth on it. The staff had written that vital information on the top sheet of the packet only – the sheet which was the directions for how to use the downtime packet, and had nothing to do with the care of the patient. I scribbled on the patient’s two identifiers to at least preserve the integrity of my notes and hurried to the next patient.

She wasn’t quite ready to be seen, so I waited for the medical assistant to come out of the room and asked for a quick summary. The medical assistant was beyond agitated. Apparently the idea of working without a chart and not knowing anything about her patient was making her anxious. I looked at the size of the medication list she had jotted down and empathized, knowing that they’d have to backload a significant amount of data once the system came back up. She didn’t respond well to my reassurance and looked like a deer in the headlights. I told her to take a minute and gather herself and let her know we’d make it through the day.

Minutes turned into hours, and before I knew it, we had been down half the day. A new kind of anxiety emerged as the staff realized they would have to have the data loaded into the system before they left for the night. I asked if they really needed to load all the data or if there was an identified subset of information to load. Unfortunately they had been told that they had to load everything that had been documented on paper. Several were worried about being able to get out of the office on time to pick up children and keep other family and personal commitments.

In my past life as a CMIO, we had a subset of “Core Clinical Data” that had to be loaded after a system outage. It was the vital information that would be useful in ongoing encounters, such as medications, allergies, diagnoses, problem list, immunizations, lab orders, charges, and plan details. The physicians could also identify other key data or particular exam findings to be loaded on top of the core data, but the expectation was not that every single scrap of data would be loaded. Practices had 24 hours to get the data loaded rather than trying to get it done by the end of the workday. We had experienced more than our share of downtimes and it worked well for us without a lot of extra overtime or anxiety.

The system came up shortly after lunch. We were excited and ready to catch up, only for the system to go down again after about 30 minutes. We continued plugging away, but it was frustrating because we weren’t getting any updates from the IT support team or from the vendor. I asked the staff what the expectations were and no one seemed to know. I suggested someone pick up the phone and ask what the schedule was for expected updates so that they would feel less in the dark. It hadn’t really occurred to them to do that.

As we got closer to closing time, I asked about any plans to cancel patients for the following day. It turns out we didn’t have the option since they only print patient schedules one day in advance. We had no idea who would be on the following day’s schedule or how to reach them.

The system came up for good during the last scheduled patient appointment of the day. We got the office administrator to agree to letting the backload process extend into the following day. The staff relaxed considerably and we were able to get about 30 percent of the charts loaded before they had to start heading home for the night.

There is a fine line between a smooth and polished downtime and complete chaos, but the steps to keep it closer to the former are pretty straightforward. My advice of “must have” elements:

• Practices need a solution to obtain at least a brief history on existing patients without asking the patient to provide it. This can take the form of a daily download of patient summaries to a local server and at a minimum should include the patients scheduled for the next work day. Ideally one would want a download on all active patients in the practice.
• Practices need to actually practice for downtime. Especially if you’re in a situation with a stable system and it never happens, staff needs to be aware of the policies and procedures and be ready to deploy them when needed. Surprise downtime drills every month aren’t a bad idea and it doesn’t have to be a “live” drill – it could be a tabletop exercise at a staff meeting where everyone talks through what they need to do in the event of a system outage.
• Identify the core data that needs to be loaded once the system is up. Don’t sweat the small stuff if it’s already documented on paper and scanned. Be sure to reference it, however, so that users looking at the chart in the future will be aware of the presence of additional details should they be needed. Any paper forms that are to be used should be clear and concise, with review and approval from the teams that have to use them.
• Make sure you understand the service level agreements with your IT support staff and with your vendor. Don’t expect hourly updates if they’re not obligated to provide them or you haven’t asked for them. If you feel like you’re not getting the information you need, speak up.
• If you don’t have a local copy of the system that shows at least several days’ worth of appointments, print at least several days’ worth of schedules in advance or save them to a local drive. It’s a few extra steps, but well worth it to not be surprised when people show up at your reception desk.

By the time I was cleared to leave I was exhausted, so I can only imagine how everyone else felt. I headed back to my hotel and picked up some take-out on the way so I could get into bed early. Even if the EHR is completely cooperative, it’s going to be a long day.

How do you handle a system outage? Email me.

Email Dr. Jayne.

HIStalk Interviews Todd Johnson, CEO, HealthLoop

Todd Johnson is CEO of HealthLoop of Mountain View, CA.

Tell me about yourself and the company.

I’ve been in healthcare IT for 18 years. I joined HealthLoop about two and a half years ago. HealthLoop is a patient engagement platform designed to guide patients in a really high-touch way through an episode of care.

The company is built on the premise that no news isn’t really good news when it comes to patients who are recuperating, managing a chronic condition, or not scheduled for an office visit soon. What are providers learning as they use technology like HealthLoop’s to keep in touch with those patients between encounters?

There’s an incredible amount of information to be learned from patients. In general, patients are the most underutilized resource in healthcare. A patient is discharged from an emergency room or a hospital or from a physician’s care. We give them instructions and expect that they’ll do really well, but we have no idea.

With today’s patient engagement platforms, you can understand how a patient is progressing the first day, the second day, the third day. You can understand where they’re having challenges or where they’re adhering to the care plan. Care plan adherence is a really interesting opportunity to understand our patients participating in a way that’s going to lend to the best outcomes at the lowest cost.

Does ongoing communication make patients feel empowered or more closely engaged with the provider?

Absolutely. What we’ve seen is that patients genuinely appreciate this level of service.

The healthcare system in general provides a pretty poor product. We’ve optimized around transactions. We’re always solving for throughput and decreased length of stay. The result of that is we’ve been discharging patients and they don’t get a lot of information.

This sense that patients have their doctor with them, monitoring them every day, is incredibly powerful. In fact, we see it every day. The first email I open every morning lists all the positive and negative sentiments we get from patients about this experience. It’s a wonderful thing to see how thrilled patients are with this level of service.

Patients get high-touch, high-feedback engagement, but there’s no overhead for the provider unless they need to take action since it’s an exception-based system, correct?

Exactly. It’s really a win-win. We’re doing a study right now with a large academic medical center in oncology. There’s a lot of noise coming into practices from patients that either don’t understand their instructions or are unsure. If you’re delivering the right information at the right time, indicating what the patient needs to be doing today, you not only drive comprehension through the roof, but the early results — and this will be published hopefully later in the year – are that patients have a 45 percent increase in just understanding their instructions and their care plan. But what’s better is that reduces unnecessary phone calls back into the practice, the questions, “Can I do this, can I do that” sort of thing.

It’s shifting to what we call exception-based medicine. Focus on the patients that need your attention.

Traditionally, we have a schedule with patients. We’re all in love with what’s happening in orthopedics right now based on what CMS has signaled. Traditionally, the patient gets discharged and then you might have a structured follow-up at two weeks or four weeks and then eight weeks. But really, it’s about monitoring the wound and monitoring adverse signs and symptoms.

If patients are doing fine, there’s no need to bring them in if they’re progressing normally and healthy and everything’s well. But if a patient’s got severe calf pain or early signs and symptoms of an infection, you’ll want to get that patient in earlier at Day Seven or Day Eight so you can mitigate the expensive emergency room visit or hospital readmission.

Beyond the desire to do the right thing, what is it that motivates health systems and practices to want to provide that experience where they are keeping in touch with patients in a manner that’s not entirely episodic?

I wish that wanting to do the right thing drove more decisions on P&Ls, but the economics of healthcare is such that you really have to focus on dollars and cents. If you look at the trends in episodic bundling, there is a huge movement that is going to put an increasing pressure on health systems that aren’t carefully monitoring their patients and engaging their patients to provide the best care at the lowest price. Patient engagement is the tool that needs to be used to do that.

We’re learning a tremendous amount of data on patients. What is rising as a crystal clear indicator is that patients who are highly engaged do absolutely have better outcomes at lower costs and they’re thrilled.

Who are your competitors and what are they doing to try to solve the same problem?

I put competition into a couple of categories. The worst is the status quo. “We’ve been doing it this way forever. We don’t need to invest in new capabilities and new technologies.” In medicine, the status quo is tricky. But if you look at the large health system that’s paid $300 million or $500 million for their Epic system, it takes a lot for that CIO to make the decision that it’s now time to bolt onto that and incorporate patient engagement technologies that are then additive and go beyond what you were hoping to get out of a single vendor.

That’s the stiffest competition. But we’re seeing a constellation, all sorts of really clever and seemingly great patient engagement applications out there. There’s not enough of it to feel like a direct threat, but I do think that this is probably going to be the next blockbuster product category for health systems.

Does the provider need to log on to your system to see those patient messages or is it integrated with EHRs?

For the Epic platform, we’ve got seamless integration. On the patient side, the notification to check in today is delivered through MyChart and the patient can complete that there. O the professional side, if a patient escalates with a DVT risk or an infection risk, that that further escalates within the Epic inbasket and then the entire HealthLoop experience is both documented and accessible through Epic. We’ve been very deliberate about integration with that particular system.

Then of course HealthLoop also operates on a standalone mode. We’ve got 40 or 50 independent practices that are using that in a standalone way seamlessly. We’ve taken a Silicon Valley approach that you can get up and running literally in days. We had a health system go live with a program in seven days from contract signature. It doesn’t need to take forever to get this stuff up and running.

How does the Silicon Valley atmosphere impact the way that HealthLoop does business?

One of the most special things about Silicon Valley is the design thinking. The designers here think about, how do you make technology habit-forming and invaluable to individuals? It’s something that is blatantly missing from so much of the health IT out there.

I was at a board meeting with a bunch of clinical chiefs from all these different departments at this large health system. For 20 minutes, they sat around looking at the screen trying to figure out how to visualize their EMR in a widescreen format and how they should move things around, which is just remarkable to me.

Silicon Valley is focused on, how do you make technology delightfully simple to implement? Up and running, no manual, and fast so you can see value quickly. You actually feel the value.

A couple of things that we’ve done in HealthLoop have demonstrated that once you get this in physicians’ hands, they’re really, truly delighted by it. They’re learning more about their patients than they’ve ever known. They feel good because they’re getting constant reinforcement, validation from their patients that this is the right thing. I don’t think that many physicians or other healthcare providers really feel good about the technology they’re using in a day-to-day basis.

Will consumer expectations push large vendors to think like Silicon Valley?

Folks in general want to tap into what’s happening here in Silicon Valley and understand what’s going on. But increasingly as health systems mature in their implementations of their electronic medical records, they understand what they need to do to add on to it and to be additive. With the large EMR providers, we’re seeing some signaling on this. I’m not sure how committed they truly are. But singly to open up their platforms and allow for innovation to occur, which would I think further concrete their long-term position on the market if they can be open to that type of innovation.

Have you measured the outcomes health systems saw after implementing HealthLoop?

We have. We’ve seen a tremendous drop in readmissions for total joint replacements, a 33.7 percent drop, which is material. On the patient satisfaction side, we’ve seen a 9.6 percent improvement in HCAHPS. HCAHPS is a complete survey with a whole bunch of assessments.One is how thrilled is the patient with their doctor, and a 19-point improvement there.

One of the surprising things or perhaps biases that people have when they first get introduced to HealthLoop is this misperception that older patients won’t use technology. We’ve found that to be just the opposite. The 60- to 70-year-olds are most likely to be 100 percent engaged. Even 63 percent of 81 and older activate their accounts and routinely engage. Patients want this, patients are ready for this, and when they engage, good things happen.

Technology usage is often stratified by income, educational level, and geography so that a company’s great ideas don’t reach the most expensive patients. Have you determined whether that target audience is easy to reach?

We’re seeing that activation and engagement rates hold with chronic disease patients, but not for long periods of time. We’re focused on acute episodic flare-ups where we can have an impact in providing a great degree of education during those flare-ups.

Across socioeconomic barriers, we haven’t seen an impact. What does change is modality. You might be using a mobile phone as opposed to a traditional desktop computer. Consistently we see young men are the worst engagers. The 18- to 25-year-old males are the ones least likely to be 100 percentage engaged in HealthLoop. They’re the invincibles.

Funding comes with an expectation for growth. How will you scale the business up?

The good news is that the payers and principally Medicare are creating all the right incentives for accelerated growth. For instance, with the comprehensive care for joint replacement payment program put forth by Medicare last month, not only is it the incentive to do better than your peers and continue to improve outcomes and decrease costs, but bonuses for collecting patient-reported outcomes, which is almost a side effect of using HealthLoop. We capture all those structured PROs as well. I think we’re going to see rapid growth that follows payment programs that incentivize that. I think it’s going to be a lot of fun. We’ve got a lot of good work in front of us.

Do you have any final thoughts?

It’s just an incredibly exciting time. Patient engagement is absolutely going to transform healthcare in a really great way for the ultimate consumer of healthcare, for patients. It’s fun to see that come to life every day. We enjoy our job and we enjoy working with our customers. It’s fun.

Morning Headlines 8/17/15

Practice Fusion Taps Interim CEO Ahead of Expected IPO

Practice Fusion replaces its founder and CEO Ryan Howard ahead of an expected IPO announcement. New CEO by Tom Langan has only been with the company for a year, and was promoted from his position as chief commercial officer.

Boots, Tesco and Superdrug to get access to NHS medical records

In England, the NHS will begin sending patient summary records to retail pharmacies following a successful 140-pharmacy pilot project that ended this spring.

Top 10 Parkland upgrades: Wi-Fi, new chapel, no fast food

Parkland Hospital (TX) opens its newly constructed hospital, equipped with an interactive patient education system, palm-vein scanners used for patient identification, and a connected ICU that streams 18 points of data from the patient’s monitors to the EHR.

Meet the doctor bringing cheap, 3D printed medical devices to Gaza

Doctors working in the war-torn Gaza strip publish designs to create a 3D-printed stethoscope that costs 30 cents to produce and performs as well as modern commercial alternatives.

Monday Morning Update 8/17/15

Top News

Practice Fusion promotes Tom Langan to interim CEO, replacing founder Ryan Howard, who will move to board chair. That’s a bizarre move given that Langan has no CEO experience (he’s always been in sales) and he joined the company only a year ago. Practice Fusion is planning an IPO that could be imminent, but that plan seems faulty with this move. Sounds fishy to me, but then again that’s been said about the company’s free (as in advertiser-sponsored and data-selling) EHR business model from the beginning. They seemed awfully anxious to get Howard out of the CEO chair without having a viable replacement identified.

Reader Comments

From Jed: “Re: your medical records saga. I came across PicnicHealth and I see you mentioned them back in 2014. The demo account looks pretty slick.” PicnicHealth, like CareSync, offers to manually obtain and input all of a patient’s records into its online system, which is presented in timeline form. They charge $19.95 per month for twice-yearly collection or $39.95 per month for constant updates. The company absorbs any records fees charged by providers, although it’s not clear from their site whether they obtain hospital records as well as those from practices. I mentioned PicnicHealth in August 2014, noting that they had five employees working from a San Francisco apartment or office above a Western wear store, sharing an address with the headquarters of sex party operator Kinky Salon. PicnicHealth raised $2 million in April 2015. I would be a bit concerned that its director of medical informatics, called “Doctor” throughout, is actually an ND (naturopathic doctor), although it probably doesn’t really matter for a consumer site. Still, that’s why the form “Dr. XXX” should never be used in writing, and when it is (incorrectly), I check the degree and school every time — it’s the folks trying to hide something that don’t state their actual degree or who conferred it.

From Digger: “Re: press releases. You mentioned that other sites basically rewrite them to look like news. I notice they also don’t link to them.” Of course they don’t – that would make it obvious that they did no original research or added no value at all. I always link to the source so you don’t have to take my word for it.

From Terry: “Re: summer Sunday haha. Saw this on LinkedIn.” As you suspected, I like it.

HIStalk Announcements and Requests

Seventy-one percent of poll respondents say Meditech’s competitive position is worsening. Reader comments include  Bread_Butter_Site: Meditech has too many platforms, got into ambulatory too late, took too long to release a Web version, and sacrificed agility to maintain their legacy platforms. PFS_Guy: Meditech offers the cheapest option for small to medium-sized facilities, but those are getting bought up by larger systems who replace it with their own system. Previous Medical User: decreasing product sales will force Meditech to raise support fees and limit product development. It’s Just Business: HCA considered moving to Epic but chose to stay on Magic.

New poll to your right or here: in which company (some publicly traded, some considering it) would you invest $10,000 if forced to choose one? I predict somebody will, as they always do, add a comment suggesting, “You should have put a ‘none of them’ response,” which of course would be irrational given the question.

Listening: new from Toto, decades-polished hard rock/progressive that stands as excellent on its own without even thinking about their late 1970s/early 1980s hits “Rosanna,” “Africa,” and “I’ll Supply the Love.” They aren’t just guys pushing 60 riding off into the sunset atop their ancient hits – the guitarist still shreds. They’re on tour now with Yes, who I say with sadness (having seen them many times as one of my favorite bands ever) is just topping off the grandchildren’s trust funds by cashing in on yet another tour as a sloppy, wooden cover band with no original members or creative energy left to do anything other than issue a zillion live albums from the band’s nearly 50 years.

Pet Twitter peeve: I’m scrolling through an endless list of utter Twitter crap, mostly retweets from the 134 people I follow (who often get maddeningly off-topic sidetracked in tweeting about baseball, a guy wearing a kilt, and pet issues like their personal airline gripes or their photography hobby) when I finally see something interesting and click on a link. Twitter then resets the very long list back to the beginning, forcing me to restart the endless scrolling. It’s time for another round of un-following.

Last Week’s Most Interesting News

• Premier adds to its analytics arsenal by acquiring Healthcare Insights for $65 million.
• Teladoc releases its first post-IPO quarterly report that shows a significant telemedicine usage ramp-up, but huge losses.
• ONC announces that its IT safety center – assuming Congress changes its mind about not funding it — will be named the Health IT Safety Collaboratory.
• A Vancouver newspaper’s investigation finds that IBM was fired from a large clinical systems transformation project and has been replaced with its subcontractor Cerner.
• AHA complains that the FCC’s decision to open up some frequency bands to wireless microphones will interfere with Wireless Medical Telemetry Services in hospitals.
• A GAO report finds that the VA and Department of Defense are missing key interoperability dates but are making progress, with the great unknown being how the DoD’s new Cerner project fits in.

Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience. 

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

Acquisitions, Funding, Business, and Stock

Wireless and needle-free continuous glucose monitoring technology vendor Echo Therapeutics proves the difficulty of turning an idea into a business: the company loses $11 million in the quarter after deciding to abandon plans to license its technology and instead focus on its own product development by working with a China-based technology company. Echo’s largest investor, an arbitrage fund, agreed to invest another $4 million in the company in December in return for having the company’s board replace three of its members with its own people. The fund had previously sued the company for mismanagement, while its former CEO received a settlement from the company after suing for wrongful termination. ECTE shares peaked at around $800 in 2000 but are priced at $1.51 today, valuing the company at $17 million.

People

Ross Martin, MD, MHA (AMIA) joins the Maryland HIE CRISP as program director.

Announcements and Implementations

Medhost will convene “The Nashville Experience” at Nashville’s Music City Center on September 16, featuring speakers Hayley Hovious (Nashville Health Care Council), Nicholas Webb (futurist and author), Farzad Mostashari, MD (former National Coordinator and current Aledade CEO), attorney Steve Blumenthal, and Jitin Asnaani (executive director, CommonWell). Registration is $250 including meals with an optional $150 ticket to the Taste of Nashville Gala.

Government and Politics

The protest period for the DoD’s EHR bid has expired, so the contract stands with the winning team of Leidos, Cerner, Accenture, and Henry Schein. Competing bidding consortia that included partners Epic and Allscripts were rumored to have been underbid by $1 billion by the ultimate winner, making their protest unlikely since a win would require them to do the work for a lot less money than they estimated.

Privacy and Security

NHS England will give chain pharmacies access to the summary care records of all patients (excepting those few who have opted out) this fall following a pilot project involving 140 pharmacies. The records, which are on file for 96 percent of the country’s residents, contain medications and diagnoses. The pharmacist is required to ask the patient for permission to view their record during their drugstore encounter. Only 15 patients responded to surveys during the pilot, so few that their input was discarded. Pharmacists have expressed some confusion about when they need the patient’s permission and how to obtain it.

University of Virginia announces that a China-based cyberattack affected its IT systems on June 11, but didn’t affect the UVa Health System.

Technology

The Nashville paper suggests that hospitals and other business consider deploying beacon technology rather than apps that require installation and updates. Beacons use Bluetooth Low Energy to broadcast to nearby Android or iOS smartphones, displaying the desired information to the user and reporting back information to the business. The advantage to customers is that their location is encrypted and push notifications aren’t sent when they are out of range or their phones are turned off. Beacons cost only around $20 are even sold at Target for finding lost devices with beacons attached. Theoretically beacons could replace some hospital RFID functions or even to transmit vital signs information, although that probably strays into FDA approval territory.

Other

The Donald is finding that it’s hard to hide from past idiocy that lives forever in social media. Many such cases!

A reader sent over the full-text JAMIA article that bizarrely concludes that HITECH had no impact on EHR adoption. The public health professor authors used some kind of diffusion model to determine that EHR adoption was imitative rather than innovative, then wanders off to a seemingly unrelated conclusions about lack of positive EHR impact on productivity and interoperability. I think what they’re trying to prove is that HITECH drove EHR adoption for the wrong reasons and may have stifled innovation as a result, with the billions of taxpayer dollars spent on HITECH returning little value in clinical outcomes or costs. That’s just guessing since I really can’t figure it out. I’m surprised JAMIA’s editors let this run without asking for more clarification.

The new $1.3 billion Parkland Hospital (TX), twice the size of the old building across the street, includes an interactive patient care system, Wi-Fi throughout, palm vein scanning for patient ID, and a more comprehensive ICU monitoring system.

Graduate diploma and associate degree nurses of a struggling for-profit college chain break into tears at their first look at their licensure exam when they realize they were poorly trained, causing the community college exam proctors to bring in a mental health counselor and to hand out information about a suicide hotline. Brown Mackie College faces national fraud charges for using unqualified instructors (the Arizona campus instructor for anatomy and physiology is a lawyer) and skipping practical instruction for tasks such as starting an IV, which students tried to learn on their own by finding YouTube videos. Parent company Education Management Corporation lost more than $2 billion in 2012 to 2014 as the government cracked down on for-profit colleges marketing themselves hard to students who didn’t know better and who were likely to default on federal student loans, taking away 90 percent of the potential school profits. The Pittsburgh-based Education Management Corporation also operates Argosy University, The Art Institutes, and South University. Taxpayers will pay billions of dollars to cover the defaulted loans of students whose schools shut down as students demand that the federal government cancel their loans because they allowed themselves to be swindled. It’s not just a problem with for-profit colleges, as private and public colleges and universities woo students with the idea that they should rack up dozens or hundreds of thousands of dollars of debt in studying whatever interests them despite the almost certain likelihood that they’ll end up with no increase in employability or earning power as a result.

Combat communications airmen with the US Air Force’s 35th Combat Communications Squadron from Tinker Air Force Base, OK rebuild the Internet connectivity of a Honduras hospital as part of a joint training exercise. The hospital had been offline for three years. Tech Sgt. Jasmine Matus says the team focused on the archives room that holds paper medical records since the hospital is hoping to migrate to digital storage. A 15-member Air Force medical team also participated, supporting classroom and drinking well construction teams from the Air Force’s 823rd Red Horse Squadron from Hurlburt Field, FL and the 271st Marine Wing Support Squadron from Marine Corps Air Station Cherry Point NC.

Employees of Willis Knighton Proton Therapy Center (LA) surprise 12-year-old spinal cord tumor patient Sophia with a flash mob dance (practiced on their own time) to celebrate the completion of her advanced proton therapy.

Weird News Andy titles this story “Jettisoned Evidence,” in which scientists study how bacterial populations differ around the world by extracting samples from the sewage holding tanks of commercial jets.

Report from the Allscripts Clinical Experience
By Joe Adkins, Clinical Pharmacist
Springhill Medical Center, Mobile, AL

I changed my mind last week about what a healthcare IT conference is really all about.

When I made plans for the Allscripts Client Experience (ACE) held August 5-7 in Boston, I had no idea just how much my world view would be changed about what lies ahead for our industry. I planned to attend the usual technology sessions to learn about product roadmaps and functionalities.

But after experiencing the opening session, I realize what I’m doing now in my role as a clinical pharmacist is helping to build the future for healthcare’s new era of personalized medicine.

From the opening session featuring Allscripts President and CEO Paul Black along with NantHealth founder Patrick Soon-Shiong, MD, I realized that this conference isn’t just about software. It’s about saving lives, thinking big, and finding a path to predictive medicine from our current reactive medicine mode. When it comes to treating cancer and other complex diseases, genomic sequencing is going to change the game – and sooner than we know.

I was given access to some of the great thinkers on health information technology (HIT), and a view into where we’re headed not next year, but five, 10, even 15 years down the road. It was interesting to see just how far Black and Soon-Shiong are planning beyond what we even know as healthcare IT today.

What I heard them saying is that the medications we use to treat and target cancer and other complex diseases are becoming more personalized and predictive thanks to nearly commonplace access to genomic sequencing. The advances in cancer treatment alone are moving ahead by leaps and bounds that we couldn’t imagine just two years ago. All of us in HIT must step up to ensure that the clinical information needed to treat patients is available in real time at the point of care just as quickly as discoveries are made.

For example, a handful of medications treat cancer well in ways we couldn’t envision just a few years ago. Eventually, there will be several dozen types of drugs to select from, and eventually, thanks to genomic sequencing, we’ll know which one works best for each individual.

The development pathways for those types of drugs have become much, much more compressed and the industry currently has no answer for how to keep up.

But Black and Soon-Shiong provided an interesting sneak peek into the future, and they are making some bets that NantHealth has the answer. It’s a little bit of a gamble, but I think it’s a calculated, good one. We don’t know yet whether this is the direction to go, but I’m glad Allscripts and NantHealth are investigating a new path to the future of HIT.

We can save more lives if we get this right. And I’m all in for that.

Sponsor Updates

• The SSI Group will exhibit at the 2015 MS HFMA Summer Workshop August 19-21 in Philadelphia, MS.
• Streamline Health will ring Nasdaq’s opening bell August 19.
• Surescripts Chief Administrative and Legal Officer Paul Uhrig is featured in a Boston Global article, “E-scrips seen as a way to combat opioid abuse.”
• T-Systems offers “Leading with Passion: Check Your Resilience.”
• TeleTracking posts “The Value of Time” in optimizing hospital operations.
• TransUnion writes its first corporate social responsibility report.
• Valence Health will exhibit at the World Congress on Health and Biomedical Informatics August 19-23 in Sao Paulo, Brazil.
• VitalHealth Software offers, “The Patient Centered Medical Home: Will the Demonstration Projects Fail?”
• Voalte offers a preview of VUE15, its first user experience conference, November 10-12 in Sarasota, FL.
• West Corp. offers, “The New Healthcare Paradigm: “Think Whole Person.”
• Xerox Healthcare explains how “Data Analytics Transforms Virginia Medicaid.”
• ZirMed will host its 2015 UGM, ZUG 15, August 17-18 in Chicago.
• Navicure offers “Shifting Attention: Value-Based Reimbursement Gains Traction.”
• Nordic offers “HIT Breakdown 10 – Patient Engagement possibilities with MyChart.”
• NTT Data posts “5 Reasons Your Cloud is About to Become a Legacy System.”
• Oneview Healthcare offers “Yelp Comes to Healthcare.”
• Orion Health writes “Does greater patient control equate to a better healthcare experience?”
• Park Place International offers “Sustaining Virtual Desktop Infrastructure.”
• Summit Healthcare reports the experience of its client Valley Regional Healthcare (NH), which is using the company’s downtime reporting system.
• Patientco publishes a new white paper, “3 Strategies for Increasing Self-Service Patient Payments with PatientWallet.”
• PatientKeeper offers “Relieving a Practice’s ICD-10sion.”
• Phynd Technologies writes “Merger Mania in the Healthcare Industry.”
• PMD submits “Digital Health: A New Haven for Physicians.”
• RelayHealth posts a new case study, “Focusing on Patients, not Dollars, makes Cooper Bend Pharmacy unique.”
• Sagacious Consultants offers a “Q&A with David Hammer: How Consolidation and Unified Reimbursement will Change Revenue Cycle Management.”
• Sandlot Solutions will exhibit at the iHT2 Health IT Summit August 18-19 in Seattle.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 8/14/15

Premier, Inc. acquires healthcare analytics leader Healthcare Insights

Premier acquires Health Insights for $65 million, a data analytics vendor focused on budgeting, forecasting, and cost analytics.

Outcome-Oriented Metrics and Goals Needed to Gauge DOD’s and VA’s Progress in Achieving Interoperability

A GAO report finds that the DoD and VA are making progress toward interoperability, but cautions that work will not be finished until sometime after 2018.

Healthcare IT: Zombie start-ups and vulture capital

Accenture publishes a report predicting that half of all funded digital health startups will fail within their first two years of launching, contributing to a culture of vulture capitalism in which larger, more established businesses cherry pick technology and talent from failed startups.

Teladoc Announces Second Quarter 2015 Results

Teladoc announces Q2 results: revenue up 78 percent to $18.3 million, EPS –$7.20 vs. -$2.15.

News 8/14/15

Top News

Premier acquires financial analytics vendor Healthcare Insights for $65 million in cash. 

Reader Comments

From Bean Enumerator: “Re: North Shore-LIJ’s JV with Newport Health. Newport says it has experienced and innovative health IT talent, but the only person listed as working for the company has no relevant experience whatsoever. It’s a bad sign when an investment banker starts a health IT company. How did Allscripts lose this one given their supposedly tight partnership with NS-LIJ and their population health management aspirations?” I couldn’t find much of anything on Newport Health other than it’s apparently connected to Newport Private Group with a real office in Newport Beach, CA and mail drawer addresses in New York and Texas. The site contains nothing that suggests why they would make a good partner for NS-LIJ or anyone else for that matter.

From Divine: “Re: Cerner. Have you heard anything about them pulling their Intermountain team back to Kansas City?” I have not.

From ACOver: “Re: Aledade. You didn’t mention that the company is expanding.” Farzad’s Aledade has nothing to do with health IT, which some of the HIT sites can’t quite grasp in confusing his former job with his current one. Non-HIT sites with healthcare reform and insurance followers are the place for that kind of story rather than HIT sites that just reword Aledade’s press releases without adding any value whatsoever.

From GeneInsight SchmeneInsight: “Re: Sunquest and Partners HealthCare marketing GeneInsight software. While the GeneInsight investment may be helping, I spoke with two folks (Meridian Health, NJ and Main Line, PA) each doing due diligence on enterprise systems to include ripping out Sunquest. Epic and Cerner are being vetted at both sites.” Unverified. The challenge with being a best-of-breed vendor is that your fervent, enterprise-resistant users don’t have the final word when health systems consider buying a broad, good-enough integrated product line from a company that supports it all. Those dominoes have been falling for years – lab, radiology, and pharmacy are moving (or being pushed) to Epic and Cerner from their favorite departmental systems. I haven’t seen any evidence that patient outcomes or costs have suffered as a result despite the dire predictions from the folks in those departments whose niche systems were, in their minds, integral to their unique mission.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor YourCareUniverse. The Franklin, TN-based company offers cloud-based technology and expertise in consumer relationship management, putting consumers at the center of the health system’s strategy. Patient-facing modules include YourCareHealth (personal health records), YourCareWellness (a wellness portal), YourCareEverywhere (consumer health content), and YourCareNavigation (rules-based care and wellness plans). Provider-facing technologies include a patient education content repository for clinician prescribing, community risk stratification analytics, an HIE and HIE connector, a patient transfer application, a Salesforce-integrated consumer marketing system, and a referral management system. The company also offers strategic consulting to guide organizations through transformational change. YourCareUniverse quickly signed up 38 customers after it was launched early this year, with its first go-live last month at Mount San Raphael Hospital (CO), which is using the patient engagement capabilities to promote its brand to consumers. Thanks to YourCareUniverse for supporting HIStalk.

The YourCareUniverse folks are excited to present their two-day “Transvisional Forum: Transforming the Health of Consumers Through Engagement” conference September 16-17 at the Music City Center in Nashville. Topics of the nine educational sessions include cultivating consumer loyalty, managing the digital patient, analyzing big data, and increasing volume. Keynote speakers are Nicholas Webb (author of “The Digital Innovation Playbook”), Farzad Mostashari, MD (former National Coordinator and CEO of Aledade), Steve Blumenthal, JD (health IT attorney and all-around HIStalk pal), and Jitin Asnaani (executive director, CommonWell Health Alliance). Early bird registration is $795 through this Saturday, August 15.

This week on HIStalk Practice: Texas physicians struggle to keep their doors open and spirits up. HelloMD pivots its telemedicine services to medical marijuana. The Senate approves the Electronic Health Fairness Act, while HHS gets a black eye over breaches. Kathryn Evans offers best practices for leveraging technology to ensure reliable disposal of hazardous drugs at physician practices. HHS Secretary Sylvia Burwell announces $169 million in funding for new health centers. CSI rolls out Doctor on Demand telemedicine services. SecurityMetrics develops a HIPAA Dashboard for physician practices.

This week on HIStalk Connect: Google X Labs partners with DexCom to develop a miniaturized, disposable continuous glucose monitor. Twitter introduces an API exposing its entire 500 million tweet history to software developers. A Cambridge, MA-based genetics startup raises a $120 million Series B to advance its research into CRISPR-Cas9 gene editing therapies. A consortium of European researchers is developing a "smart mirror" that will screen users for early signs of chronic diseases.

My love-hate affair with Windows 10 continues after one of its silent updates trashed my laptop’s Wi-Fi connectivity yesterday due to what I initially thought was device driver incompatibility. I spent a couple of hours trying to fix it before giving up and taking it to the repair shop (which I’ve never had to do since I can usually fix things myself). The shop owner left a message last night saying he had spent hours of analysis without figuring out a solution, with the only option he could suggest being to downgrade back to Windows 8.1. I returned his call this morning and he had experienced some sort of nocturnal epiphany and fixed the update-corrupted Windows networking components by matching up individual DLLs with versions and dates and then reinstalling and registering them one at a time. It’s back on my desk working fine. The $89 cost was worth it and I’m pretty happy to keep Win10, although I’m annoyed at the exasperation and expense of fixing the damage it caused and fearing the havoc the next update will wreak. The repair shop owner has added my problem to his Win10 issues folder, which is rather thick after just two weeks of its availability. He’s probably thrilled at the business uptick.

Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience. 

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

Acquisitions, Funding, Business, and Stock

Roswell, GA-based Tea Leaves Health, which sells hospital marketing software, will be acquired for $30 million by consumer health website publisher Everyday Health. Tea Leaves Founder Reuben Kennedy will make a pile of money he doesn’t really need given his LinkedIn endorsement of a car detailing company that attends to his “five Ferraris, several Porsches, and a Lamborghini.”

PokitDok, which offers 16 healthcare transaction APIs for application developers, raises $34 million.

DispatchHealth, which offers cities a mobile acute care alternative to dispatching an ambulance in response to 911 calls, raises $3.6 million. Dispatchers route non-urgent calls to the company, which sends out cars with a clinician, a mobile lab, medical equipment, medications, and Internet connectivity. The company was previously known as True North Health Navigation. It doesn’t indicate pricing, but a FAQ on its old site suggests $200 to $300 per visit with insurance accepted.  

Freshly IPOed telehealth vendor Teladoc reports Q2 results: revenue up 78 percent, EPS –$7.20 vs. -$2.15. The company warns that it expects to lose $50 million in the fiscal year. Teladoc reports that 83 percent of its revenue comes from the per-member, per-month fees paid by employers, health plans, and health systems, with the remaining 17 percent coming from visit fees averaging $40. Teladoc made reference to future possibilities that include behavioral health, dermatology, second opinions, at-home testing and biometrics, post-discharge monitoring, and wellness programs.

In a strange business shift, HelloMD, which previously offered expensive, cash-only video visits with big-name medical specialists, relaunches itself as a seller of $49 video consultations for medical marijuana cards. Note that the site says “Approved in 20 mins,” which suggests that a minimal amount of clinical rigor is applied during the video visit. The lady on its home page indeed seems to have been relieved of all her medical suffering and is now in a blissful state of deep-breathing wellness, surrounded by clouds.

Sales

BayCare Health System (FL) chooses Legacy Data Access to retire its SoftMed application.

New England Healthcare Exchange Network chooses Cognizant and its TriZetto subsidiary to manage its technology infrastructure.

University Hospitals (OH) will use Sectra’s vendor-neutral archive.

Cambridge Health Alliance (MA) chooses Imprivata’s two-factor authentication for e-prescribing of controlled substances.

Athol Hospital (MA) will implement Medhost’s ED information system.

People

Cureatr appoints former Highmark CEO William Winkenwerder, Jr., MD to its board.

Bill Wallace (Kansas HIE, BCBS of Kansas) takes over as interim CEO of the Kansas Foundation for Medical Care.

University of Iowa Health Care names Maia Hightower, MD, MBA, MPH (Stanford Health Care) as CMIO. She replaces Douglas Van Daele, MD, who will serve as executive director of University of Iowa Physicians.

Announcements and Implementations

InterSystems will use technology from Validic to integrate user-generated and wearables data into its HealthShare interoperability suite.

HIMSS brags on its Cleveland conference center and its role in helping its vendor members market their products as it trolls for “collaborators” (i.e., paying tenants). The upcoming events list isn’t very compelling with mostly small HIMSS meetings and vendor presentations for attendees yearning for a junket to Cleveland. I’m starting to think that from my experience with health systems and member organizations that the concept of non-profit (meaning “non-taxpaying”) organizations should be eliminated.

Government and Politics

A GAO analysis finds that the VA and DoD are working on interoperability between their systems, but are missing dates and won’t be finished until 2018.

Privacy and Security

The Economist ponders whether databases can remain useful after being anonymized, or if in fact real anonymization is even possible given the relative ease of matching one database to another to re-identify the information. Possible solutions include releasing data only to researchers rather than to the general public, making data recipients sign use contracts, making re-identification illegal, encrypting data queries as a package so that researchers can’t see the underlying data rows, and dividing the database among multiple hosts.

The Greater New York Hospital Association bans filming in the city’s hospitals without the the prior written consent of patients, embarrassed by a 2012 episode of “NY Med” that captured the ED death of a patient whose family recognized him on TV despite his digitally obscured face.

Innovation and Research

I can’t see the full article since I don’t subscribe to JAMIA, but I would question the methodology of this study, which concludes that HITECH didn’t change the EHR adoption trajectory – it was just practices without EHRs imitating those that had them.

Other

Peer60 publishes a “Rapid Reaction Report” on IBM’s planned acquisition of Merge Healthcare, collecting thoughts from 130 healthcare leaders in the two days following the announcement. One-third of the Merge customer contacts said the acquisition will be negative, but 20 percent said they will expand their use of Merge’s solutions under IBM’s ownership. Radiology and non-CIO IT folks felt pretty good about the announcement, but 60 percent of CIOs see it as negative. The main concern seems to be whether IBM is too big and too light on PACS knowledge to keep Merge customers happy while they try to sex up Watson with Merge-supplied “eyes.”

A British newspaper profiles EMIS Health Managing Director and former Misys Healthcare executive Duane Lawrence, noting that he was the #1 territory sales manager for Coca-Cola at 22 years of age before deciding, “I wanted to do something that was going to make a difference.” I can’t think of any positive healthcare difference Misys ever made other than getting out of it, but perhaps he has finally found his calling.

The shrill shrieking for Internet attention has unfortunately encouraged the proliferation of witless, intellect-insulting puns in headlines, I’ve noticed. The reporter’s credentials suggest he should know better, although maybe I’m expecting too much since he also contributes to “Painting and Wallcovering Contractor.”

Nice job spell-checking, Health Gorilla (or is that Health Gorrila?)

The former network manager of Yukon Kuskokwim Health Corporation (AK) is indicted for collecting and distributing child pornography over the hospital’s network after investigators find 29 terabytes of images and videos.

An Accenture analysis of 900 digital health IT startups labels half of them as “zombies” that are likely to fail in their first two years, creating a “vulture capital’ market in which better companies pick at their carcasses for people and technologies. The report identified the zombie startups as those “dead but unaware of it” companies that raised up to $50 million from 2008 through 2013 but haven’t had new financing in the past 20 months. I’m not as optimistic as Accenture that those struggling newcomers have people or intellectual property worth poaching, but we’ll see. They left out the most interesting part – the list of those companies they targeted as zombies. It would be fun to run a death pool contest.

In Australia, a state review of the new Queensland children’s hospital finds that patients were endangered in the rush to open the facility quickly before medical equipment, computer systems, and even hand sanitizers were in place. Employees didn’t meet each other for the first time until the day of opening. Everyone agrees now that the hospital needed another two months before opening its doors.

I winced when I saw the “register for HIMSS16” subject line in my inbox. The pushed-back Chicago version was like Daylight Saving Time – it was great having the extra weeks before last year’s conference, but now we’ll all pay as the clocks are set forward for Las Vegas and the dreaded week comes all too quickly (you’re likely an HIT newbie or anything-to-miss-work conference junkie if you actually look forward to it). Early bird member registration runs $765. Las Vegas always requires messing up the familiar schedule to accommodate the busloads of gamblers that the hotels and casinos won’t displace over the weekend, meaning the HIMSS conference runs Monday through Friday instead of Sunday through Thursday. The opening keynote will be at 5:00 p.m. Monday and the exhibit hall won’t open until Tuesday morning. HIStalkapalooza will be Monday night as usual, so hopefully the opening keynote will be as unappealing as in the past several years so people can bail out to arrive at my event on time. The closing keynote will be delivered by noted healthcare IT expert Peyton Manning, who will face a Friday afternoon audience smaller than at a Denver Broncos closed practice scrimmage. Hotel rates are, as always, jacked up for expense account attendees, with the same Treasure Island room running triple what it would cost to go next week in the miserably hot Las Vegas summer. In case you forgot, HIMSS announced earlier this year that the conference will alternate between Las Vegas and Orlando, having outgrown all the more interesting places.

Sponsor Updates

• E-MDs offers a free ICD-10 Survival Kit.
• Extension Healthcare offers “Market Trends: Counting Down to Alarm Safety Readiness.”
• Galen Healthcare offers “Healthcare Interoperability Musings: Incentives, Barriers, Blocking.”
• Access demonstrated its electronic forms and signatures solutions at Meditech South Africa’s event in Johannesburg.
• Greenway Health posts “Electronic Prescribing of Controlled Substances: a Convenient Tool to Improve Patient Care and Safety.”
• Hayes Management Consulting offers “Secure Messaging – Why It Makes Your Job Easier & Your Patients Happier.”
• ZeOmega earns NCQA’s disease management certification.
• The HCI Group publishes “4 Steps for Success: ICD-10 Training for Physicians and Non-Clinicians.”
• HDS offers “FDA Warns of Medical Device Hacking.”
• Cumberland Consulting Group is named to the Inc. 5000.
• Healthfinch says “Document, Document, Document!”
• HealthMedx offers “Proposed CMS rules set new destinations for SNFs … but where’s the path?”
• Healthwise offers “Engaging Moms on Medicaid.”
• Iatric Systems posts “EHR Optimization: Go-LIVE Marks the Beginning.”
• VitalWare is named to the Inc. 500/5000.
• Impact Advisors is recognized by KLAS for service performance.
• InstaMed offers “In Healthcare Payments, EMV May be a Driver, But Dodging PCI is the Benefit.”
• InterSystems and Leidos Health will exhibit at the Defense Health Information Technology Symposium August 18-20 in Orlando.
• Liaison Technologies is named a finalist in the 2015 North Carolina Healthcare Information and Communications Alliance Health IT Transformation Awards.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
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EPtalk by Dr. Jayne 8/13/15

CMS continues to remind everyone that the ICD-10 transition is less than 50 days away. Unfortunately this seems to be news to some. I’ve been absolutely inundated with requests for ICD-10 training. I suspect the previous delays encouraged some providers to procrastinate, thinking there would be another reprieve. I’d be seriously surprised if there is one, so if you haven’t started prepping, now is definitely the time. My free consulting advice:

• Every provider should have a list of his or her top 50 diagnoses and should practice documenting those diagnoses in the EHR, either with dual-coding on a live system or otherwise in a test system.
• By specialty, providers should know what common codes might have pitfalls and be ready to diagnose them.
• Organizations should follow their vendors’ ICD-10 readiness checklists. Some EHRs require updates and there may be nuances on how they need to be applied compared to “typical” updates given the number of moving parts for ICD.
• Each office should identify an ICD-10 point person to handle issues on October 1.
• Everyone should dust off their business continuity plans. Your office may be OK, but your clearinghouse or payers may not, so it pays to think through the possibilities.

CMS also sent out a link to the National Broadband Map, where providers can see if they will qualify for certain Meaningful Use exclusions based on the availability of broadband service. I don’t qualify for an exclusion, but the page did have some interesting information about my county, including racial and ethnic data, median income, poverty rate, and educational status.

My former employer still hasn’t figured out how to remove me from all its email distribution lists. From time to time I still receive confidential information, including physician performance data. This week I received a system-wide bulletin stating that in order to prepare for ICD-10, effective next week the hospitals are no longer going to accept only ICD-9 codes for the patient diagnosis. Physicians must include a narrative description of the diagnosis if they want their orders to be processed. Quarterbacking from afar, I think a week’s notice is pretty short and the lack of a grace period isn’t very provider-friendly. They also didn’t mention what they would do when orders are received without a narrative. Will the patient be turned away? Will someone try to contact the provider? Heaven forbid will someone whip out a code book and scribble a narrative on the order so the patient can be taken care of? I’ve asked a couple of my former colleagues to let me know how it goes.

I wrote a few months ago about a friend who had knee surgery and some of her experiences while I played patient advocate for a day. She still hasn’t gotten a full copy of her records, but watching the bills and insurance Explanation of Benefits statements come in has been entertaining. Although it’s been more than four months and she’s 90 percent back to normal activities, the surgeon still hasn’t billed her. The hospital sent her a mysterious refund check with no explanation even though her insurance statement indicated that she actually owed money. Given the slim margins that some of us operate on, it surprises me that anyone would leave money on the table.

The DME vendor has double billed her and two other vendors have failed to submit to insurance prior to billing her. The only vendor that seems to have its act together is the physical therapy provider. The bills arrive monthly and are detailed and accurate. Even though I’m in healthcare and understand the markups, the actual dollar amounts are pretty amazing. Overall she was billed more than $45,000 and insurance has adjusted off about 75 percent of that. She’s got tremendous insurance, so her out-of-pocket cost has been manageable. Not being in healthcare, I’m pretty sure she has decided that our entire industry is simply crazy.

PricewaterhouseCoopers (you have to love the arrangement of that name) is projecting a potential increase in healthcare costs. The cost of security for electronic systems is cited as a factor, along with new and expensive specialty drugs hitting the market. Increasing employment of physicians by hospitals is also cited, particularly with the practice of billing out physician office visits with a hospital facility charge. Team-based care is predicted to help lower or stabilize spending. Not surprisingly, they predict that patients with high-deductible plans will be more cost conscious. It will be interesting to see what the data shows in five years and whether patients who forego medical services due to high deductibles end up having larger expenditures as conditions are left underdiagnosed or undertreated. The proliferation of such plans feels a bit like an experiment being conducted on people without the benefit of an institutional review board to protect them.

What do you think about healthcare spending trends? Email me.

Email Dr. Jayne.

Morning Headlines 8/13/15

Health IT Policy Committee Meeting Data Update

According to new data published at yesterday’s HITPC meeting, electronic information sharing is improving among US hospitals and practices. 76 percent of hospitals are exchanging information with outside provider organizations, up from 41 percent in 2008.

94M records stolen so far this year

Driven by massive data breaches at Anthem, UCLA Health, and others, hackers have stolen the personal medical information of 94 million patients thus far in 2015.

Mostashari’s Aledade to form new ACOs in 7 states

Farzad Mostashari, MD Former national coordinator for health IT and current startup CEO, is in the process of registering new ACOs across seven states.

Google’s Life Sciences division to build a miniature glucose tracker

Google X Labs partners with DexCom to co-develop a miniaturized, disposable continuous glucose monitor. DexCom will pay Google $100 million plus royalties for the rights to exclusively distribute the new CGM.

Readers Write: Interesting Times for ePA and EPCS

Interesting Times for ePA and EPCS
By Connie Sinclair, RPh

These are interesting times in the e-prescribing world. Readers may recall that NCPCP approved the SCRIPT electronic prior authorization (ePA) transaction standard in July 2013. Several state legislatures have passed laws requiring support for the NCPDP ePA transaction 24 months after its adoption, which brings us to right now. With Missouri’s new e-prescribing of controlled substances (EPCS) rules becoming effective July 30, EPCS is allowed in all 50 states and DC, with only Vermont holding out on EPCS of Schedule II substances.

Having been involved with electronic prescription applications for almost 30 years and today tracking what states are legislating and regulating, it is gratifying to see the tremendous progress the industry has made in terms of adoption and in advancing e-prescribing to become the standard of care. Even EPCS, which was considered one of the biggest hurdles, is now legally a done deal.

EPCS not only provides better tracking and deterrence of controlled substance diversion and abuse, it also helps patients get the medication they need in a more timely manner. Orthopedic patients no longer have to hobble into their surgeon’s office when they need pain relief prescriptions. Adults and children who are on ADHD meds can also avoid unnecessary trips to the doctor for maintenance med prescriptions.

Some might say, “Whew, we’re done.” Not so fast. Although EPCS is allowed and transaction flow for controlled substance prescriptions is certainly increasing, we still have a long way to go to get adoption to levels that are equal to non-controlled substance prescribing. Anecdotal evidence suggests that many practices are unaware of the legality of EPCS, most likely because they do not yet have access to an EPCS certified version of their EHR. Also, many states are watching New York very closely to see the impact of mandatory e-prescribing and EPCS effective March 2016, and some are expected to follow suit.

While EHR vendors have been slogging their way through MU requirements, industry stakeholders, prescribers, standards organizations, and legislators have been busy advocating for prior authorization (PA) reform. As I am sure most HIStalk readers are aware, the traditional and cumbersome PA process is a huge sore spot for prescribers and patients alike who believe it hinders patients from getting needed medication per their doctors’ orders. Over the last few years, state legislators have taken note and have approved new laws requiring reform and automation of the process. 

A big part of my current job is to monitor state law. Seven states had July 2015 effective dates for some level of support for electronic prior authorization. In addition, four states already require electronic submission of the PA form and three additional states have laws on the books with future effective dates regarding ePA support. As always, the devil is in the details as each state has a different interpretation of what constitutes an electronic prior authorization. Most states impose the requirement to support ePA on the health plan, but EHR vendors should take note because at least two states impose the requirements on the provider.

As patients and as caregivers for patients as well as EHR stakeholders, we should all be encouraged by the progress of the ePA and EPCS initiatives and do what we can to keep things moving along in the right direction.

Connie Sinclair, RPh is director of the regulatory resource center of Point-of-Care Partners of Coral Springs, FL.

HIStalk Interviews Scott Bagwell, President, Experian Health

Scott Bagwell is president of Experian Health.

Tell me about yourself and the company.

I’ve been in the HIT industry since the late 1990s. I’ve been through a dozen acquisitions on both sides. I started out with a small company in Charlotte called Systems Associates, Incorporated — which was the SAINT hospital system — that was acquired by American Express, which became First Data, which sold to HBOC, which became McKesson HBOC. I stayed through all those acquisitions. In 2000 I went to Sunquest in Tucson, acquired by Misys Healthcare. I then went to NDC Health in Atlanta, which was mainly a healthcare claims and pharmacy transaction company, including analytics. That was acquired by PerSe, which was acquired by McKesson, and I ended up again at McKesson. I left there in 2010 and came to Passport Health Communications, which was acquired by Experian.

What is included under the Experian Health umbrella and what’s changed since Experian acquired Passport?

I came to Passport in 2010. My former boss Scott MacKenzie and I had worked together for 10 years at McKesson, NDC, RelayHealth, and all those McKesson companies.

Passport was known primarily in the early days for patient access, focusing on eligibility, address verification, those front-end components of the patient access solution. We eventually became an integrated workflow. We replaced multiple point solutions in hospitals and physician offices. In the patient access world, there could be as many as seven different vendors on the front-end process. We developed a platform called eCare Next that integrated all of the front-end functions, from ordering, scheduling, eligibility, address verification, patient estimation, quality control, and payment systems, including claims and management.

Experian Health originally acquired Search America in 2008. Search America had a strong presence in about 900 hospitals, primarily providing payment prediction services, correction software, and address verification. They were also focused on data analytics. That was Experian’s first venture into health. In 2011, they acquired Medical Present Value, which is primarily focused on physician practices. It was an Austin, TX and San Antonio-based company providing services for physician practices in large academic medical centers for over 75,000 doctors,  focused on improving reimbursement and payments from commercial providers.

That was 2011. That was Experian Healthcare. Then in 2013, Experian acquired Passport. We had a strong presence in both hospital and physician markets. Our products were focused on front office efficiency and an integrated workflow management system. Our guiding principle at Passport was payment certainty. Our systems were designed to find a payment for patient, no matter whether it was charity, Medicaid, Medicare, or third party. We focused on that guiding principle of payment certainty for every patient.

That’s who Experian Health is today. It’s a combination of those three companies: Search America, Medical Present Value, and Passport Health.

Passport was a fairly quiet company that sold for $850 million. How does a company position itself for success in ways that might not be obvious?

Passport began in the mid to late 1990s providing Medicaid eligibility systems. At its heart, it was really a technology company. It’s those roots and that focus on technology that allowed us to evolve into SaaS. We’re a SaaS solution today. That allowed us to begin to integrate those disparate modules into one integrated workflow. Our core value is client driven, first and foremost. Focusing on the customer. We believe if you focus on the customer first and foremost, everything else follows in line.

Technology was the enabler that we had in place. We had some really smart people at Passport. We encouraged teamwork. Consider the source, but I think it’s one of the best collections of employees that I have ever worked with, really dedicated to our customers. We are somewhat maniacal about customer satisfaction.

We are in a tough market. Tough with all of the variables that we deal with, but we are very metric driven. Every function that we have at now Experian Health — we began this at Passport — we measure. We measure the user experience. We get automated reports showing how our customers are actually using our products. The ultimate goal is to help those customers optimize our products and solutions.

Customer driven first and foremost, high-performing teams, and then the metrics –measuring how we do. Never, never, ever achieving “becoming good enough” because we always know there’s room for improvement.

What is the biggest change for providers trying to collect the increasing amounts of patient responsibility while maintaining their satisfaction scores?

It’s tremendous change with uncertainty over financial responsibility, the fact that a patient can’t know in advance what their service is going to cost them. There’s increasing ownership and involvement by the patient to become more engaged in that part of the healthcare system. There’s a need for transparency.

We developed a patient estimation solution several years ago. It is one of the most widely deployed out there. It’s part of that integrated workflow. The uncertainty of financial responsibility, both from the provider and the patient perspective and the payer as well, and then that need for transparency. Part of what we focus on and the challenge that we see is how to optimize performance in the midst of the growing out-of-pocket fees and the decline in reimbursement for our customers.

Reimbursement seems to have diverged, where on one end patients are expected to pay for their specific services in cash, while on the other end value-based care makes charges mostly irrelevant. Is it a challenge to deploy technology to manage both?

Yes, it absolutely is. There’s a blurring of the lines in a trend that’s moving quicker from providers to the payer side with this value-based reimbursement model that’s gaining strength in the marketplace. There definitely is a blurring of the lines. 

In post-acute care, the patient goes into a black hole today. There’s a coordinated care document in a hospital, but it rarely follows the patient. In order for the payers to bill for bundled payments, for the providers to understand what payments they should be getting, we think there’s some common good in there. We believe we’re in particularly good position to do that today. That’s the part of the growth strategy that we’re focused on right now. How we can help with that whole value-based reimbursement world, both from the provider perspective to the payer. The bulk of our business is with hospitals and physicians. We have a number of payers, but we’re a pretty provider-centric organization today.

What drives you crazy as a patient when you experience your provider’s revenue cycle first hand?

I like to know that my bills are paid. The fact that a provider would take so long to get the bill back … I just think it’s crazy to wait 60 to 90 days for the providers to get paid.

At NDC, we worked in the pharmacy transaction world. It’s a simpler transaction, but the standard in the pharmacy world is NCPDP. When we were at NDC, we used to wonder why we couldn’t auto-adjudicate for hospitals like we did for pharmacy. Granted it’s greatly more complex, but why can’t we get there? To this day I wonder why we can’t get there. We had a number of initiatives and we thought we could pull it off, but it still hasn’t happened.

What opportunities and threats do you see for provider revenue cycle?

Wherever there’s a threat, there’s typically an opportunity. Our goal is to encourage greater patient engagement. We are working on mobile applications for mobile access to our applications today. Maybe not schedule an appointment, but why can’t you request an appointment? We’re looking at greater patient engagement. We engage our clients in client-driven innovation. We’re in almost 3,000 hospitals today and we work with some of the largest systems in the country. They drive us. We like delivering client-driven innovation.

The other thing that has been one of our guiding principles is touchless processing. I talked about being metric driven and how we measure everything we do. We look at the customers who are coming closest to achieving touchless processing. You’ll never get 100 percent touchless processing, particularly in what we do in the patient access-revenue cycle world, but 85 percent of the time, we believe a transaction could go through our integrated workflow. We think that’s the ultimate goal and we’re continuing to drive to that.

We’re not there yet. We’ve got some large customers who are achieving 80 percent touchless processing, so the workflow just goes through.  The hospitals only touch the exceptions in the process. That’s where we think the opportunity will continue and we’re focused on delivering it.

Do you have any final thoughts?

I’m pretty proud of the company. We achieved #1 in KLAS last year. That in itself is a challenge because people will tell you the only way to go is down. We’ve had a contest among every department to see how we not just live on last year’s laurels, but how we can improve our customer satisfaction scores. We really are focused on that. We’re just announcing the winners. Every department, every functional part, sales and marketing, the sys ops, the devs all had nominations to see how they could personally improve our customer satisfaction scores. We’re pretty proud of what we’ve done. We’re not going to rest on our laurels moving forward.