Qualcomm’s healthcare arm acquires Capsule Tech, a data integration firm that helps hospitals capture and analyze data from medical devices. Qualcomm will use the technology to advance its connected home health efforts. Financial terms were undisclosed.
An analysis of data breaches reported during the first half of 2015 finds that the healthcare industry is the most vulnerable to breaches, accounting for 21.1 percent of total reported breaches. Healthcare was also responsible for the largest consumer impacting breach, a cyberattack on Anthem that exposed 80 million patient records.
A systematic review published in JAMIA finds that there is no evidence base for developing patient portals that increase patient engagement. Authors conclude the review by recommending future research topics that would address these gaps.
Researchers from Harvard and MIT studying links between genetic variations and diseases have analyzed the genetic data from thousands of patients and have identified around 10 million genetic variants scattered throughout the genome, most of which have never been described before.
September 14, 2015Dr. JayneComments Off on Curbside Consult with Dr. Jayne 9/14/15
We hear a lot of chatter about big data and the ability to conduct analysis and draw conclusions from enormous volumes of information. I know I’ve written previously about attempts to determine whether Agatha Christie was developing dementia through analysis of her writings. I’d love to do analysis right now on some of the physicians I’m connected with through social media. Based on some of their posts, one might extrapolate a far-reaching conspiracy, mass paranoia, psychosis, or all three.
What has them so excited? It’s ICD-10, of course. Apparently quite a few hospitals are just beginning their ICD-10 preparations. For physicians who are on staff at multiple facilities, the training requirements are converging to form a perfect storm of regulatory madness. One of my friends from medical school reports being required to complete training programs at all three hospitals where he has medical staff privileges.
Despite having completed two previous programs, the third hospital is requiring him to complete more than 20 online training modules. Even though he’s a particularly specialized surgeon that deals with a part of the human body smaller than an elementary school milk carton, he had to sit through courses on coding for OB/GYN, neonatal diseases, and specialties he’s never going to use.
Since this was his third go-round, he timed the modules. They took more than 15 hours. He also reports that the narration was done by someone “with no idea how to pronounce medical terms.” I hope he was multitasking during the non-relevant portions or at least enjoying a cocktail because I know I would have gone crazy if faced with the same scenario.
It’s been entertaining to watch the back-and-forth as other physicians respond to posts complaining about ICD-10. One friend asked, “Is it just me or is ICD-10 going to make the practice of medicine more inefficient? Does it seem like it was created by bureaucrats who are trying to assert a rationale for their existence?” Another responded that the second question provides the answer to the first.
A third friend answered that without required ICD-10 courses, new regulations, and more hassles, “the woman who doesn’t know how to pronounce medical terms and lots of other people like her wouldn’t have a job, so they come up with new rules to keep themselves busy to justify their jobs.”
Indeed, that sounds a lot like some of the bodies that have been making an increasing number of healthcare regulations over the last several decades. There was a comment that ICD-10 is a conspiracy “to force physicians into the arms of hospital networks.” Certainly one might be inclined to only be on staff at one or two facilities rather than three or four if one has to take redundant training. I sympathize with what he’s going through – I once went live on the same EHR at two different hospitals and had to complete the entire training curriculum for both, even the parts of the system that are not client-configurable.
Another friend suggested just blowing through the slides and taking the end of module test since “doctors are some of the best test-takers in the country.” One physician chimed in that she has so many emails in her inbox about ICD-10 that it would take days to go through them. She plans to take a course at a local medical school and hopes it will be “helpful rather than soul-sucking.” Unfortunately, many of the ICD-10 courses I’ve heard about represent the latter.
One of the best follow-up comments I read was from a friend of a friend of a friend (funny how social media works that way) who said his hospital offered an animated course with a cowboy and a talking horse/donkey character. I certainly haven’t heard of that one, but would love to see it if anyone can point me in the right direction. Just thinking it reminds me of my own hospital’s HIPAA videos, which had a questionably-executed gangster/flapper theme.
It’s all too easy to get sucked into social media and I didn’t want to waste much more time than I had already spent. Before I closed my browser, though, I did come across this video of a woman surfing in stilettos. I thought it was pretty impressive, but one of my shoe diva friends commented it was a way to ruin a good pair of shoes for sure.
What’s the best ICD-10 training you’ve seen? Email me.
September 14, 2015InterviewsComments Off on HIStalk Interviews Beth Wrobel, CEO, HealthLinc
Beth Wrobel is CEO of HealthLinc of Valparaiso, IN.
Describe what HealthLinc does.
We are a Federally Qualified Health Center. The federal government realized that there was a need to build a national infrastructure for the underserved, which up until now was the uninsured, Medicaid, and Medicare, although that’s changing.
HealthLinc was one of those free clinics back in the 1990s. In early 2000, we applied to become a Federally Qualified Health Center. We get a little bit of state funding and some federal funding, but most of our funding comes from patient fees — Medicaid, Medicare, or a sliding fee basis.
We treat the whole body. We have medical, dental, and behavioral health on site. At one of our sites, we have optometry. We have on-site pharmacies. Truly we’re a one-stop shop for those who are underserved.
We’ve seen a huge change as people get $5,000 or $10,000 deductibles. In my mind, those are becoming our underserved. At least in Indiana, we’ve been able to get a lot of the uninsured to get services through what they call the Healthy Indiana plan. We’re not supposed to call it Medicaid expansion, but it really is our Medicaid expansion. We’re a healthcare provider that treats the whole body.
What lessons have you learned in managing health and not just healthcare episodes?
It goes down to data. A lot of times the healthcare system sees bits and pieces of that body and they don’t communicate. The number one thing that we have learned even internally is to see that person as a whole body.
I like to tease when we talk about optometry, behavioral health, and dental that we put the neck back on the body. The human body is intertwined. If you treat one part of it but don’t look at the other, you could be hurting that person’s outcome. At HealthLinc and with Federally Qualified Health Centers, we look at every part of that and help them.
The other part that is different for us is we never start with, "The patient will…" You can say until you’re blue in the face, "The patient will go get their meds. They’ll exercise." We have people that help them set goals and help them understand that. Treating the whole body and communication are the two things we do best.
What technology do you use?
We have a practice management system that talks to our electronic health record. That’s from Greenway. They have three platforms, but the one we use is called Intergy. We use it for optometry. We use it for behavioral health. It’s very flexible. We just switched to a new dental program, MediaDent, so that it talks to it.
Our medical providers can see what’s happened over on the dental side, optometry side, or behavioral health side and vice versa. It’s very common during flu shot season, which we’re just starting in, for dentists to say because it pops up in their side, "You haven’t had your flu shot. I can call someone if you want to get your flu shot right now." That’s just not heard of. It takes the IT infrastructure to be able to leverage that and to be able to do what we do.
How are you using your technology to reach out to patients?
About a year ago we got a call from The Guideline Advantage, which is a consortium of the American Cancer Society, the American Heart Association, and the American Diabetes Association. They had received a grant from the GE Foundation to work with Forward Health Group, a software company, to do population health.
That patient can look great in our electronic health record, but you can’t see what that population is going through. What are you doing? Are there things that we could be doing on a population-wide basis through this Guideline Advantage and Forward Health Group software that would improve not only that patient, but all the diabetics or all the hypertensive patients? That’s our next step in improving our patients’ health.
We’ve also found — I like to joke about this — that once we put in the PopulationManager of Forward Health Group, we were able to see data that wasn’t put in correctly. When we started looking at the population of a site and the BMI of patients in that site, we saw someone that had a 30,000 BMI, which is pretty much impossible [laughs]. It wasn’t me — that was the good news, there’s somebody worse than I am. We were able to start to clean up our data. We’re starting to do a lot more interfaces that go right in to the system and see that the medical assistant typed in the number wrong. Instead of maybe a weight of 130, they might have done 13,000. That doesn’t always come through, but it did in PopulationManager.
Our providers want to give the best care. but sometimes they don’t know what they don’t know. By looking at PopulationManager and seeing that maybe Dr. Smith — we don’t have a Dr. Smith, so I’m going to use that name — his hypertensives are not under control. We can go in there and see why. Is it the population? Is there some additional training? Something that he didn’t know? Is he using the wrong drugs?
We code everything green, yellow, and red. Green is the good — meeting your goals. Yellow is kind of, “You’re almost there.” And red. They all want to be green. When you start to show them a population, it motivates them. It gives them a better picture than what they have when they look at just each patient. That’s making a huge difference, having the TGA people working with us with Forward Health Group.
How would you describe your relationship with traditional health systems and how does the technology fit?
I used to always say we were their safety net, because the Medicaid and Medicare population and the uninsured weren’t the patients that they really wanted. We still have great partnerships. At HealthLinc, we’re pretty well spread across about 100 miles of northern Indiana, across the top of the state, and probably another 80 miles down.
We work with five hospital systems. With some FQHCs I’ve heard of competition, but we work with them more. But I could see as we start seeing these more of these commercial insurances come to us, there is the potential of that.
I have heard stories – again, I’ve never been able to document it — that the primary care aspect of a hospital system is the loss leader. They make money on everything else. My dream someday is to get a hospital system that says, "You guys are really, really good at primary care. You’re a patient-centered medical home. You have the infrastructure and everything. We’ll let you be that primary care infrastructure. You’re going to send labs and things like that to us."
From a community financial standpoint, that makes more sense to me. Of course, that’s me talking and not a hospital CEO. But looking at those relationships and what we can do to improve the health of the community, because we have been doing this infrastructure where we treat the whole body for a while now, it’s hard to catch up with that, but we’re there. So far, so good. We aren’t seen as a competition, but I could see where that could happen down the line.
FQHCs are required to have strong patient representation on their boards, which isn’t common with health systems. How does the patient perspective influence how your operation is conducted?
Patients of the clinic are 51 percent of our board. That makes a huge difference. I’ll give you an example. Before we had optometry, we had an eye doctor who would see our patients. It was in another town. There were transportation issues and things got in the way. Every time they had a no-show, they would call up. For $35, you got an eye exam and glasses. She would fund-raise on her own to pay for the glasses.
I brought that up to the board. I said, "I’m really struggling. I’m afraid we’re going to lose this doctor. Any ideas?" One of the patients on our board said, "Why don’t you charge them the $35 up front and make them sign and if they didn’t go, they lose it?" Not that $35 is much money for someone with means, but for them, it meant a lot. Once we implemented that, the no-show rate dropped drastically. We got our own optometrist. We were able to keep that eye doctor.
Social determinants of health are becoming very prevalent now. Are you close to a grocery store? Do you have transportation? Do you have babysitting services? You can’t come to your appointment because you have to drag six kids, but Medicaid only pays for you to bring one kid in transportation? Those kind of things. They can really help us with that, too. It’s a win-win because we understand more of what it is for our patients. But everybody has those social determinants sometimes, whether you have money or not. That’s an aspect that isn’t there in primary care.
We’re open until 8:00 four nights a week, 6:00 on Friday, and open on Saturday. A lot of primary care hospital-run systems are not open that late. They want you to go to urgent care. Urgent care can take care of your urgent needs, but they’re not going to take care of your diabetes or hypertension and do your well checks.
In one of our sites that we were able to build about two years ago, we started seeing more commercial insurance patients. They’re at work and they can’t get to the doctor, but we’re open until 8:00, so they can come to us. Again, they have money. They could go anywhere. They have insurance. But because of our hours, they like to come to us. It’s bringing in what that patient needs.
Do patients who could go anywhere consider your services to be at least equivalent?
When they get through the door and they see the one-stop shop, they are like, "Oh my gosh, this is great." A newspaper editor came and we went, "Wow, I’ve never seen something this nice." We treat them with respect. We treat everybody with respect. That comes through very quickly to people.
It’s been a journey. At one time, we wouldn’t take commercial insurance. We started before the marketplace, but a lot of our patients were over 200 percent of poverty, which is $24,000 a year, approximately. When the marketplace came, they were able to get some insurance, but they stayed with us because they liked it. They felt like they were getting good care. Our hours were convenient. We treated them well. That’s important. If you feel comfortable where you’re going to your doctor, that helps with keeping you in good health, or if you’re sick, improving your health.
Where do you see the healthcare system in 10 years?
My crystal ball is broken, but I guess what I can say is that we’ve got to do something. We cannot continue for these costs to go out of control.
What I’d like to see is that every system has population health, that patients can get the healthcare wherever they want, whether it’s going to the doctor or doing telehealth. Until we get to the point where we can control the cost and use these population health programs like Forward Health Group and through the TGA, we’re not going to do that. My dream is that we will see the costs go down and that our health improves.
Comments Off on HIStalk Interviews Beth Wrobel, CEO, HealthLinc
ONC launches a new EHR complaint form that it will use to “better triage, track, route, and respond to your health IT concerns or challenges.” Users can file complaints concerning EHR usability, interoperability, safety, and more.
The New York Times profiles the philanthropic organization established by Meditech co-founder Mort Ruderman, and the role his grandson plays managing it.
During last week’s Health IT Policy Committee, team members from the Interoperability Task Force presented its report on the barriers facing EHR interoperability, concluding that the market is slowly moving in the right direction, but at an unacceptably slow pace that is being caused by unclear financial incentives for embracing interoperability.
The 21st Century Cures Act, which passed in the House 344-77 this past July, is facing a tougher time gaining traction in the Senate due to funding issues and its $8.75 billion price tag.
ONC launches a health IT complaints webpage for providers to report health IT concerns or challenges that they can’t resolve through other channels, including information blocking, EHR usability issues, or certified EHR products that aren’t performing as expected. ONC says it will triage, track, route, and respond to submissions, although it adds that “we may not always have the ability to step in and fix the problem.” Meanwhile, to whom should I complain about the error message I receive when trying to access the alleged complaints page?
Reader Comments
From Reluctant Epic User: “Re: DonorsChoose project. I’m inspire by the anonymous vendor executive’s matching contribution pot, but I don’t have an anonymous vendor executive’s paycheck. Can you set up a way for your provider readers to kick in small amounts to keep the pot alive?” DonorsChoose helped me figure out how to do it:
Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
I’ll be notified of your donation and you can print your own receipt for tax purposes.
I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.
The reason I set a $1,000 vendor minimum initially was because I was offering them an HIStalk plug for their donation and that seems worth a fair donation amount to a vendor. For companies or individuals who don’t need that exposure, you can donate whatever amount you like using the process above and I’ll take it from there.
Speaking of DonorsChoose, Mrs. W reports from Las Vegas, “I cannot begin to explain what an impact the iPad case, iPad adapter, and Chromecast have made in my classroom! Since the day I received the package in the mail, the materials have been in the hands of students. The students love using apps to extend learning, we love watching academic content using the adapters on our projector, and we know our iPad is safe. These are such special tools that I will continue to use every day in my classroom. Thank you for making a difference and improving my classroom environment. I work so hard to provide the best education for my students, and this donation helps to make their classroom a fun and exciting place to learn!”
From The PACS Designer: “Re: Apple’s iPad Pro. Medical capabilities were demonstrated at Apple’s launch event. The iPad Pro has double the resolution of previous devices and also 3D.” Video of the announcement is here. I wouldn’t be a prospect for a “tablet” that weights 1.57 pounds and has a screen nearly as big as a laptop’s, especially when it costs $799 for just 32GB of storage. I could get two laptops for that price and have a terabyte hard drive, nice keyboard, and 8GB of memory (my Toshiba Satellite cost less than $400). Still, I’m sure the Apple fanboys will be waving their giant new toy conspicuously around at every opportunity. It’s fascinating to me that phones are now as big as tablets and tablets are now as big as laptops even thought portability was the genesis of all three. It will be interesting to see how the iPad Pro competes with Microsoft’s Surface Pro running Windows 10, especially since neither device seems to solve any particular problem or market deficiency except for people who desperately need an expensive, heavy, electronic version of a pencil and paper.
HIStalk Announcements and Requests
Seventy percent of poll respondents have designed or written clinical software, which I find commendable (since I’m one of the majority). New poll to your right or here: how much success will Salesforce have in healthcare?
An anonymous reader reported last week that Portland Adventist has experienced significant revenue cycle problems following their June go-live on Cerner. That’s not true, according to folks on site. Bills are processing, claims are being submitted, and nothing unusual is happening considering where they are in their conversion.
I filed an Office for Civil Rights complaint in early July after my hospital refused to give me an electronic copy of my medical record. I still haven’t heard anything from OCR or the hospital other than the auto-generated “we have received your submission” OCR message.
I’m not honored to be speaking at a conference, not thrilled to have been nominated for an award, not exhausted from a vacation to Bora Bora, and not grateful that some journal has published my article. We get it, Mr. Social Media humblebragger – you are way more wonderful than the rest of us. Meanwhile, I’m having fun unfollowing Twits who litter my feed with sports-related tweets, possibly unaware that I could just go to ESPN.com rather than follow healthcare IT people if I cared about tennis or college football updates.
Last Week’s Most Interesting News
Excellus BlueCross BlueShield discovers that hackers have had access to the information of 10 million people since December 2013.
GetWellNetwork acquires Skylight Health Systems, combining the #1 and #2 KLAS-ranked interactive patient systems vendors.
3M announces that it may sell or spin off 3M Health Information Systems.
IBM Watson Health announces a population health application and brings on former Philips Healthcare CEO Deborah DiSanzo as GM.
An independent assessment of the death of Ebola patient Thomas Duncan commissioned by Texas Health Resources finds that its employees were overly reliant on Epic to convey critical information, the placement of travel history information separate from the patient assessment in Epic was ill advised, and employees either didn’t understand or ignored an on-screen infection warning in discharging the patient when he had a fever.
The New York Times profiles hospital cost analytics work done by University of Utah Health Care.
Webinars
September 22 (Tuesday) noon ET. “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements Using Simple but Predictive Adoption Metrics.” Sponsored by The Breakaway Group. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group; Gene Thomas, VP/CIO, Memorial Hospital at Gulfport. Simple performance metrics such as those measuring end-user proficiency and clinical leadership engagement can accurately assess EHR adoption. This presentation will describe how Memorial Hospital at Gulfport used an EHR adoption assessment to quickly target priorities in gaining value from its large Cerner implementation, with real-life results proving the need for a disciplined approach to set and measure key success factors. Commit to taking that scary first step and step onto the scale, knowing that it will get measurably better every day.
September 22 (Tuesday) 5 p.m. ET. “Laying the Groundwork for an Effective CDS Strategy: Prepare for CMS’s Mandate for Advanced Imaging, Reduce Costs, and Improve Care.” Sponsored by Stanson Health. Presenters: Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai; Anne Wellington, VP of informatics, Stanson Health. Medicare will soon penalize physicians in specific settings who do not certify that they consulted "appropriate use" criteria before ordering advanced imaging services such as CT, MRI, nuclear medicine, and PET. This webinar will provide an overview of how this critical payment change is evolving, how it will likely be expanded, and how to begin preparations now. A key part of the CMS proposal is clinical decision support, which will help meet the new requirements while immediately unlocking EHR return on investment. Cedars-Sinai will discuss how they decreased inappropriate utilization of diagnostic tests and treatments, including imaging.
Sales
WellCare Health Plans will use analytics from Inovalon.
People
Altru Health Systems (ND) promotes Mark Waind to CIO.
Privacy and Security
A study finds that longer, more complex passwords may actually be less secure than easier ones because users are likely to put them on sticky notes left lying around. It gives as an example a recent Super Bowl live TV camera shot that displayed the press-only Wi-Fi network credentials as jotted down by someone worried about forgetting them, allowing thousands of fans to jump on.
Other
A New York Times article about family philanthropic foundations profiles the grandson of Meditech co-founder Morton Ruderman, who earns $225,000 per year to give away $10 million per year of the foundation’s $185 million in assets to recipients in the US and Israel while making sure not to run afoul of the IRS while disbursing the money to organizations that can have the desired social impact. Morton Ruderman (above), who died in 2011, was also involved in real estate development.
A federal judge declines to send a Chinese citizen and former NYU professor to prison for accepting a $4 million NIH grant that he used to patent his research findings on behalf of the China-based imaging company for which he was secretly working.
The Portland business paper profiles Michael Blum, MD, cardiologist and CMIO at UCSF Medical Center and his thoughts on the future of healthcare. He likes ever-shrinking sensors, analytics, treatment of addiction behaviors (including food), and DNA sequencing.
Weird News Andy will be sorry he didn’t get to the bottom of this gem of a story. A woman arrested on jewelry theft charges after surveillance video showed her swapping a fake diamond for the real one she then secretively swallowed produces the evidence when the six-carat, $278,000 diamond is removed via colonoscopy.
Sponsor Updates
Huron Consulting Group will present at the Deutsche Bank Technology Conference September 16 in Las Vegas.
Streamline Health will exhibit at Medhost’s The Nashville Experience September 16.
HIMSS Analytics releases its 2015 Telemedicine Study which surveys health IT executives on current telemedicine projects. The survey measured an uptick in both adoption and awareness of telemedicine products and services and finds that two-way video conferencing systems are the most popular communications systems being used.
IBM opens its new Watson Health headquarters in Cambridge, MA while simultaneously announcing a new population health solution that integrates its data analytics tools with Apple’s HealthKit and ResearchKit.
3M is shopping around its health information systems business, which offers coding software, services, and analytics tools, and expects to make a decision on whether or not to sell by Q2 2016. The business unit booked $730 million in revenue in 2014 and has delivered “greater than 10-percent compounded annual growth over the past three, five and 10 years.”
New York insurer Excellus BlueCross BlueShield announces that the information of 10 million members has been exposed in a previously undetected cyberattack that started in December 2013.
Reader Comments
From DejaVuAllOverAgain: “Re: Portland Adventist in Oregon. Word is they’re having revenue cycle problems after going live on Cerner in June, with no claims sent since. Patients are filing complaints that they know they owe something, but don’t know what amount.” Unverified.
HIStalk Announcements and Requests
Mrs. S says she was “honestly blown away” by our DonorsChoose grant that provided two Amazon Fire tablets for STEM time in her Oklahoma elementary school class. She adds, “My favorite part about getting this project funded was explaining to my students that people we don’t even know bought these Kindle Fires for us to use in our classroom so that we can access all the technology we need. They couldn’t believe that people cared that much about their education that they would buy those for them.” I still have matching funds from an anonymous vendor executive for companies or individuals who would like to donate $1,000 or more to DonorsChoose – it’s a really easy process and I’ll give you credit on HIStalk unless you would rather remain anonymous. Contact me.
Also checking in was SC second grade teacher Mrs. J, for whom we covered lodging expenses so she could attend a national educator’s conference (with matching funds from the Bill & Melinda Gates Foundation). She’s using techniques she learned every day, such as playing boom box music for a quick class dance when they answer hard questions.
Listening: new from LA skate punkers FIDLAR, an acronym that is, like most of their music, exuberant but far from family friendly. Also, new from David Gilmour, who just started his first tour (including some Pink Floyd songs and a tribute to deceased Floyd keyboardist Richard Wright) since 2006 to support his upcoming new album.
I use Upflix to sort Netflix offerings by category and by IMDB and Rotten Tomatoes scores, which led me to find The Babadook, an excellent Australian horror film that avoids cheap jump scares and instead focuses on the psychology of the characters. It’s annoying that Netflix’s star system is a history-driven recommendation rather than a summary of actual reviews, but that’s where Upflix comes in.
My latest grammar and usage peeve: people doing product demos who refer to an unnamed doctor as “he” or an unnamed nurse as “she,” perpetuating gender stereotyping (“they” is probably incorrect although I like it, but otherwise “he or she” will do or just “Dr. Smith”). Even more annoying are those who hiply overcompensate by referring to the doctor as “she.”
This week on HIStalk Practice: ICD-10 optimism overshadows lack of provider prep. The Pennsylvania eHealth Partnership Authority offers $10 million in grants to connect practices to its P3N HIE. Medical actors give new meaning to self-exams. VillageMD co-founder outlines the role primary care will play in population health management. New Jersey and Tennessee rank at the bottom for EHR utilization by office-based physicians. Med students take advantage of farm-to-table culinary medicine courses.
This week on HIStalk Connect: Researchers working in organ engineering achieve "single-cell resolution" that will allow them to construct biologically accurate organ structures. Fitbit sues Jawbone for patent infringement in response to the three lawsuits Jawbone filed against Fitbit earlier this year. Scanadu recruits 4,000 clinical trial participants from its list of Indiegogo campaign backers. Digital health accelerator programs begin targeting international markets.
Webinars
September 22 (Tuesday) noon ET. “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements Using Simple but Predictive Adoption Metrics.” Sponsored by The Breakaway Group. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group; Gene Thomas, VP/CIO, Memorial Hospital at Gulfport. Simple performance metrics such as those measuring end-user proficiency and clinical leadership engagement can accurately assess EHR adoption. This presentation will describe how Memorial Hospital at Gulfport used an EHR adoption assessment to quickly target priorities in gaining value from its large Cerner implementation, with real-life results proving the need for a disciplined approach to set and measure key success factors. Commit to taking that scary first step and step onto the scale, knowing that it will get measurably better every day.
September 22 (Tuesday) 5 p.m. ET. “Laying the Groundwork for an Effective CDS Strategy: Prepare for CMS’s Mandate for Advanced Imaging, Reduce Costs, and Improve Care.” Sponsored by Stanson Health. Presenters: Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai; Anne Wellington, VP of informatics, Stanson Health. Medicare will soon penalize physicians in specific settings who do not certify that they consulted "appropriate use" criteria before ordering advanced imaging services such as CT, MRI, nuclear medicine, and PET. This webinar will provide an overview of how this critical payment change is evolving, how it will likely be expanded, and how to begin preparations now. A key part of the CMS proposal is clinical decision support, which will help meet the new requirements while immediately unlocking EHR return on investment. Cedars-Sinai will discuss how they decreased inappropriate utilization of diagnostic tests and treatments, including imaging.
Acquisitions, Funding, Business, and Stock
GetWellNetwork acquires Skylight Healthcare Systems, combining the top-rated interactive patient systems vendors.
Streamline Health Solutions announces Q2 results: revenue up 19 percent, EPS –$0.05 vs. –$0.14. Above is the one-year price chart of STRM (blue, down 27 percent) vs. the Nasdaq (red, up 5 percent). The company said in the earnings call that it is talking to leading healthcare IT vendors about reselling its Looking Glass solutions. It has also implemented a message bus that will tie its solutions together using RESTful APIs, allowing it to create value around existing client EMRs. Streamline says working with NantHealth on genomics is fun for its engineers and good for the company as it adds life sciences customers.
3M is exploring the sale or spinoff of 3M Health Information Systems, expecting to reach a decision by early next year. The business generates $730 million in annual revenue in sales of technology for coding, population health management, clinical documentation improvement, transcription, and revenue cycle management.
Roper Industries acquires RF Ideas (card readers and proximity-based workstation security) and Atlantic Health Partners (a healthcare group purchasing organization) for a combined purchase price of $277 million. Some of Roper’s other healthcare companies include Sunquest, Strata Decision Technology, Data Innovations, IPA, Managed Health Care Associates, Verathon, SoftWriters, and SHP. ROP shares are up 8.5 percent in the past year, valuing the company at $16 billion.
Sales
St. Joseph Health (CA) chooses Meditech’s Business and Clinical Analytics solution.
Value Care Alliance (CT) will deploy analytics from Arcadia Healthcare Solutions to its five member hospitals to compare cost, quality, and efficiency metrics.
People
Leidos Health promotes Tom Aikens to deputy group president.
PeraHealth hires Elizabeth Pruett (Innovative Healthcare Solutions) as VP of clinical services.
Deborah DiSanzo (Philips Healthcare) joins IBM Watson Health as general manager.
Richard Taylor, national sales director for ScImage, died Monday at 63.
Announcements and Implementations
HIMSS Analytics releases its ”2015 Telemedicine Study,” which points out that while telemedicine adoption increased only modestly in the past year, providers are using a “hub and spoke” model to spread services over their locations. The study adds that the term “telemedicine” is loosely defined and no single solution or service dominates, but that situation is changing as providers get serious about expanding their services, most often by using two-way video.
Mobile charge capture and physician communication technology vendor PMD announces release of a mobile ICD-10 conversion tool.
Partners HealthCare and Health Catalyst will create the Partners HealthCare Center for Population Health, which will train employees of both organizations on care management and population health. Health Catalyst will license Partners intellectual property, while Partners has signed an enterprise-wide Health Catalyst subscription. Partners has been a Health Catalyst investor since 2013 and will increase its equity stake.
IBM Watson Health announces a population health solution that integrates Watson Health with Apple’s HealthKit and ResearchKit. The company also announced collaboration with Boston Children’s Hospital and Columbia University.
Merge Healthcare will collaborate with the non-profit Rad-Aid International, offering charitable contributions of software and expertise to medically underserved and poor regions of the world.
Israel-based Archimedicx launches an “intelligent and objective global hospital search engine” that allows consumers to find hospitals based on condition or procedure. The company’s methodology is certified by HIMSS Europe, although the data sources and algorithms are not stated. It covers only 300 hospitals. The company’s terms of use indicate that it makes money when someone outside the US contracts for services from a US hospital – the hospital pays Archimedicx a fee ranging from $2,000 to $15,000. I’m surprised at how prominently the company includes the HIMSS logo on its materials – I assume money changed hands to make that happen.
Government and Politics
The biggest IT project in Rhode Island’s history, a Medicaid and food stamp management system being developed by Deloitte, will cost at least triple the original estimates. Federal taxpayers will cover all but $77 million of the project’s estimated $364 million completion cost. A state executive says the new estimate isn’t due to cost overruns, but rather that changes made to get more federal money, saying, “With another administration in Washington, it is unclear as to whether this kind of opportunity to get federal support and federal funds to build a system like this would be possible. Then it would fall on Rhode Island taxpayers.” A limited government advocacy group calls the project a “dependency portal” that encourages residents to go on the dole.
A fourth rural Tennessee closes following the state’s decision to opt out of Medicaid expansion, although low volumes made them unprofitable anyway. People seem to want to do something about the closures despite lack of market demand, although I don’t know why the hospitals couldn’t just run a free-standing ED instead of staffing empty beds that nobody wants to be in. Every small town hates to lose the local hospital, but in most cases they would receive better routine and elective care at a bigger and busier facility (I say that having worked in small, rural hospitals for years).
Innovation and Research
A UK company a 3D barcode that can be imprinted as tiny pinpricks on tablets to detect counterfeit drugs. The challenge would seem to be in getting hospitals and pharmacies to perform the scan, especially since the drug supply chain is better protected in the US than in many other countries.
Otsuka Pharmaceutical Co. and Proteus Digital Health announce that the FDA has accepted their New Drug Application for the first “digital medicine,” an aripiprazole tablet (for psychiatric problems) embedded with a digital sensor that reports back to the prescriber whether the patient is taking their medication correctly. The drug-device combination requires FDA approval for each component, the tablet itself and the ingestible sensor that sends information via a patient-worn patch.
Technology
AirStrip announces on stage at Apple’s event this week that it will allow users to authenticate simply by wearing an Apple Watch running the AirStrip app. Video from the Apple event shows how pregnant women at home can be being monitored via AirStrip’s Sense4Baby (which it acquired last year) while wearing a sensor and Apple Watch, which can distinguish the mother’s heartbeat from that of the baby.
Other
The Miami paper lists the highest-paid employees of tax-funded Jackson Health System, with the CEO topping the list (of course) at $1 million. The CIO was #69 at $282K and the CMIO #85 at $256K. I’m surprised that several nurse anesthetists topped $250K in annual compensation, but then again I haven’t paid attention to CRNA salaries.
England’s NHS asks the government to include nurses on its list of positions with official shortages, saying it needs at least 1,000 RNs from India and the Philippines in the next six months.
Philadelphia’s fire department is investigating a video showing an ambulance driver checking Facebook and texting while transporting a woman and her toddler to the ED.
EClinicalWorks will exhibit at the International Vision Expo & Conference September 17-19 in Las Vegas.
FormFast will exhibit at the InSight 2015 Annual Conference September 15-18 in Nashville.
Healthcare Data Solutions will exhibit at the H-E-B Pharmacy Conference September 15 in San Antonio.
Health Catalyst announces that its Healthcare Analytics Summit 2015 drew 1,000 attendees to Salt Lake City this week.
Healthfinch, Iatric Systems, and Liaison Technologies will exhibit at the North Carolina Healthcare Information & Communications Alliance Annual Conference September 13-16 in Pinehurst, NC.
Ingenious Med will exhibit at the 13th Annual Canadian Society of Hospital Medicine Conference September 17-24 in Ontario.
Leidos Health will exhibit at InSight 2015 Annual Conference September 15-18 in Nashville.
LiveProcess will exhibit at the Vermont Association of Hospitals and Health Systems 2015 Annual Meeting September 16-18 in Jay.
AirStrip will exhibit at the Leerink Partners Healthcare Summit September 16-18 in St. Helena, CA.
Impact Advisors is named to Modern Healthcare’s “Largest Revenue Cycle Management Firms.”
Aprima will exhibit at the Ohio American Academy of Pediatrics Annual Meeting September 11-12 in Dublin.
Bottomline Technologies will host its annual Race for a Cause September 12 at its headquarters in Portsmouth, NH. Proceeds from the event will benefit Families First Health & Support Center.
Capsule Tech will exhibit at the Medhost Mpact Summit September 15-18 in Nashville.
CoverMyMeds will exhibit at the Minnesota Pharmacists Association Annual Conference September 11-13 in St. Paul.
Quest Diagnostics SVP and CFO Mark Guinan presents at the 10th Annual Wells Fargo Healthcare Conference in New York City.
Navicure will exhibit at the Oregon MGMA Fall Conference September 16-18 in Eugene.
Netsmart will exhibit at the Kansas Public Health Association Conference September 17 in Manhattan.
Park Place International Systems Engineer Erick Marshall is recognized as a #vExpert for contributions and engagement with the VMware community.
Experian Health will exhibit at the 2015 Alabama HFMA Fall Institute September 13-16 in Sandestin, FL.
Patientco will host an Arkansas kick-off event September 17 in Little Rock.
September 10, 2015Dr. JayneComments Off on EPtalk by Dr. Jayne 9/10/15
I was pleased to see that Vermont finally legalized electronic prescribing of controlled substances, making the process now legal in all 50 states. According to Surescripts, only 2 percent of physicians are electronically prescribing controlled substances. Early on, even if it was legal in your state, it was still a challenge due to lack of pharmacy participation. Now nearly 80 percent of pharmacies can accept controlled substance prescriptions and I’m guessing that the cumbersome workflows involved are contributing to the low numbers.
The two-factor authentication options offered by my primary vendor include a key fob token or a soft token installed on a cell phone. We have a strict “no cell phones” policy (even for physicians) so that option is out and my partners weren’t too wild about having to carry a token. We dispense most of our controlled substances in-house, so our practice hasn’t adopted yet. Since we dispense, we’re not afraid of being able to meet the controlled substances requirements, but I have several friends who are nervous about the auditing and reporting requirements.
This week, CMS is urging practice to contact their software vendors, clearinghouses, and billing services to “ask about testing and training opportunities.” We’re three weeks out and I think it’s a little late in the game if practices are just starting this process. I continue to be amazed by the number of practices that are way behind on their preparations. A solo physician contacted me today, finally realizing that we’re not going to get a reprieve. He forwarded a 26-page “checklist” of to-do items from his software vendor. It was more like a novella than a checklist and had cross-references to more than a dozen other documents, each with other check lists.
Although the document was overwhelming, I can’t fault the vendor too much because their checklist outlined a timeline that was to have begun six months ago. Had the work been done on the vendor’s suggested timeline, the steps would have been relatively small and manageable by any practice. Trying to tackle it at the last minute though is like standing at the bottom of a cliff and hoping a flying elephant can help you get to the top. I’m going to do some ICD-10 coding training for him, but had to refer him out for the technical pieces. I haven’t adjusted my fee schedule for the last-minute rush, but I bet clients will be paying a premium for technical services as we get closer to the deadline.
CMS also released webcasts for Dental, Lab, Pharmacy, and Radiology clinical concepts. In addition to new documentation requirements, the presentations cover physician perspective. I’m sure the physician perspectives they present are pretty far from what many of my colleagues are thinking, which ranges from, “Why did I go into medicine again?” to, “I should have gone to a cash-only practice when I could.”
Last week, Mr. H mentioned a study that looked at episodes of “Grey’s Anatomy” and “House” and how on-screen patients fared with CPR. They survived at twice the rate of real patients. Thanks to Netflix and some quality time on the treadmill, I’m finally caught up on “Grey’s” and was happy to see Dr. Miranda Bailey discuss her end-of-life preferences with her husband even if he didn’t agree.
HIMSS recently sent me a “Connected Health” survey that asked about my organization’s plans to expand technologies in the next year. Most of the organizations I’m working with are delaying any strategic planning sessions until after the Meaningful Use final rule is released. Between the uncertainty of the requirements and the strain of ICD-10 and related upgrades, everyone just seems to be running out of gas.
A reader made my day with this piece in The Onion: “Health Experts Recommend Standing Up at Desk, Leaving Office, Never Coming Back.” I’ve definitely had days when I feel like taking their advice to use my lunch break “to walk until nothing looks familiar any more.” I sent back an email of thanks and was rewarded with this gem from Gomer Blog detailing an EHR upgrade gone wrong.
Have you ever had a week when you feel like you’re going to have to send your IT team to a safe house? Email me.
Excellus BlueCross BlueShield and its affiliate Lifetime Healthcare Companies reports that a cyberattack executed in December 2013 has exposed the demographic and medical claims data of 10.5 million of its customers.
A JAMA study evaluates EHR vendor compliance with ONC’s usability and user centered design requirements, finding that many certified vendors are out of compliance but continue to hold their certifications.
A federal district judge has approved a House GOP lawsuit against the ACA to move forward. The suit alleges that the White House is using unauthorized funds to pay for components of the healthcare law.
HIMSS publishes its annual list of congressional asks, including: bolstering support of EHR interoperability, helping organizations combat cyber threats, and approving broad telehealth reimbursement for Medicare beneficiaries.
Arcadia is an EHR data harmonization and analytics company. We focus on building high quality, highly usable data assets for risk-sharing entities such as health plans, IDNs, and IPAs. The scope of the business has us covering 20 million patients, 40,000 providers, and 4,000 practices, both owned and affiliated.
As for myself, I am a lifer in health IT. I’ve been at it for almost 30 years across six companies. All of those companies have had some principal focus on data and some form of disruptive technology or business model component. I’ve been here at Arcadia for two and a half years.
Your solutions connect to the back end of EHRs. Interoperability seems to have settled on two sides of the equation, one being real-time integration that requires vendor participation and the other being to extract information in some other way as needed. Do you see that perhaps the market forgets that external applications can sometimes access EHR databases directly?
Yes. That’s been our focus, certainly for the last decade — working quite deliberately on the back end of the top 30-plus electronic health record systems in the market. I think right now the standard is less about two-way operability, especially between EHRs. That’s very rare if not non-existent. But more so the kind of deep integration that is needed to execute against the kinds of measures that are emerging in the marketplace largely driven by value-based care.
Do you need the EHR vendor’s help to understand their data catalog and metadata or can you discover that on your own?
We don’t need their help, necessarily. We certainly need a customer who has invested in electronic health records to work with us to make all parties helpful to the process, because in the end, it’s the patient we’re trying to help, and it’s the customer who has made that investment who needs to drive how to get at that data to provide quality care and lower cost.
You connect to 30-plus data sources. How much information outside the EHR is needed to give you a complete picture of a patient or of quality?
Right now I would say it’s very helpful fringe-level data. Most of the market is still reconciling to the notion that deep clinical data from electronic health records is paramount to creating a high quality, highly usable data asset. We do have clients who are already well into that path, of course, and have asked us to pull in data from practice management systems or other systems that have bits and pieces of information that might not exist elsewhere.
What insights are customers discovering that they wouldn’t have been able to figure out just by looking at the EHR?
A simple example would be if you are looking at claims data — which is principally how people begin to think about analytics around healthcare data that’s been the standard for so long — you would be able to see from a claims component that someone had a cancer screening test done. But without the integrated EHR data in that analysis, you wouldn’t know necessarily whether they have cancer. If you think about where healthcare is trying to move to in terms of closing gaps in care and being efficient, the combination of those two things is what’s really needed to be more timely and efficient in how you handle the patients. That’s a very basic but I think a very important and high-profile example.
Providers often don’t know what questions to ask until they see a report that, by definition as a canned report, reflects the collective best practices of the vendor’s other customers. Are your off-the-shelf reports a surprise to providers who wouldn’t have thought about looking at specific information on their own?
Absolutely. Some of that is driven by the breadth of the information that results from that combined data set. But oftentimes with electronic health record data in the mix, you’re seeing things much more real time than you would from claims-based analysis only. They’re in a position to react to situation much more quickly through deeper and broader information that is much more timely, as most of our data refreshes every 24 hours.
EHRs focus on transaction management and data completion. They don’t do a lot on the front end with patient engagement and then on the back end some of them don’t have robust analytics. Do you see the post-EHR era being three legs of a stool with the EHR vendor providing just one?
Absolutely. The future would suggest that it’s the next generation of systems that have the capability to harmonize data from a variety of systems and draw insights from that aggregated data set. That was the original thesis for the electronic health record. Given how adoption has been less and it has taken the time that it has and the business model of value-based care and global payment is now in the driver’s seat in the marketplace, I see the electronic health record systems as a source of information among many. Albeit a very very important one and with a great deal of the necessary information, but still just a source.
EHRs were supposed to be different from EMRs because they would collect and present health information from many systems in many encounter locations outside a given provider, such as dental offices, drugstores, and long-term care facilities. That EHR concept was sidetracked when ONC decided to certify the same old EMR products and call them EHRs. Would you agree that no provider has deployed what might truly be called an EHR under that original definition?
There are unique deployments of electronic health records with unique organizations that have gotten close to the original promise of what they were intended for, but the vast majority of the market has not realized the original dream. Based on the slow march towards value-based care, we’re going to see a reset where next-generation technology is going to drop on that substantial footprint of EHRs that exist, but it won’t be the single answer. It will have to be compiled with clinical, business, and claims data from other systems to affect and support the change that’s required in the healthcare model.
Is it common now to incorporate claims data?
It’s more common. Certainly the payer marketplace is recognizing that their data coupled with clinical data is a great asset in the marketplace. About half of our clients are payers and some of the more advanced ones — like a large Blue Cross organization in New England that we work with — use aggregated claims and electronic health record data to support the administration of a very creative pay-per-performance program. That’s been very successful in bringing together providers and in the plan on the premise that if we share information carefully and appropriately, we can in fact provide incentives, control costs, and affect quality in the way that we want.
There are certainly real things happening out there with data when it comes together with the provider side of market and the payer side of the market. It works the other way, too. We have direct clients who are large provider organizations or large ACOs who are doing the same thing for similar reasons. But the concept is very much the same – the datasets together provide the lens into what’s happening across principally their ambulatory networks and they can see and manage at the population level.
Are providers are getting into the payer side of the business?
Sure. We talk to provider organizations all the time who are contemplating moving toward building a plan.
We see this in both directions, but the trend we’re seeing more is a much stronger willingness to come to the table, provided that the technology exists and there is the presence of some form of trusted third party — which is a role that we typically play — to help aggregate and arbitrage the right data to the right people in a very trusted and appropriate way. We’re seeing that trend more than providers standing up plans or plans somehow getting closer to providers.
What factors should a provider consider when choosing an analytics vendor?
It’s a very needed competency. It truly is all about the data when it comes to being effective in a value-based model. I would make sure that a supplier can connect you up with clients who’ve really put the technology to use and have seen tangible outcomes. Many organizations in the market are still early stage in the development of their technology. Secondly is the question of the source. The source in our mind is electronic health record data.
It’s very customary for us to engage in a dialog with even a medium-sized IDN who might have 50 different EHRs across their network. When you think about extracting the right data from 50 different systems just at the EHR level and getting that harmonized appropriately, it’s very heavy lifting. I would make sure that who you’re talking to can demonstrate that capability in a real way and with references.
The last piece goes back to the provider themselves. Do they have a clear strategy? Because what we’ve found is that many organizations know that they need to move in this direction and they know that data and technology in particular is important or perhaps even a backbone, but they haven’t fleshed out their full plan yet. Therefore, they’re not quite ready for the technology. That’s one of the reasons we acquired the Sage business — to help those organizations who are just a little more early stage to move closer to value-based or risk-sharing before making the investment in a solid data asset on which to drive the strategy.
How did the Sage Technologies acquisition change what you offer?
It added a deep tenure in managed care through this Midwest-based business that provides end-to-end services to provider networks that are engaged in risk-based contracts with managed care payers and ACOs. They provide everything from claims processing, network administration, utilization management including case management, customer service, data management, reporting, and critical care management. Really a full suite of supporting services that are required for an IPA or some form of other provider network to execute when they’re engaged in risk and to be good at it.
A large part of the market is still in that state, thinking about more aggressive moves and deeper risk arrangements where technology starts to become more critical. We wanted to have an ability to serve those clients now and also to make sure that we had the resident services to offer some of our technology clients in support of their activities. It has helped us with a little bit more of an end-to-end capability serving a larger portion of the market, which is very much in transition with a variety of different maturity levels amongst the organizations as it relates to risk-based contracting.
How would you like the company to change over the next five years?
We’re very dedicated to the notion that clinical data in particular — for the next five years and perhaps beyond — aggregated from electronic health record, is fundamental to an effective data strategy. A data strategy is fundamental to being successful in value-based care. We’re focused on that.
We certainly understand the necessity to deliver on the full outcome, but our focus will remain on solving this important and fundamental challenge that organizations have, which is, "I’ve made huge investments in my electronic health record strategy. I need the information out of all of them. I need it timely. I need to be able to then process it right it away in much broader ways, including looking at the full population that I serve. That’s the only way that I will be effective in executing in any sort of risk model."
Our focus will stay there. We hope to be the recognized leader in that particular competency. We’ve been at it for 10 years. We have quite a bit of intellectual property in and around that process. Beyond that, our mission is to help patients and help the system evolve in a high quality way and to deliver to providers a useful tool that will be efficient in the way they provide medicine as these models evolve.
Do you have any final thoughts?
We’re very enthused that the market is signaling clearly that value and value-based models are the landing spot. We see that through multiple things happening with CMS, including recent announcements about supporting value-based characteristics and Medicare Advantage. That’s just another signal. We’re very curious about that. We think that that is where healthcare should be. We think we can play a significant role in assisting in that journey.
Clinical data from EHRs is a difference-maker. We’ve seen it over and over again with our 40 clients. The speed, the depth, and the comprehensiveness of that data, coupled with payer data and other sources, is critical. We believe plans and providers can and will — and in fact, must — come together to share the kind of information that will make all this possible. We’re seeing that happen more and more in the marketplace. We’re looking forward to being a part of this tremendously positive momentum that’s occurring.
Preservation Wellness Technologies, LLC sues Allscripts, Athenahealth, Epic, and NextGen for patent infringement on its patent which generically describes a patient portal that “employs a server on which the health care records of participating patients are stored” and where “patients can review their own records via Internet and can edit them.”
Cerner’s board of directors has approved a stock repurchase program authorizing the purchase of $245 million of its common stock, representing an estimated 1.2 percent of its outstanding shares. The stock will be repurchased in blocks over an undisclosed period of time.
Peer60 publishes analysis on the Clinical Lab and Pathology market, finding that Meditech (25 percent) and Cerner (22 percent) are the segment’s market share leaders, while replacement vendor mind share is closely split between Epic (33 percent) and Cerner (30 percent). 51 percent of respondents report that they are planning to move away from their current vendor.
The New York Times profiles cost analysis work being done at the University of Utah Health Care, kicked off when the CEO found that nobody could tell her what it costs to operate an MRI or OR for an hour. Medical costs have declined 0.5 percent a year since the health system was able to compare costs with outcomes. Sixty seconds in the ED costs $0.82 vs. $12.00 for operating an OR for an orthopedics case, for example. Experts say the health system’s VDO database with 200 million rows makes it one of very few health systems that have any idea of their true costs. The health system saves $200,000 per year simply by requiring medical residents to justify each lab order that they otherwise were cranking out by habit. The depressing aspect is that it’s still novelty news when a health system actually wonders what its true costs are, much less does something about them, which is unfortunately not all that uncommon with non-profits who get to stick someone else with their overhead.
Here’s a video overview of University of Utah Health Care’s VDO (value-driven outcomes) project.
Reader Comments
From Slightly Jaded Epic CIO: “Re: UGM. I was overall underwhelmed by this year’s UGM experience. On the plus side, I continue to be amazed at the show and presentation Epic is able to put on, drawing almost entirely from the talents of their own employees. It is still an amazing group of people to be around at all levels. The new features they demo always have a few real whiz-bang moments, as well.The headlining Judy did regarding aggregating data for clinical research grabbed my attention, but it’s coming in the broader environment of a whole bunch of other services and ideas that have not been executed very well. Epic’s new consultancy service was mentioned, but we and every organization I talked to that had been interested in using it were told that there were no staff available. A program to help implement new features with every upgrade touched on several UGMs ago. Nothing happened until just recently, and my sense is that it doesn’t cover anywhere near the services originally advertised. Also mentioned several UGMs ago (I think originally in 2008) was a move towards a Web-based architecture that could replace Citrix. Several years later, this is still in limbo. It wasn’t even mentioned this year. What is not in limbo is all the money we’re paying to Citrix. I hope some of these big ideas come to pass, but it’s getting harder and harder to walk around all the opulence in Verona and not wonder if our money has been buying an illusion.”
From Former Epic CMIO: “Re: UGM. Someone committed suicide that the Marriott where all the CIOs and CMIOs were staying, apparently jumping from a high floor into the main atrium. Very sad.” The only mention I found confirmed that the suicide occurred on September 1 at the Marriott in Middleton. My first thought was that it must have been someone associated with the event given the number of hotel rooms the user group meeting requires.
From Clarity Disparity: “Re: Nordic. I followed your sponsor link to their site, which is clean and well presented, but it contains an error.” It does indeed, although the number of folks who misspell or mispronounce Epic’s analytics and reporting product Cogito Ergo Sum (“I think, therefore I am”) is in my experience quite high. I like the incorrect name Cognito, though – “incognito” means “unknown,” so “cognito” should mean “known” and is also easy to pronounce. I think Nordic (or is that Nordnic?) is on to something.
From Torn Ligament: “Re: Healthcare Tech Outlook magazine. I received an email that our company has been ‘shortlisted’ for an elite opportunity to sponsor the magazine for $3,000 (woo!) A magazine about healthcare technology that spells HIPAA wrong on its cover? Sign me up!” They also got creative in spelling “administration” as “admisidtration” right above their “HIPPA” gaffe. I tried to figure out who publishes the magazine, but Google turns up nothing about the company, the editor isn’t on LinkedIn or anywhere I could find, and the owner of the web domain is hidden. The magazine’s address suggests that the publisher is SiliconIndia, a Bangalore-based community of Indian professionals that also publishes magazines, with a handful of people working from Fremont, CA and everybody else in India.
From Bamboozled Public Healther: “Re: Mitchell & McCormick EHR/PM for public health. It’s like going back to the 1980s – DOS-based, the company provides no training materials, there’s no MPI, it takes 25 minutes to register, and multiple family members share a single MRN. We’ve had multiple data breaches (of luckily a small number of records) since the system has only three roles – admin, clinician, and business ops – and both clinician users and business ops can see and access all records. According to ONC’s database, no a single health system or provider used this certified EHR to meet Meaningful Use.” Unverified, but this comment is from a system user.
HIStalk Announcements and Requests
Three-quarters of poll respondents haven’t seen a “gag clause” in a vendor’s software contract. A CIO says the closest he’s seen is a clause requiring both parties to review public announcements or publications involving the other organization. New poll to your right or here, brought on my nostalgia for programming I’ve done: have you ever designed or written software that was used by clinicians?
I planned to write a Monday morning post as usual, but after I wrote up all the available news, it would have been a waste of reader time. I just retitled what little content I had and moved on from there.
Welcome to new HIStalk Platinum Sponsor Crossings Healthcare Solutions. The King of Prussia, PA company’s parent is Universal Health Services, which addressed workflow gaps it found in rolling out Cerner solutions to 25 of its hospitals. The Crossings development team optimized the EHR for clinician use by building many software components as mPages and Advisors, focusing a significant part of their effort on Cerner’s Dynamic Documentation solution to move physician documentation from dictation and paper in 11 hospitals in 2015, with 12 more scheduled in the next five months. Those hospitals have seen voluntary transcription reductions from 50 to 90 percent with good physician feedback from all specialties, earning the company Cerner’s “2015 Physician All Stars Award for Physician Documentation.” A CMIO of a large health system says, “You should be incredibly proud … the best client innovation I’ve seen in my 10 years working with Cerner.” Just released is TPN Advisor, which aggregates patient nutrition information on one Millennium chart, decreasing TPN ordering time and calculating compounding instructions that are sent electronically to the pharmacy (a pharmacist describes it as “the most sophisticated clinical decision support tool I have ever seen.”) Future releases include a CNO Dashboard, daily physician documentation with Core Measure advisors, a discharge package, and an DKA advisor. The company will exhibit at Cerner’s CHC15 in Kansas City, MO on October 11-14. Thanks to Crossings Healthcare Solutions for supporting HIStalk.
I found this YouTube video that describes and demonstrates enhanced Dynamic Documentation from Crossings Healthcare Solutions.
Mrs. S sent photos of her Oklahoma third graders using the two iPad Minis bought via our DonorsChoose project, adding that they love playing educational games on them during listening and word study sessions.
Sites keep running new polls about ICD-10 readiness. Why? It’s happening no matter what, so just wait three weeks and we’ll find out who’s ready.
My latest grammar and usage peeve: people who say something such as, “I went to two different doctors,” inserting the pointless “different” to proactively address any misconception that they visited two of the same doctors.
Last Week’s Most Interesting News
ONC revokes certification for the SkyCare EHR after the company appears to go belly up.
Salesforce announces Health Cloud, its patient relationship management foray into healthcare.
Voalte raises $17 million in funding with Cerner as one of its investors.
Epic announces formation of a research network in which the information of its opt-in clients can be searched.
MEA|NEA acquires The White Stone Group.
Former BIDMC CEO Paul Levy calls for an attorney general anti-trust review of Epic in his blog.
Webinars
September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services.
Acquisitions, Funding, Business, and Stock
Cerner announces that it will repurchase up to $245 million in shares of its common stock. Neal Patterson says that “the repurchase of our stock is a good use of funds,” although I’ve never understand how a company buying its own shares from investors does anything more than provide the market with reassurance that it thinks they are undervalued despite what shareholders might otherwise believe.
Craneware announces FY15 results: revenue up 5 percent, adjusted EPS $0.38 vs. $0.34.
Long-term care software vendor PointClickCare files its IPO forms with the SEC. In it, the company reports $102 million in 2014 revenue, up 24 percent even as its losses widened from $3.3 million to $11 million.
Preservation Wellness Technologies, of which no Internet trace exists except for lawsuit filings, sues Allscripts, Athenahealth, Epic, and NextGen for patent infringement. Its patent is summarized as, “A portable heath care records system employs a server on which the health care records of participating patients are stored. The patients may access the system using cards or CD-ROMS that are inserted into the patient’s computer. The patients can review their own records via Internet and can edit them.” The inventor appears to be a hairstyling salon owner.
Franklin, TN-based patient engagement technology vendor Relatient will move into larger office space to accommodate its 24 employees.
Post-acute care EHR vendor Netsmart acquires Trend Consulting Services, a Solon, OH-based IT outsourcing and infrastructure support services vendor.
Community Health Systems files the initial SEC paperwork to spin off 38 of its small-town hospitals and management consulting subsidiary Quorum Health Resources to form Quorum Health Corporation.
Sales
In China, Qingdao United Family Hospital will deploy the InterSystems TrakCare healthcare information system.
People
Dann Lemerand (Evariant) joins Infor as director of healthcare industry and solution strategy. He started the HIStalk Fan Club on LinkedIn many years ago, which has grown to 3,634 members. I should have a random drawing or something since it’s cool to have a fan club and it would be nice to give folks something for signing up.
Darthmouth-Hitchcock Medical Center (NH) Chief Innovation Officer Terry Carroll resigns.
Chris Longhurst, MD, MS (Stanford Children’s Health) will join UC San Diego Health Sciences as CIO, replacing the retired Ed Babakanian on November 2. He will also serve as a faculty member in the Department of Biomedical Informatics.
Surgical ICD-10 coding vendor Vincari hires Maqbool Patel, PhD (YourCareUniverse) as CTO and Hugh Lee (Perigen) as RVP of sales.
Todd Cozzens (Sequoia Capital) joins Leerink Capital Partners as managing director.
Announcements and Implementations
The Tucson paper tells the locals that Banner Health will replace its $115 million Epic system with Cerner in early 2018 at the former University of Arizona Health Network it acquired earlier this year. The article summarizes, “Installing the Epic system and training employees to use it was one of the key reasons the former University of Arizona Health Network, acquired by Phoenix-based Banner March 1, struggled financially throughout 2014 … The investment in Epic was so expensive that the UA Health Network experienced unprecedented operating losses in its 2014 fiscal year, including $32 million in unbudgeted costs.”
Versus announces VUE16, its third Versus User Experience, May 4-6, 2016 in Scottsdale, AZ.
Peer60 releases “Trends in Clinical Lab & Digital Pathology,” which finds that the top LIS mind share leaders are Epic, Cerner, Orchard, and Meditech. Half of the respondents say they’ll switch LIS vendors, not surprising given that they scored their existing vendor an average of 5.2 on a 10-point scale (although that means they’ll most likely be switching to a different but equally low-ranked product). When asked what LIS vendors could do to retain clients, additional functionality and better support rose to the top, but about the same percentage said it wouldn’t really matter since the lab won’t get to make the decision. Half say they’ll never buy digital pathology, most because they don’t offer on-site pathology. Three-quarters say they’re seeing more requests for genetic testing, molecular testing, or both.
The CDC awards a four-year grant worth nearly $4 million to the Kentucky Injury Prevention and Research Center to integrate the state’s KASPER prescription drug monitoring database with EHRs.
The West Texas VA system, which was reporting 43 percent of its positions as vacant, admits that nobody had updated the national computer system for months. The actual vacancy rate was 22.3 percent, still the third-highest in the VA.
Privacy and Security
A Wired editorial on the Ashley Madison breach concludes,
There is a naiveté to how we use the Internet. We never read the small print. We scroll to the bottom, check the box and cross our fingers. We are still terrible at basic online security. The top two passwords used to access Ashley Madison were "123456" and "password", just like everywhere else on the Internet. We trust people we shouldn’t to look after the most personal information about ourselves. "There is no such thing as the cloud", the saying goes, "it’s just someone else’s computer." The data held by Ashley Madison, although embarrassing, was small fry. Every mobile phone in our pockets, every sat-nav in our cars, and every smart meter in our homes is recording something about our lives. We as humans are creating the richest source of information about ourselves in history. Unfortunately for social scientists and historians, that information is held securely by private corporations. Unfortunately for everyone, that information isn’t always held as securely as we might hope.
A Microsoft Research study finds that legacy-friendly database encryption systems such as CryptDB and Cipherbase aren’t very good at protecting EHR information, mostly because the encryption key is held in memory where it can be extracted by exploits. The researchers conclude that CryptDB shouldn’t be used to secure EHR databases.
Innovation and Research
Researchers at the Scripps Translational Science Institute enroll 4,000 people in the first clinical trial of the Scanadu Scout. The six-month study invites participants to use the Scout however they would like to measure heart rate, blood pressure, blood oxygen level, and temperature by touching the device to their temples for 10 seconds. Scanadu’s CEO describes the choice of Scripps for the trial by using one of my least-favorite expressions, calling it “a no-brainer.” The Scout doesn’t sound nearly as cool, useful, or innovative as the early Tricorder hype suggested.
Technology
Dell will sell Microsoft Surface Pro tablets and services to enterprises starting next month.
This is both brilliant and life-changing for some people. The Brightly wearable abdominal belt monitors bladder conductivity to alert incontinent wearers via their smartphone that they need to find a restroom. A similar product in Japan provides the same service for people with fecal incontinence. In either case, wearers suffer less embarrassment and dependence on external pads.
A hospital in England installs an arrhythmia scanner at its visitor entrance, with the palm-scanning technology looking specifically for atrial fibrillation that can cause strokes. Results from the 30-second test are emailed to the hospital’s cardiology department, which can offer a same-day EKG. The hospital wrote the software that uses RhythmPad system of Cardiocity, which was formed in 2011 to use car racing telemetry for mobile health.
Other
The mother of a Penn student who committed suicide sues Amazon for selling her daughter cyanide, which is banned for sale in the US. Amazon stopped sales of a cyanide-containing product from Thailand in early 2013, but the lawsuit claims 52 customers had purchased it by then and 11 of them died shortly after receiving their order.
Monadnock Community Hospital (NH) turned patients away, diverted ED patients, and cancelled surgeries last week during a four-day computer outage caused by a failed network upgrade.
An independent panel hired by Texas Health Resources to assess the 2014 death of Ebola patient Thomas Duncan and the infection of two of its nurses finds that (a) THR employees were overly reliant on Epic to convey critical information; (b) the hospital’s Epic configuration didn’t place the patient’s travel history on the standard patient assessment screen; (c) caregivers failed to monitor the patient’s clinical information; (d) the hospital worried too much about patient satisfaction instead of outcomes; and (e) the hospital didn’t get Ebola treatment information into the right hands quickly. The committee suggested that all hospitals be prepared to react as THR did in quickly reconfiguring Epic to improve caregiver communication. It also notes that the care team was presented with an electronic warning via Systemic Inflammatory Response Syndrome Score, but either didn’t understand it or ignored it as the patient was discharged with a temperature of 101.4 degrees. Another problem is that nobody understood CDC’s role in managing the patients or suggesting caregiver protection, which is advisory only.
A law review journal suggests that medical malpractice attorneys scour the defendant’s EHR to find a single data element that is incorrect or falsified, then have their entire medical record dismissed as being untrustworthy.
Weird News Andy says the subject of this story hasn’t showered for three years, with WNA adding that he hasn’t either because his typically last around five minutes. An MIT-trained engineer creates Mother Dirt, a spray that contains live bacteria intended to replace baths and showers. He theorizes that humans have killed off good skin bacteria due to over-cleaning, with his company’s GM adding, “We’ve confused clean with sterile.” A single bottle contains 3.4 fluid ounces, which lasts about a month and costs $49.00.
Sponsor Updates
Dimmit County Memorial Hospital (TX) documents its love of T-Systems in video and song.
VisionWare and ZeOmega will exhibit at the Accountable Care & Health IT Strategies Summit September 10-11 in Chicago.
VitalWare will exhibit at the QHR Vendor Fair September 10 in Orlando.
ZirMed will exhibit at the California Ambulatory Surgery Association conference through September 11 in Huntington Beach, CA.
The New York Times covers efforts by the University of Utah Health Care to use data analytics to calculate the cost of the care per minute in each care area, as well as across various procedures and conditions. The team has already cut $200,000 per year in unnecessary lab tests and reduced costs associated with bypass surgeries by 30 percent.
In England, the NHS’s electronic patient data sharing program Care.data has been suspended just ahead of its pilot program launch. Concerns over the wording used on the patient consent and opt out form was the reason for the delay.
The CDC issues a four-year, $4 million grant to Kentucky to help it integrate its prescription drug monitoring program with EHRs being used by hospitals in the state.
A local Tucson paper reports that Banner Health will replace the University of Arizona Health Network’s $115 million Epic platform with Cerner by early 2018.
Medicaid programs in California, Louisiana, Maryland, and Montana have been granted permission from CMS to continue using ICD-9 codes after the October 1 switchover because their systems are not fully capable of supporting ICD-10. The state offices will convert submitted ICD-10 codes into ICD-9 codes and then use those codes to calculate payments.
England will create a national cyber security center to support the NHS and other healthcare organizations, providing “expert advice and guidance on cyber security threats and best practice.” The new service will be launch in phases between January and autumn 2016.
Salesforce announces the launch of its new Health Cloud platform, a CRM platform optimized to help healthcare organizations manage patient relationships.
A new KLAS report finds that Epic, Cerner, and Athenahealth are the only vendors that were able to expand their acute EHR market share in 2014. While only two vendors, Epic and Athena, recorded no customer losses through the year.
The VA OIG publishes a report concluding that more than 300,000 of the VA’s 889,000 pending healthcare applications were for patients that have died, while an additional 50,000 applications were either erroneously deleted or otherwise left unprocessed for more than three years. The errors are being attributed to substandard IT processes.
The NIH awards $35 million in funding to 10 organizations working to integrate genetics data into EHR systems. Recipients include Mayo Clinic, Geisinger Health System, and Brigham and Women’s Hospital, among others.
ONC revokes certification for Platinum Health Information System’s SkyCare EHR (the former PlatinumMD) after the apparently defunct company ignores information requests, forcing the 48 SkyCare users who attested to Meaningful Use Stage 1 to either replace the system or drop out of the MU program. I’m guessing the company has gone out of business since its website is down and several Ripoff Reports say it closed its doors in March, leaving customers in a lurch right after it threatened to sue users for $10,000 if they stopped paying their monthly fees that were financed through external lenders as five-year contracts. The company was apparently owned by UBcare, a huge South Korean holding company. The complaints of users seem to revolve around the company’s squeaking by on MU Stage 1 certification with unfulfilled promises to develop MU Stage 2 enhancements. That, unfortunately, is a business rather than a certification issue and small practices are notorious for being naive in letting major decisions be made by inexperienced and minimally educated office managers (often chosen from a pool of candidates consisting of the spouse or other relative of the solo physician).
Here’s a January 2015 snip from someone claiming to be a customer of SkyCare, although it misspells the name of SkyCare President and CEO Alex Chang.
Reader Comments
From Red Corvette: “Re: Salesforce interview. They have ambitious plans and have brought on a team that understands the industry’s big players, but I think they will struggle for traction. I assume their new product is a healthcare-optimized version of their Force Platform, which requires third-party developers to flesh out features and functions. Those potential developers will want to know how many healthcare organizations have deployed Salesforce, just as prospects will want to know how many third-party applications are available immediately. This will be a difficult cycle for Salesforce to break. The Saleseforce exec team will need patience to wait for their healthcare vertical to gain traction, which will take much, much longer than they think. Salesforce needs to make a strategic acquisition to give them a customer base and to fast-track third-party developers.” I’m always wary of big companies suddenly barging into healthcare as their latest lust interest, but Salesforce has chosen a good time to address the new need for providers to engage with consumers. They have a highly recognized name, thrive on an open ecosystem, are already working with big-name sites, and make sensible arguments as to why patient relationship management is more their domain as a customer relationship management technology vendor than for traditional healthcare-only software vendors.
On the other hand, Salesforce has to figure out how to play nice with Cerner, Epic, and Meditech, and leading off the launch by calling out their closed walls and dated technologies probably wasn’t the best way to start cultivating those relationships. Their main problem, however, will be getting in front of provider decision-makers who have a million other problems to worry about, keeping the sales plates spinning through infinitely long sales cycles, and giving providers the hand-holding they’re accustomed to. Still, what they’re offering is just a healthcare-tweaked version of their existing products, so it’s not a huge leap into the abyss. I’ll be interested to see whether they appeal only to the marketing function of health systems instead of the much more interesting and lucrative clinical outreach and patient engagement side of the house. The track record of outsiders barging into healthcare with guns blazing is abysmal – nearly all of them end up whimpering away quietly with their tails between their legs. But for yet another counterpoint, health systems are starting to look more like health plans in dealing with large numbers of consumers who aren’t necessarily regular patients, and for that kind of marketing, EHRs aren’t going to cut it.
Speaking of the Salesforce announcement, clueless writers suggested that Health Cloud: (a) solves interoperability; (b) competes with Athenahealth; (c) is an EHR; (d) is a personal health record; and (e) might required FDA approval. Others spat out unrelated old news from other health IT companies in adding confusion while struggling to say something original that wasn’t already contained in the press release. It’s depressing to think that someone might believe some of this misinformed but confidently presented drivel.
From Kitty Carr: “Re: St. Luke’s, Idaho anti-trust case. Epic finding itself in the eye of an anti-trust spat isn’t new to Partners or the Northeast.” The US district judge agreed with the plaintiffs (competitors of St. Luke’s) that its acquisition of a big medical practice would give it a near monopoly since even without St. Luke’s expressly mandating practices to send them all their business. One aspect of that is encouraging practices to use the same EHR as the health system to make referrals to it easier and to prevent “leakage.”
From EpicUGM: “Re: TV clips played in the Cool Stuff Ahead and executive address sessions. Did Epic license those from Gilligan’s Island and Batman? If so, that must have been one really expensive show.”
From Lookie Here: “Re: contributed articles. I thought you don’t post articles that have appeared elsewhere, but ‘Can We Create a Market for Health Tech?’ comes right from the contributor’s blog.” Thanks for catching that since I didn’t. I’ve deleted that article and notified the author that he’s banned from submitting future posts. You only get one strike when it comes to sending me something claimed to be unpublished anywhere.
From FlyOnTheWall: “Re: Emdeon. Announced today that they are becoming Change Healthcare.” Verified. Emdeon acquired consumer engagement technology vendor Change Healthcare in November 2014 and will now adopt its name.
HIStalk Announcements and Requests
I’m reminiscing about my early days as a hospital software analyst, thinking about how I viewed (and still do) programming as a personal form of art. I would look at thousands of lines of intricate code that handled extraordinarily complicated clinical and billing functions, marveling at how much thought went into figuring out how the program should work and making sure that every weird thing a user might do was corralled by carefully defined exceptions. Programmers characterize each other by how they code – do they favor elegant, brilliant analysis and clean and well-documented programming, or do they just jam in brute force changes to handle a specific problem without really understanding it? Programmers sit alone, immersed in the artificial world a program creates and mentally turning dry lines of code into a visual picture of what the program does and should do. I think that’s the mark of an exceptional analyst – not necessarily their code-slinging proficiency, but their ability to understand and then visualize what the user needs the program to do. I think the proudest moments of my career were in working solo to create occasionally ingenious programs that helped people do their jobs or helped patients to get out of the hospital unharmed.
This week on HIStalk Practice: MGMA calls on CMS to extend Meaningful Use reporting deadlines for medical groups. BCBS of Minnesota picks Doctor on Demand as its preferred telemedicine provider. Wisconsin looks to join the Interstate Medical Licensure Compact. CenturyLink sees telemedicine potential thanks to $500 million FCC grant. HHS makes an example out of Cancer Care Group’s HIPAA violations. The Independence Blue Cross Foundation invests in healthcare tech for safety net health centers in Pennsylvania.
This week on HIStalk Connect: Google announces a strategic partnership with French pharmaceutical giant Sanofi focused on developing a platform of Bluetooth enabled insulin pens and glucometers. The American Society of Clinical Oncologists updates its statement on the use of genetic testing in cancer screening and care delivery. Voalte raises a $17 million Series D that it will use to ramp up as demand for its point-of-care communications platform grows. Providence, RI-based digital health startup Sproutel launches Jerry the Bear, a diabetic patient education tool for children built in the form of a stuffed bear.
I admit that I ignore the instructions and don’t stir frozen dinners when microwaving then – I just set the timer for the total number of minutes and figure it won’t make that much difference.
Webinars
September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day. We get a lot of webinar page views and registrations from interested readers.
Acquisitions, Funding, Business, and Stock
Analytics vendor MedeAnalytics sells a majority interest in the company to Thoma Bravo.
Healthcare communications platform vendor Voalte raises $17 million in a Series D funding round, increasing its total to $60 million. Investors are Ascension Ventures, Cerner Capital, and Bedford Funding. The company reported Q2 YOY growth of 250 percent with 44 new sites signed last year. Founder and CEO Trey Lauderdale told me that the health systems that created the industry were academic medical centers and pediatric hospitals and the capital infusion will help Voalte reach the big health systems as demand shifts to enterprise standardization in replacing pagers and legacy smart phones. Cerner will get a Voalte board seat as part o the investment.
Shareable Ink will change its name to Shareable following the departure this year of CEO Laurie McGraw and founder/CTO Stephen Hau.
Leidos covered its DoD EHR contract award in a Wednesday investor webcast. It was mostly a glossy overview with some details on how the company will recognize revenue as it completes task orders. The go-lives won’t start until summer 2017 and will take six years to finish. Leidos says it earns $50-$75 million per year in revenue supporting the current AHLTA system, which will wind down as it implements the new system. The company says profit margins will be at or slightly above its usual margins, but declined to explain further. Leidos says that it expects the contract to be worth the awarded $4.3 billion despite rumored higher numbers, saying those higher dollar estimates include internal government costs that won’t be paid to contractors. The company declined to say how the money will be divided among the subcontractors.
Sales
Holyoke Medical Center (MA) chooses QPID Health to identity behavioral health patients at risk for ED visits and readmissions.
Cerner announces its much-discussed replacement of Epic ambulatory at Glens Falls Hospitals (NY), which also uses Cerner’s ITWorks.
The Greater Houston Healthconnect HIE hires Deepak Chaudhry (Nexus Health Systems) as CTO.
Peter Schmitt (Nomacorc) joins release of information vendor MRO as president/COO/CFO.
Hunt Blair, former Vermont health IT coordinator and consultant to ONC, has died.
Announcements and Implementations
Salesforce launches Health Cloud, a patient relationship management solution that was designed with the help of UCSF and Centura Health. I interviewed Salesforce Chief Medical Officer Josh Newman, MD this week, who described the new application as:
What we want to do for healthcare is what we’ve done for business, which is to enable those relationships. Service Cloud is our product name. It’s like a call center app, but customized for healthcare so that everyone can have that same relationship with the patient wherever they are, on any device, to support healthcare. Not the stuff the EMR does — not medication ordering, laboratory ordering and resulting, or procedure ordering or notes — but the interpersonal communication that supports the success of those other things.
The FDA clears the $199 Eko Core digital add-on for stethoscopes following completion of clinical trials at UCSF. Stanford University Department of Medicine will issue the devices to its internal medicine residents. The device provides amplification, background noise filters, and Bluetooth connection to its app that powers its dashboard and can send recordings to EHRs.
Government and Politics
A VA OIG report commissioned by the House Committee on Veterans’ Affairs finds that the agency’s poor recordkeeping and sloppy IT processes makes it impossible to accurately report the rumored extent of backlogged healthcare applications, the number of veterans who died while their claims were pending, and suspicions that the VA intentionally deleted records. The report states, “Enrollment program data were generally unreliable for monitoring, reporting on the status of health care enrollments, and making decisions regarding overall processing timeliness, in spite of the costs to collect the data and maintain ES [enrollment system].”
NIH awards 10 grants of around $3.5 million each to researchers studying how to add DNA sequence information into EHRs. Receiving awards were Group Health Research Institute/University of Washington, Brigham and Women’s Hospital, Vanderbilt University School of Medicine (two grants), Cincinnati Children’s Medical Center, Mayo Clinic, Geisinger Health System, Columbia University, Children’s Hospital of Philadelphia, and Northwestern University. Brigham and Women’s and Baylor College of Medicine already received $8.4 million each in funding.
Privacy and Security
A jury throws out the $1.25 million data breach lawsuit brought against UCLA Health System by a woman whose sexually transmitted disease diagnosis was sent to to her former boyfriend by a UCLA temp (who also happened to be the former boyfriend’s current girlfriend).
In England, an NHS clinic sends out its HIV patient newsletter by using Outlook’s CC function instead of BCC, exposing the names of all 780 people to each other. The clinic tried using Outlook’s recall feature, then sent another email containing an apology and an urgent plea for everybody to delete the original.
Sony Pictures settles the proposed class action lawsuit filed by employees whose medical information was exposed in last year’s data breach.
Other
In South Australia, a hospital radiologist who complained that administrators were deleting his notes and entering orders under his name is vindicated by state investigators who find that four employees tried unsuccessfully to delete a patient’s record from the imaging system.
The Madison paper covers the kickoff of Epic’s UGM, which is themed around classic (meaning off the air for decades) TV shows. A new offering, Cosmos Research Network, was apparently announced that involves commingling the information participating Epic clients for clinical research. CEO Judy Faulkner told attendees that Epic is talking to Congress about telehealth and cybersecurity.
The call for an anti-trust investigation into Epic was one of the last healthcare-related posts on the blog of former BIDMC CEO Paul Levy, who says he’s finished writing about healthcare and will instead focus future articles on his current interest — negotiation.
I don’t recall having heard of the provider-led, non-profit Healthcare Services Platform Consortium that is working on interoperability, but it announces founding members Intermountain Healthcare and LSU Health Care Services Division.
Speaking of BIDMC, the health system is rumored to be talking again with Lahey Health about a merger to compete with Partners HealthCare.
A KLAS report finds that only Epic, Cerner, and Athenahealth gained inpatient EHR market share in 2014. Athenahealth (the former RazorInsights) and Epic were the only vendors who didn’t lost customers last year. Epic’s customer count increased the most, but Cerner’s market share is larger following its acquisition of Siemens Healthcare Solutions.
The United Auto Works suggests that Detroit car manufacturers form a single healthcare purchasing group to increase their bargaining power in providing health benefits to 1 million people.
In England, a few newspaper-contacted doctors and organizations express unhappiness with the plans of Health Secretary Jeremy Hunt to give patients access to their entire medical record by 2018 and to allow them to read and update their records by smartphone within a year. Most interesting is the response by the chair of the Royal College of GPs, who says, “GPs are under incredible pressure, seeing more patients than ever before, and we simply do not have the resources to analyze data that patients upload to their records as a matter of course.” Articles like this suggest that all doctors are unhappy with the announcement even though the writer didn’t contact any practicing physicians, a method quite a few publications use to stir up emotion without having to expend effort in doing real research that proves the headline’s pre-digested conclusion.
An interesting analysis of episodes of “Grey’s Anatomy” and “House” finds that TV patients survived CPR at twice the rate of real-life patients, which might unduly influence anyone making Do Not Resuscitate decisions.
PhantomAlert, a competitor to Waze (the GPS and directions service Google bought for $1 billion in 2013) sues Google, claiming the pre-acquisition company stole its mapping information. PhantomAlert says it can prove it because it placed fake locations in its databases just to catch copycats, adding that Waze needed to steal its information in its desperation to find a buyer that turned out to be Google.
Sponsor Updates
Impact Advisors is named to Modern Healthcare’s “Largest Healthcare Management Consulting Firms” list.
Forward Health Group creates an overview video called “Population Health Management for the Real World.”
TransFirst will provide payment processing solutions that integrate with PatientPay.
Medicomp announces Medcin U North America and New Asia conferences.
Nordic brews up an EHR IPA to raise funds for veterans and the unemployed during Epic’s UGM in Madison.
NTT Data partners with the City of Plano, Texas in its Food 4 Kids program.
Experian Health/Passport will exhibit at the North Carolina Association of Healthcare Access Management
PerfectServe releases a new case study featuring IPC Healthcare’s Memorial City practice.
Impact Advisors releases a white paper titled “Realizing Value from an Enteprise EHR Investment.”
PMD makes the Inc. 5000 list of fastest-growing private companies in the U.S. for the fourth consecutive year.
RelayHealth is named a leader in clinical data exchange in IDC’s latest MarketScape report.
CMS is pushing their “ABCs of ICD-10.” Although this week’s focus is on “B,” I hadn’t seen the campaign before. As a physician, I couldn’t help but think of the fact that when we hear “ABCs” we immediately tend to think “Airway, Breathing, and Circulation” as we’re trying to resuscitate patients. Based on some of what I’m seeing in the community, I think we’re going to be resuscitating more than a few providers and billing supervisors as their practices are decidedly not ready for the transition.
I was on the phone with a client today who has decided not to take its vendor’s mandatory ICD-10 patch and instead will try to customize the system on their own. They plan some brute force workarounds if that doesn’t work. At this point in the game, I just don’t have the stomach for working with people in that mindset. I told them that if they agree to take their vendor’s patch I’ll be happy to assist, but if not, they’re on their own. It’s just too risky when there are fewer than 30 days on the clock and there are tested solutions available.
Interestingly, the “B” campaign stands for “Be sure your systems are ready.” They recommend practices test to make sure they can generate and submit claims, schedule appointments and procedures, verify eligibility and benefits, submit quality data, update patient histories and encounters, and code encounters. If you’re just thinking about testing these items now, you have a lot of work in front of you.
Speaking of the October 1 date, I’ve seen an uptick in requests for last-minute locum tenens placements spanning the go-live date. I am not sure if people are thinking the system will grind to a halt and want to staff up or if small practice providers are deciding to take vacation during the transition and return to practice when things are stable. I see more specific EHR information in the listings than I have seen in the past.
I had to laugh though at one of them, which was not only trying to recruit a “Physican,” but also said the small-town practice includes “tell a med.” I can only infer that telemedicine is involved, but there were enough problems with the listing to make me worry about what one might be walking into (including spelling the name of the EHR wrong and failing to capitalize “September.”) The one site only sees 6-10 patients a day and that’s certainly tempting, but I doubt the locum agency’s ability to handle professional liability coverage and credentialing when they can’t spell.
My former hospital made me chuckle today by announcing (at 11:30 a.m.) that they would be taking the hospital system down from noon to five for a scheduled upgrade. Seriously, who performs upgrades in the middle of the work day? They’re offering a special support line from 5-7 p.m. then going back to regular support hours. I suppose they assume all bugs will present themselves in the first two hours after the upgrade. There was no mention of what the upgrades would bring or how users should anticipate their workflows might change. Needless to say, I’m feeling pretty good about having jumped ship when I did. I just hope they keep me on the distribution list because it’s been amusing.
I’m always happy to feature companies that are giving back to the community. While the Epic User Group Meeting is in full swing, Nordic Consulting is partnering with local organizations to make the world a better place. Monday night at their open house, Nordic served a custom-brewed Nordic EHR IPA. For every pint poured, they donated $1 to The Road Home program at Rush University Medical Center, which helps veterans return to civilian life.
For beer connoisseurs, the EHR IPA contains Equinox, Hallertau, and Rakau hops. It’s also on tap at more than a dozen bars and restaurants in Madison, so grab a glass if you can. Their open house also featured cookies from The River Bakery, which provides job training and placement in the baking industry. Everyone knows how much I love pastry, so this made me smile.
From Eager Reader: “Re: keeping up. I’m working on an informatics project and wanted your take on something. How do physicians with extremely busy schedules keep up with new scientific data? Do you rely on certain sources now, or do you have to grunt through the medical journals on your own?”
That’s a great question. The short answer is that it’s hard to keep up, especially if you’re really in the trenches. I have a few key journals that I read. Unfortunately, I don’t read them regularly, but rather stack them up (I’m still a paper girl at heart), and when the pile gets so tall, then I curl up and read the articles that are pertinent to my practice and my clients. In addition to new articles and reviews, several also have “tips from other journals” sections that may lead me to read parts of other journals.
I’m also a big fan of the Wolters Kluwer Health UpToDate product as far as researching the most current thinking on a given condition, especially when you have someone in front of you with a condition you may not have seen in years. In my clinical setting, I’m often working alone and don’t have a colleague I can grab between patients and bounce ideas off of them. I do have clinical decision support in my EHR that links to the literature, but I rarely use the links. With my current vendor, I trust that the physician informaticists on staff did the right thing when it was built, but I’ve seen some crazy bugs in previous systems.
Regarding the 99% drop in AmWell stock -- True fact--I mad a profit buying AmWell on a dip once, and…