The Government Reform and Oversight Committee met alongside the House Veterans Affairs Committee to hear the testimony from DHMSM and GAO representatives on why the VA and DoD has failed to integrate its EHR systems, despite having spent billions in taxpayer dollars.
McKesson repots Q2 results: revenue up 10 percent to $49 billion, adjusted EPS $3.31 vs. $2.79, beating analyst expectations on both. McKesson also announces that its board has approved a $2 billion stock buy back plan.
Theranos announces a restructuring of its board of directors, reducing it from 12 to just five members and establishing a supplementary board of counselors and another board that will give medical advice.
October 29, 2015Dr. JayneComments Off on EPtalk by Dr. Jayne 10/29/15
October is finally coming to an end, and with it, Breast Cancer Awareness Month. Several of my clients did population health outreach campaigns around mammograms and breast cancer screening. It’s rewarding to see that so many patients were reminded of the need to stay on top of preventive health care.
I literally ran across one of these pink carts on my morning jog, with its “Kick Cancer to the Curb” slogan. Definitely an interesting campaign, but I’m wondering how long it will be until a veritable rainbow of carts for other diseases starts to appear. They could probably get some traction with medical offices and shredding services, replacing the standard boring carts with disease-awareness ones.
I’m a big fan of focused population health outreach campaigns, which we used to refer to as “disease of the month” at my practice. With the advent of unquestionably powerful population health applications, it can be overwhelming to start robo-calling or texting patients who are overdue for multiple screening and interventions.
I recommend that my clients gradually work their way into full-scale reminders, selecting first a disease or condition that is either of high prevalence in the community or of key importance to the practice. Once the staff is familiar with managing patients who respond to the outreach messages and can handle the volumes it may bring in, it becomes easier to incrementally add additional outreach campaigns.
I also recommend they put signage in the offices and provide relevant patient education material as well as educating the staff through in-services. That way everyone in the office can assist as patients respond. It’s tempting to fire up multiple campaigns at the same time, but unless your system is sophisticated enough to combine reminders, it can quickly become annoying. Even if the reminders are combined, I’m not sure I would want to be a patient on the receiving end of a laundry list of preventive services being read to me by a disembodied computer voice.
I’ve spent a fair amount of time over the last decade helping practices redesign their offices, not only from a workflow perspective, but also architecturally. Transitioning to an EHR works best with appropriate exam room layouts. Getting rid of the chart room usually frees up space that can be used either for employee engagement or revenue generation.
I’ve worked with quite a few office designers and am always interested in looking at computer carts and other equipment at HIMSS. One of my designer friends shared information on the Beam Virtual Playground, which is a ceiling-mounted projector that creates a “touch screen” on the floor for games. I like the idea, and the fact that it’s germ free is a big plus. I’m always astounded when I see well-chewed books and slobbery toys in medical waiting rooms.
‘Tis the season for vendor user groups, and apparently I’m attending all the wrong ones. This week’s IBM Insight conference featured an exclusive performance by Maroon 5, sponsored by Rocket Software. Talk about a client appreciation event. And for those working the show from the vendor side, not a bad day at the office.
I had a couple of days off this week and spent most of them trying to tame the email monster and complete long-overdue tasks. Thank goodness for being able to work anywhere. As I was hanging out at the car dealer having my oil changed, I got a glimpse behind the scenes at something that resembled a medical chart room. I was surprised since this is a high-tech dealer who appears to do everything electronically from checking you in with the electronic code on your car key to sending email reminders. Apparently they have a dark secret, however. I’m glad that the people who make chart tabs and other filing accessories found another line of business since we don’t need them very much any more in medicine.
I’ve got two conferences to attend in the next three weeks, so it will be good to get things squared away before I go back on the road. The only thing left to do is purchase candy for Saturday night. Thanks to Travel+Leisure magazine for providing these wine pairings for Halloween candy. I’m not sure I agree with some of their selections (Hot Tamales and Riesling, anyone?) but I can definitely get on board with Raisinets and Merlot.
What’s your favorite candy and beverage combination? Email me.
Rep. Tammy Duckworth (D-IL), a former Army helicopter pilot who lost her legs when her Black Hawk took rocket-propelled grenade fire in Iraq, joins several other members of Congress who are fed up that the VA and Department of Defense still haven’t integrated their systems. Lawmakers are reviewing VA-DoD progress in a joint hearing of two House committees this week. Duckworth says that as a former VA employee, she regularly saw the DoD stonewall the VA’s projects in defending its turf. She’s also still mad about her first VA visit where she was asked to take her clothes off to prove that she was still an amputee since the VA wasn’t allowed to accept her DoD medical records, to which she replied to the physician assistant, “I’m not a gecko. They don’t grow back.” Chris Miller, who runs the DoD’s DHMSM project, testified that connecting the VA with DoD is harder than it seems, while the GAO’s IT director observed that her watchdog agency still doesn’t understand why the DoD and VA decided not to build a single system together in the first place. The GAO still wants that answer, but says that neither the VA nor DoD are responding to its inquiries. The GAO suspects that the VA and DoD have spent more than billion dollars in trying and failing to share information, which doesn’t even include the countless mega-billions of taxpayer money that was spent building and supporting their systems.
Speaking of the VA-DoD imbroglio, some members of Congress are convinced that the only way to get the VA and DoD play nicely together is to have the President personally make them. Rep. Dan Benishek (R-MI) says of his peers, “We can’t stand the fact that we’re spending a billion dollars on integrating healthcare and you tell us it can’t be done. We get sick of this.” DHMSM’s Chris Miller says the organizations weren’t ready in 2011 because while the IT part is easy, nobody wanted to address the people and process issues. He opined that interoperability is worse in civilian healthcare, raising the ire of Rep. Gerry Connolly (D-VA), who scolded him by saying that both agencies deal with a specific population but “can’t get their acts together on behalf of the men and women we’re serving.”
Reader Comments
From Don’t Mess with Texas: “Re: vendors pressuring clients. I heard that the day Texas Health Resources issued its press release blaming Epic for its improper treatment of its Ebola patient, Judy and Carl flew to THR that night to pressure the CEO into putting out a retraction, which they did. Epic plays hardball – they’ve done it at our site, too. I don’t blame Epic for being unhappy with the press release, and while veteran CIOs like me knew to take the release with skepticism, flying down in person to get a retraction is pretty heavy handed. I’m sure Epic’s spin is that they care so much for their clients that they wanted to show up in person and offer their help.” That entire process was bungled, although nothing in the THR recap describes a visit by anyone from Epic. THR leadership appears to have thrown Epic under the bus as a knee-jerk reaction without even talking to their own IT folks, who would have been involved with the configuration of the system that was blamed incorrectly (given their quick retraction) for missing their patient’s travel history. Any EHR vendor would have protested and asked for proof of their customer’s claim, although I agree that Epic is among the most vigorous enforcers of its own interests and I’m sure calls were made. THR wasn’t great at managing the Ebola virus, but it was much more aggressive in trying to manage the viral spread of unfavorable publicity.
From Uneasy Detente: “Re: vendor gag clauses. I’ve never seen them pre-loaded into one of my contracts, but I’ve signed a few with a major health IT software vendor as condition of contract settlement, where software doesn’t work and we refuse to go live, for example. The vendor may offer concessions or a refund conditional on signing a number of terms, which generally includes not going out and talking about the problem we’ve discovered. Here’s an example for your eyes only.” I can see why both parties would approve that condition given that they are reaching agreement on either a parting of ways or deciding not to implement a specific application. I’m on the fence about whether that’s a gag clause, but leaning toward no since the customer never actually went live. You would think that customers who did actually implement the application would see and report the same issue, but that’s wishful thinking. That leads us back to the same challenges we have with interoperability – as much as we as patients would like providers to publish and share information that might benefit us, there’s no incentive for those providers to do so and therefore they don’t bother. In fact, going public with software problems introduces the near-certain risk of creating an adversarial relationship with the vendor to which they’ve expensively hitched their wagon. I don’t know of any solution except maybe FDA-type oversight that requires companies to report the patient-endangering defects they discover. Just about any solution that requires providers – competing or otherwise – to voluntarily share information is not likely to succeed. Replace “providers” with “attorneys” or “car dealers” in the previous sentence to put it into a less emotional perspective.
From QM Employee: “Re: NextGen Hospital Solutions. Can anyone explain why QuadraMed acquired it? QuadraMed has not sold their current solution for three years and their product has so many holes (surgery, emergency, scheduling, etc.). There are constant layoffs and some really great employees have left. NextGen customers are in the under-100-bed hospital range and their product is unstable.” The Canada-based parent of QuadraMed (Constellation Software) seems to have broken its own acquisition rules in buying both QuadraMed and NextGen Hospital Solutions since it claims to be interested only in companies that are #1 or #2 in their market, have at least “hundreds” of customers, and face “unimposing” competitors. I can see why QSI wanted rid of its failed hospital business, but agree that it’s puzzling why someone else would want it, although that brings up the strong possibility that it was basically given away just to eliminate distraction and appease torch-wielding QSI shareholders.
From Erstwhile ICD-9er: “Re: Georgia Medicaid’s stance on ICD-10 coding specificity. The CMS leniency was limited to Medicare. Medicaid was given the authority to make the decision for themselves. Georgia is the first to come out with aggressive messaging around their acceptance of ICD-10 specificity. An important distinction is that they related all of their ICD-10 edits for UB claims, but are holding firm on CMS 1500 claims. They have posted notice of this to providers along with a list of codes that will likely be denied. They are accepting feedback from providers about which codes should be accepted.” Thanks for that clarification.
From Kilt Lifter: “Re: ICD-10. Select Health Medicaid in SC refused to do any user testing prior to implementation. They are now telling practices they will not pay any claims until the end of November at the earliest.” The company’s ICD-10 FAQ page brags confidently about their testing, remediation efforts, and overall readiness for October 1.
From Public Health Helpful: “Re: public health. I’m a long-time HIStalk fanboy, but you hit it out of the park with your comment that we ‘irrationally celebrate advancements that are very narrow in scope.’ We should be doing what will benefit the most people in the most significant way – immunizations, blood pressure control, weight loss, cancer screening, following preventive guidelines, and using proven treatments.” The only way to fix “healthcare” is to embrace public health as other countries have done rather than tinkering with how we deliver reactive health-related interventions. We don’t like thinking about that because it requires uncomfortable discussions about social services and the role of government that quickly degrade into political divisiveness. It’s easier and much more profitable to focus on expensive interventions that benefit a small percentage of the population while the far larger population suffers (and drags down economic growth) with chronic conditions whose management standards are well known, just not well practiced by either providers or the patients themselves. We have all the knowledge we need to make the country healthier and therefore more economically competitive, just not the will to use it.
HIStalk Announcements and Requests
I put the $750 raised by Dana Moore’s Epic vs. Centura basketball game to immediate use, applying matching money from my anonymous vendor executive as well as from other charitable organizations to fund these DonorsChoose projects:
A document camera for Mrs. Marler’s third-grade class in Phenix City, AL.
A video camera and accessories for recording advanced placement calculus and physics lessons so that absent students can review them later for Mr. Blachly’s high school class in Indianapolis, IN.
A STEM bundle for Ms. W’s elementary school class in Englewood, NJ.
An iPad Mini to support STEM studies in Mrs. K’s middle school class in Brooklyn, NY.
Four science activity tubs for Mrs. N’s elementary school class in Dothan, AL.
Two tablets for Ms. S’s first grade class in East Haven, CT.
A laptop and accessories for Ms. M’s class of eight emotionally disturbed first grade boys in South Bronx, NY.
Hands-on materials for Ms. M’s advanced placement statistics seniors in Denver, CO.
This week on HIStalk Practice: The wave of physician "Just Say No to Meaningful Use" movements rolls on. American Well digs further into the employer market. AdvantageCare Physicians achieves Stage 6 EHR adoption. ZocDoc and Kareo top the list of US-based deals with Q3 VC funding. A GAO "sting" results in further Healthcare.gov scrutiny. The Interstate Medical Licensure Compact Commission meets for the first time. Maine ups its healthcare price transparency efforts.
This week on HIStalk Connect: the FDA releases its inspection findings from an unannounced visit to Theranos, concluding that their nanotainer technology is an uncleared medical device. IBM Watson will debut on the Apple Watch in 2016 within a patient engagement app being developed by Welltok. Carnegie Mellon University researchers create an app that uses iBeacon technology to provide navigational support for blind users. The team behind the app hopes to add facial recognition features in the coming years. HealthTap launches a suite of new patient engagement apps in a bid to move into the enterprise healthcare space.
Webinars
November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
McKesson announces Q2 earnings: revenue up 10 percent, adjusted EPS $3.31 vs. $2.79, beating Wall Street expectations for both. The company raised guidance and announced an additional $2 billion in share repurchases. Technology Solutions revenue dropped 6 percent, much of that due to “our decision to exit the Horizon hospital software business,” with good performance from payer solutions and RelayHealth.
Theranos continues its fascinating, overly defensive implosion by eliminating seven of its 12 board member positions – including those held by Henry Kissinger and George Shultz – but creating a new board of counselors (which includes all of the old board members) and a medical advisory board. CEO Elizabeth Holmes claims the changes were made in July, although as in the case of the company’s proprietary lab methods, she provides no data to back up that assertion. The company’s new board includes Holmes, her COO, a billionaire who inherited his grandfather’s construction business, a retired general, and a wealthy lawyer who sues big companies. Some speculate that the departed board members wanted to distance themselves from the company and any potential litigation that may result. Meanwhile, Theranos, which has already raised $752 million, authorizes new shares that will value the company at over $10 billion, although that happened right before the critical Wall Street Journal came out.
Leidos reports Q3 results: revenue up 2 percent, adjusted EPS $0.71 vs. $0.65, beating expectations for both.
Sales
Carilion Clinic (VA) chooses Sagacious Consultants, now owned by Accenture, for revenue cycle improvement.
People
Timothy Johnson, DO, MMM (Children’s Mercy Integrated Care Solutions) joins Valence Health as SVP of pediatrics.
Ingenious Med names Scott McClintock (Have Marketing, Will Travel) as chief marketing officer.
Corepoint Health names Dan Simenc (3M HIS) as sales VP.
Announcements and Implementations
Analysis by The Advisory Board Company finds that hospitals are increasingly implementing CDC-recommended antibiotic stewardship programs to reduce inappropriate use, but many of them are too short on staffing and data to be effective. Most organizations have pharmacists rather than the prescriber review orders, most don’t record monitoring overall antibiotic use by prescriber, and few have adequate data to determine whether their programs are improving patient outcomes.
UV Angel announces an ultraviolet-powered patient room IT device disinfection system that automatically runs a cleaning cycle up to 40 times per day when it detects that a targeted device has been used.
Atlantic Medical Imaging (NJ) goes live on patient self-scheduling from OpenDr.
Hackensack University Medical Center (NJ), which self-styles itself with the annoying one-word nonsense of “HackensackUMC,” will integrate Gauss Surgical’s iPad-powered Triton blood loss estimation system with Epic.
Government and Politics
A study finds that the FDA is approving cancer drugs based on short-term patient response rather than their effect on overall survival, with the agency often neglecting to require manufacturers to perform the post-marketing studies that FDA required as a condition of approval. That means many of the most expensive and most important drugs on the market haven’t proven that they actually work, which has been a problem with oncology drugs for decades – drug companies, oncologists, and hospitals make tons of money pumping them into patients with soothing optimism but no guarantee that the patient will live longer or better.
While deaths from overdoses of heroin and prescription narcotics are skyrocketing – the former because addicts are switching from expensive and heavily marketed prescription drugs to cheaper heroin – 80 percent of addicts couldn’t get treatment even if they wanted it because capacity is lacking. I was talking to a first responder the other day who said exactly the same thing – in his tiny, rural town, heroin deaths are common since addicts can buy it on the street for a few dollars per dose vs. the high cost (no pun intended) of oxycodone and other prescription narcotics. The so-called war on drugs has been lost as prisons and morgues fill up and suppliers get even richer as reduced availability drives up prices (a lesson possibly learned from their legal but equally morally challenged pharma counterparts). As usual, these studies are coming from public health experts (Johns Hopkins Bloomberg School of Public Health in this case) since it’s not considered a healthcare or medical issue that provides a business opportunity.
The Department of Justice arrests the former president of drug maker Warner Chilcott, owned by Allergan, for conspiring to pay kickbacks to doctors who prescribed its drugs. The company will also pay $125 million in fines and plead guilty to criminal charges. Meanwhile, Ireland-based Allergan and competitor Pfizer begin merger talks in what would create the world’s biggest drug company with a combined market value of $340 billion, making that $125 million fine look like a valet tip. It would also provide a way for US-based Pfizer to dodge US taxes in declaring the headquarters of the newly created company to be Ireland.
CMS announces that it’s been a quiet October for ICD-10, with the number of claims submitted due to incomplete or invalid information remaining unchanged at 2 percent. The denial rate and percentage of claims rejected due to invalid ICD codes also hasn’t changed much. It a bit early to declare ICD-10 victory, but CMS seems to have defied the naysayers who didn’t believe its optimistic testing status reports.
Other
The AMA and MedStar Health publish their review of EHRs for user-centered design, which instead of looking at actual user usability or testing anything against standards, simply reviewed ONC’s certification test results for use of best practices. The top-scoring products were Allscripts Enterprise, Allscripts Sunrise, McKesson Paragon, McKesson IKnowMed, and Athena Clinicals. Bottom-scoring products are EClinicalWorks Version 1.0, Dr Systems, Greenway PrimeSuite, Epic EpicCare Ambulatory, and NextGen Ambulatory. The analysis used factors such as the vendor’s self-reported UCD process, the involvement of clinicians in testing, and the design of rigorous use cases for testing. It’s a puzzling list when the ancient Meditech Magic finishes one spot behind Cerner in the top 10. I also wonder how meaningful it is to critique user-centered design process by repurposing certification submissions for individual products – you would think a given vendor would use the same design and testing methods for all of their products. The end result will be what it always is in healthcare IT: the top-ranked vendors will brag loudly about the results while glossing over the methodology and applicability, while the low-ranked ones will criticize the methodology and applicability while glossing over the results.
Santosh Mohan, a management fellow at Stanford Health Care and long-time HIStalk reader, sent over this photo if the IT department’s Halloween celebration, in which the three folks above are dressed up as the (a) electronic (b) medical (c) record. I like subtle humor like this because once you get it, you can feel superior in imagining folks who didn’t get the joke.
Meanwhile, PatientSafe Solutions tweeted out this photo of its team. It brings back not-so-fond memories of my hospital’s IT department Halloween celebration, which despite featuring nothing more interesting than pumpkin bowling and orange-iced cupcakes, had to be renamed to the politically correct “fall festival” when a couple of employees complained that it celebrated devil worship.
Weird News Andy cries, “Bring out your dead” as he reads how New York’s health insurance exchange enrolled 354 dead people for health insurance, paying out $325,000 in claims to 230 of them. Design flaws, including people having multiple identification numbers, caused another $3.4 million in overpayments in the program’s first year.
Sponsor Updates
Healthcare Data Solutions publishes a white paper titled “Understanding the Opportunities & Challenges of Telehealth 2015.”
Impact Advisors sponsors an article titled “A Unique Approach to Business Analytics: The Scottsdale Institute Health IT Benchmarking Program.”
Stella Technology and DataMotion will participate in the interoperability showcase at the New Jersey and Delaware Valley HIMSS chapters conference in Atlantic City October 29-30.
InterSystems CEO Terry Ragon is featured in MIT’s Spectrum Magazine.
PDR and Leidos Health will exhibit at the NextGen User Conference November 1-4 in Las Vegas.
LiveProcess will exhibit at the New England Rural Health Round Table November 5-6 in South Bridge, MA.
Wellcentive CEO Tom Zajac will present at the inaugural meeting of The Leader’s Board for Population Health Management November 5 in Dallas.
MedCPU is recognized as one of Entrepreneur’s “Best Entrepreneurial Companies in America.”
Navicure will exhibit at Michigan MGMA October 30 in Mount Pleasant.
Recondo Technology and Sutherland Healthcare Solutions will sell each other’s solutions.
Over 1,000 health and human services leaders attended Netsmart’s Connections 2015 client conference, which featured mental health advocate and former Congressman Patrick J. Kennedy.
NTT Data will exhibit at the 2015 LeadingAge Annual Meeting and Exposition November 1-4 in Boston.
Obix will exhibit at the 14th annual Perinatal Conference November 5 in Dublin, OH.
Epworth Eastern Hospital (Australia) realizes improved outcomes with Oneview interactive patient care technology solutions.
PerfectServe will exhibit at ASN Kidney Week November 3-8 in San Diego.
The SSI Group will exhibit at the Georgia HFMA Fall Institute November 4-6 in Savannah.
Streamline Health will exhibit at the Health IT Leadership Summit November 3 in Atlanta.
Surgical Information Systems will exhibit at HealthAchieve 2015 November 2 in Toronto.
Surescripts will exhibit at the NextGen 2015 user group meeting November 1-4 in Las Vegas.
The Senate passes the Cybersecurity Information Sharing Act, a bill designed to curb cyberattacks by providing US companies legal immunity for sharing protected information with the federal government. CHIME published a statement of support just after the bill cleared the Senate.
AMA publishes findings from its EHR user-centered design study, with McKesson and Allscripts finishing at the top with perfect scores, and Epic falling behind both Cerner and Meditech’s legacy system. AMA evaluated 20 EHRs in the study, choosing a mix of inpatient, ambulatory, current, and legacy systems.
HealthTap launches an all-in-one patient engagement platform designed to help health systems roll out telehealth, secure messaging, online appointment booking, appointment reminders, and a population health analytics system.
The FDA releases the findings from its unannounced inspection of the Theranos laboratory, concluding that the proprietary blood draw container used by Theranos is an “uncleared medical device” that will require a full review.
US investigators conclude that Chinese hackers targeted Anthem to learn how medical coverage is setup in the US, as the country struggles to deliver on a promise of providing universal healthcare to its aging population by 2020.
Walgreens will reportedly acquire Rite Aid for $9.4 billion, offering $9 per share, a 48 percent premium to Rite Aids closing price Monday. The acquisition will also transfer Rite Aid’s $7.4 billion in debt to Walgreens. An announcement is expected as early as Wednesday.
Roper Technologies, the parent company of Sunquest Information Systems, acquires CliniSys Group, a European laboratory information systems vendor, and Atlas Medical, which connects diagnostic testing facilities with patients.
FDA declares the proprietary nanotainer blood draw containers used by Theranos to be an “uncleared medical device” following a Wall Street Journal report that the company had voluntarily already stopped using the finger-stick containers for all but one test. A September FDA inspection of the company’s Alameda, CA facility noted a number of deficiencies, including shipping its nanotainer collection tubes across state lines without having them approved by the FDA; not performing quality audits; and documenting required software validation on a shared Excel worksheet. Meanwhile, Theranos says it will now publish data proving the effectiveness and accuracy of its methods.
Reader Comments
From Prostetnic Vogon Jeltz: “Re: ICD-10. Georgia Medicaid is denying claims that use unspecified ICD-10 codes even though CMS said that wouldn’t happen. When I first see a patient with atrial fibrillation, I might not know whether it is paroxysmal, persistent, or chronic – that’s what the unspecified codes are for. I think this is important for HIStalk readers to know about.” The agency didn’t say it wouldn’t be ready for ICD-10, so it appears to have simply made the decision that it will not conform to CMS’s policies.
From Unbridled: “Re: PatientSafe Solutions. They have parted ways with CEO Joe Condurso.” Joe is still listed as president and CEO on the company’s web page, but an internal email sent my way says he resigned last Friday in a mutual decision and that Chief of Staff Si Luo will take over as president. The company announced last Wednesday that it has acquired readmission technology vendor Vree Health.
From Publius: “Re: VA. I predict the VA will go full Epic, forcing Epic and Cerner to get serious about developing interoperability with each other since DoD will be on Cerner. This will benefit all customers. A Cerner-Epic ROI exchange will be as seamless as Care Everywhere (Epic to Epic ROI module).” Politicians seem to be fretting that since VistA uses old technology (just like Epic), it therefore should be replaced with a commercial product despite the VA’s decades-long satisfaction with its internally developed system. The VA and DoD always seem to find reasons to not work together, so perhaps choosing Epic would prolong the hostilities.
From All-Around Good Guy: “Re: Lee Marley, SVP/CIO, Presbyterian Healthcare Services in Albuquerque. She has left and will be missed. The data center was built and Epic was installed during her tenure.” Unverified.
HIStalk Announcements and Requests
A reader who wishes to remain anonymous donated $250 to my DonorsChoose project, to which I applied double matching (from my anonymous vendor executive and from charitable foundations) to purchase materials for Mrs. Sandler’s elementary school class in Aurora, CO (math games), Mrs. Jones’s K-2 class of intellectually and emotionally disabled students in Galivants Fry, SC (math manipulatives), Ms. Sobczak’s Grade 1-3 class of students with communication disorders in South Holland, IL (math games), and the elementary school class of Mrs. Bowers of Oklahoma City, OK (headphones for online math intervention programs).
I’m regularly puzzled when people email me story links that I covered days before, apparently thinking that because other sites ran the news days later that I missed it. I don’t think I’ve ever missed a significant story, so I can only implore you to read all of HIStalk each time I post news on Tuesday and Thursday nights and over the weekend. Reason: other sites keep repeating the same news over and over trying to get more clicks, while I assume readers are smart enough to only need to see it once and therefore I don’t run repeats. Obviously my logic is incorrect if folks are either skimming or skipping certain posts. My other suggestion is to avoid assuming that just because I can summarize a big story in a few sentences doesn’t mean it’s not important – I don’t pad out the content with a lot of filler.
Who should I interview? Tell me someone who: (a) doesn’t work for a for-profit organization; (b) is smarter than most people; (c) is interesting and opinionated; and (d) I haven’t already interviewed recently. I like to expose fresh viewpoints, but those who possess them don’t always volunteer to be interviewed.
I was thinking that what we need to learn in this country that advancing health for a tiny percentage of the population (via precision medicine, expensive celebrity surgeons and surgical gadgets, and dramatic and expensive interventions) is the wrong goal. Our overall health (and health expense) isn’t driven by new developments for the wealthiest and best informed, but rather how well we can move the public health needle for the most people who are involved alongside the medical experts. Research and new medical technology aren’t needed when we can’t even broadly roll out basic services such as prenatal care, end-of-life counseling, mental health treatment, and addressing the social determinants of health. I worry that we irrationally celebrate advancements that are very narrow in scope and outcomes.
Gag Clauses: I Find No Evidence They Exist
Some of the worst and most sensationalistic healthcare IT reporting I’ve seen (and I’ve seen a ton) involves so-called gag clauses, where IT vendors supposedly insert standard contractual terms that prohibit users from openly discussing patient-endangering software errors. That inflammatory topic, like the Loch Ness monster, has generated a lot of rhetoric (some of it political) despite the lack of proof that gag clauses actually exist.
Take the above hype-filled story, in which the reporter not only provides no examples of the gag clauses he claims to have seen, he completely confuses standard intellectual property (IP) terms — like not being allowed to post source code or product documentation on the Internet — with prohibiting EHR-using providers from speaking publicly about product problems via a non-disparagement clause.
The folks at HIMSS Analytics gave me access to its CapSite Database, which contains actual vendor contracts they obtained using Freedom of Information Act requests. I reviewed dozens of contracts from Epic, Cerner, Meditech, Allscripts, EClinicalWorks, Athenahealth, and several other vendors.
I didn’t see a single clause that prohibits customers from speaking out about software problems. I had previously challenged readers to give me a real-life example of a gag clause and I didn’t receive any there, either.
My experience working for providers is that any pressure to keep quiet about software problems is self-imposed. Health system executives don’t want to jeopardize an expensive implementation or annoy their vendor “partner,” so internal policies require that employees obtain approval before making any public comments or publishing articles. The CIO of one of the health systems I’ve worked for said outright that nobody in the IT department (including clinicians) was allowed to publicly comment on anything without his explicit review and approval (“I’ve been burned by that before”) or they would be subject to termination, which may give you insight as to why I remain anonymous.
Epic has raised the most ire by enforcing the intellectual property provision to include screen shots. Customers can’t publish or share Epic screen images – even those involving customizations of Epic they perform themselves – without approval from Epic. The company’s rationale is that screen design exposes IP, where just seeing what fields are captured provides a lot of insight as to what’s happening under the covers such that a competitor could steal the logic. They give permission to publish the screenshots when that isn’t the case.
That doesn’t prevent users from talking about or describing Epic software problems. It just means they can’t publish screen shots, documentation excerpts, or source code (yes, Epic customers receive source code) to make their point without the company’s permission. I saw nothing to prohibit or even discourage that kind of discussion in any of the contracts I reviewed. Perhaps it is included elsewhere, such as in the particulars of Epic’s support fee rebate program where customers get money back for voluntarily following Epic’s suggestions, but I haven’t seen it or heard of a real-life example. I’ve also not heard of a vendor taking formal action against a provider for making unflattering software comments.
I’ll throw out one more challenge and them I’m calling gag clauses a Snopes-like false rumor spread by misinformed people. If you’ve seen an example of a vendor software contract that includes anything resembling a gag clause that prohibits customers and their users from talking about product or company problems, send it my way anonymously and confidentially. I would also like to hear of examples where a provider has spoken unfavorably about a company or product and was pressured to stop, either from the vendor or from their employer, since I suspect that information pressure is far more common.
Webinars
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Sunquest owner Roper Technologies acquires CliniSys Group and Atlas Medical, which offer laboratory information systems to 2,000 labs in Europe and lab-customer connectivity in the US, respectively.
Walgreens is rumored to be preparing for a Wednesday announcement that it will buy competitor drugstore chain Rite Aid for up to $10 billion and will take on its $7.4 billion debt load. The deal would give Walgreens 17,800 stores worldwide vs. the 7,800 owned by CVS. Walgreens would also gain Rite Aid’s walk-in clinics, wellness stores, and EnvisionRX pharmacy benefits business. Italian-born businessman Stefano Pessina became the CEO and majority shareholder of Walgreens when it acquired his British pharmacy chain Alliance boots Group in 2012, giving the 74-year-old net worth of $14 billion.
Xerox reports Q3 results: revenue down 10 percent, EPS –$0.04 vs. $0.22 following a $385 million write-down after pulling out of two state Medicaid system contracts. The company says it won’t sell itself, but “a comprehensive review of structural options for the company’s portfolio is the right decision at this time.” Above is the one-year share price chart of XRX (blue, down 28 percent) vs. the Dow (red, up 4 percent). Shares dropped 8.3 percent Tuesday to a 52-week low on 13 times average volume.
Lexmark announces Q3 results: revenue down 7 percent, adjusted EPS $0.57 vs. $0.96. The company’s board has authorized “the exploration of strategic alternatives to enhance shareholder value and unlock the intrinsic value created by the company.” Shares dropped 13 percent following Tuesday’s announcement before the market’s open. Above is the one-year share price chart of LXK (blue, down 25 percent) vs. the Dow (red, up 4 percent).
San Francisco-based, 15-employee medical image analysis vendor Enlitic raises $10 million from an Australian diagnostic imaging company.
HCA announces Q3 results: revenue up 6.9 percent, adjusted EPS $1.17 vs. $1.18. The company blames lower profit on patients who were previously insured but stopped paying their Affordable Care Act premiums. The board authorized the repurchase of up to $3 billion of the company’s shares.
Dialysis Clinic (TN) chooses the EClinicalWorks EHR.
UNC Health Care (NC) and UF Health Shands Hospital (FL) choose Lexmark’s vendor-neutral archive.
Catholic Health Initiatives will expand its agreement with Allscripts to include managed services and its FollowMyHealth patient engagement platform. Mineopie reported as a rumor on October 21 that CHI had signed managed service agreements with both Allscripts (outpatient) and Cerner (inpatient). CHI signed a three-year, $200 million infrastructure outsourcing deal with India-based Wipro in March 2013 with little fanfare since except for IT employees complaining on Glassdoor that outsourcing, layoffs, and marginal management has put IT in shambles. The CEO said in 2010 that the organization would spend $1.5 billion on EHRs and other IT systems.
People
Jyotishman Pathak, PhD (Mayo Clinic) is named chief of health informatics at Weill Cornell Medicine.
Announcements and Implementations
IBM releases Datacap Insight Edition, which can classify and route scanned documents using advanced imaging, natural language processing, and machine learning. It provides an unconvincing healthcare example: “Where doctors and hospitals are transferring hand written notes and images into electronic health records for analysis or filing.”
Truman Medical Centers (MO) and Cerner will work together in piloting healthcare IT and giving Cerner employees on-site experience.
Peer60 publishes “Into the Minds of the C-Suite 2015.”
The American Dental Association’s ADA 2015 conference chooses DataMotion to provide Direct Secure Message and secure e-mail solutions as the technology backbone for secure digital exchange demonstrations.
Privacy and Security
In a remarkable statement, an FBI cyberattack expert says the agency often advises people to just pay cybercriminals the demanded money when a PC is infected with ransomware, which locks their computer information until payment is made to release it. He suggests that the malware is so sophisticated that payment is the best option, with the others being to revert to a backup or pay a security expert to try to remove the malware. Knowing that most people never make backups means they’ll pay either way. It’s a bit surprising that people still store their one single copy of valuable data on their local hard drive, which is a problem we’ve always had in hospitals where employees ignore strong suggestions (or policies) to store everything on the shared drive only. You can easily determine those who didn’t by the volume of their whining when they report a problem that requires immediately replacing or re-imaging their laptop or desktop.
Investigators conclude that China-based hackers breached insurer Anthem because the Chinese government is desperate for ideas on how to care for its aging population. Chinese citizens were promised universal access to healthcare by 2020, but they are not satisfied with the cost, quality, and gaps between the rich and the poor. Somehow the hackers missed the fact that the US has failed equally spectacularly on those same issues despite spending many times more than China and everybody else, so perhaps our cyber-retaliation involves hoping they follow our pitiful example.
Celebrity gossip site TMZ says several employees of Sunrise Hospital (NV) have been fired for trying to take photos and look up the medical records of former NBA star and comatose brothel patron Lamar Odom.
Other
A observational study by Massachusetts General Hospital finds that medication errors were made in half of its surgeries, a third of which caused patient harm. The most common errors involved mislabeled drugs, incorrect doses, failing to treat situations indicated by vital signs, and documentation mistakes.
In Australia, the Queensland government will provide an extra $4.2 million to support the Cerner rollout at the newly opened Lady Cilento Children’s Hospital, which has had many planning-related problems since its opening including an IT budget estimated at $29 million now standing at $67 million.
A state audit finds that South Australia’s Cerner Millennium pathology information system implementation skipped project steps and will fall short of money to complete the project, as additional costs for an unplanned disaster recovery center, legacy system decommissioning, and absence of an electronic ordering module are expected to exceed originally estimated costs of $22 million by several million dollars.
UMass Memorial Health Care (MA) will staff its $700 million Epic implementation by moving its 500-employee IT team to downtown Worcester to create room to house the 250 new hires needed. That’s what the local business paper says, although I would bet a lot of those new IT people are assigned there temporarily for the Epic implementation only. A common Epic implementation model is to choose existing IT team members for the Epic project via interviews and scores on Epic-mandated personality tests, hire new people as needed using the same interviews and tests, bring on temporary resources from clinical and administrative departments to provide subject matter expertise, and move everybody to a sequestered location where they won’t be bothered by unrelated IT work. A lot of those folks are borrowed until after go-live, when they return to their home departments. Hospitals usually hire experienced consultants as well to get them through implementation, after which they go away.
I mentioned previously that I had run into problems using Stride Health to look up available health insurance in various parts of the country to see how many plans involve high deductibles (answer: just about all of them). The company quickly responded with a request for details, then let me know that they had fixed the problems, one of which they hadn’t heard of until my report. It’s working great now.
In bizarre irony, the SXSW festival cancels two panel discussions covering the bullying of females in the online gaming industry after it receives threats of on-site violence. Members of Gamergate, whose members claim a lack of game journalism transparency, have threatened gaming industry women, vowing to publish their personal information or to rape or kill them.
Weird News Andy calls this story “You Don’t Know Squat.” A hospitalized woman in labor passes on the nurse’s recommendation that she perform squats to hasten her delivery, instead choosing to dance down the hall to a rap tune.
Sponsor Updates
Medecision will sponsor the HIMSS Summit of the Southeast 2015 October 29-30 in Nashville and HIMSS Big Data and Analytics Forum November 5-6 in Boston.
AirStrip will exhibit at The Health Management Academy’s CMO and CMIO Forums October 28-30 in Deer Valley, Utah.
Bernoulli becomes a sponsoring partner of the AAMI Foundation’s Coalition for Alarm Management Safety and Coalition to Promote Continuous Monitoring for Patients on Opioids.
Bottomline Technologies sponsors the nonprofit Leadership Seacoast for the fourth consecutive year.
Divurgent wins Business of the Year and Executive of the Year awards from the Business Intelligence Group.
EClinicalWorks will exhibit at the 2015 NJPCA Annual Conference October 28-29 in Las Vegas.
Extension Healthcare receives a 2015 Innovation Award in the Technology category from the Greater Fort Wayne Business Weekly.
FormFast will host a virtual user group meeting November 3 and 4.
HCS will exhibit at the LeadingAge 2015 Annual Meeting November 1-4 in Boston.
HDS will exhibit at Summit of the Southeast 2015 October 28 in Nashville.
Healthcare Growth Partners advises Lavender & Wyatt Systems on its sale to Netsmart.
Zynx Healthcare SVP of Mobile Strategy Siva Subramanian, PhD will participate as a panelist at Partners HealthCare’s Connected Health Symposium October 29-30 in Boston.
Burwood Group becomes one of the first Citrix Solution Advisors to complete three Citrix specializations in virtualization, networking, and mobility.
CitiusTech will exhibit at the NAHC Annual Meeting 2015 October 28-30 in Nashville.
Researchers at Massachusetts General Hospital analyze records from 277 operations and observed that 124 of the operations included at least one medication error, one-third of which resulted in harm to patients.
Truman Medical Center (MO) expands its partnership with Cerner, a fellow Kansas City organization. Under the new partnership, Truman’s IT staff will become Cerner employees and TMC will provide Cerner with a nearby “living lab” to research new solutions.
In preparation for its Epic implementation, UMass Memorial Health Care (MA) will relocate its 250 employee IT staff to a new 94,000 square foot office space in Worcester, MA that will provide enough room to expand the department to 500 people.
With the goal of expanding the number of meetings and conferences we report on, Mr. H is sending me to the AMIA Annual Symposium this year. I’ll be reporting on the activities each day. I’m looking forward to it as I haven’t attended previously. I’m also eager to log some hours towards Maintenance of Certification (MOC) for my Clinical Informatics board certification.
I’m not the only one looking forward to getting the continuing education credits. The AMIA listserv for the Clinical Informatics Community of Practice (CICOP) has been hopping with quite a few complaints about the whole MOC process for those of us in this new specialty. With the first cohort passing their exams in the fall of 2013, we’re decently into the first part of our 10-year recertification cycle. Those of us certified through the American Board of Preventive Medicine (the American Board of Pathology also certifies) are required to obtain a certain number of ABPM Lifelong Learning and Self-Assessment (LLSA) hours every three years in addition to regular continuing education hours.
Most of the current LLSA-approved continuing education offerings are within ABPM’s longer-standing subspecialties such as Aerospace Medicine, Occupational Medicine, General Preventive Medicine, and Undersea/Hyperbaric Medicine. The number of courses for clinical informatics are few and far between and typically involve on-site courses. AMIA has completed the process to offer LLSA hours for the fall meeting, and for those of us unable to get hours over the previous two years, it’s a huge help.
When I initially decided to try to become part of the first class of board certified clinical informaticists, I really didn’t think about what it would be like to maintain certification with two different board organizations. The American Board of Family Medicine already requires me to do 150 hours of CME each year, of which a certain percentage has to meet specified criteria. Certification by the AMA or the American Academy of Family Physicians are two of the criteria that count. Finding AMA- or AAFP-approved CME is easy. It’s everywhere, and can be earned not only through face-to-face symposia but also by reading journal articles and taking CME quizzes or doing online coursework.
We’re one of the first specialties that required Maintenance of Certification. Although the policies are a little tedious, they’re well documented and pretty straightforward. With Clinical Informatics being relatively new (coupled with the fact that many of us in the first two certification cohorts are, shall we say, fairly Type-A personalities) there’s a lot of tension around MOC. In addition to the LLSA credit, we’re also supposed to complete a “patient safety module” which is somewhat ill-defined (although ABPM did offer a link to a discounted course from the National Patient Safety Foundation that they’ll accept). A friend of mine got his university course approved as well, but the rest of us may not have that option.
I’m grateful that the Board has agreed to recognize some of the MOC (called Part IV) activities that physicians are already performing for their primary board certification. The current Clinical Informatics subspecialty certification requires physicians to maintain full certification in another American Board of Medical Specialties sanctioned discipline so it seems only fair, especially considering that the Board has yet to come out with a recognized clinical informatics module. I have to admit that the process to have my Family Medicine credits recognized was fairly straightforward, although it did require printing and completing a paper form and emailing it to the Board.
One of the respondents on the AMIA email thread mentioned that as a specialty deeply involved in computer-based projects, we should be at the forefront for virtual and online courses. Unfortunately one of the major challenges is completing the paperwork from the board to have your course recognized, which I hear is not exactly straightforward. I don’t know if there are fees involved with submitting a course offering, but that could be a de-motivator for some providers of continuing education credit.
There aren’t any well-known online providers for the kind of credit we need. Although some of our colleagues in academic settings are going to try to get their local courses certified, that doesn’t help those of us who are in parts of the country where we’re thinly populated. I’m one of two certified informaticists in my metropolitan area of over three million people, and I’m sure there are others even more sparsely arranged than we are.
One of the AMIA representatives mentioned being in contact with the Board and that we’re going to get an extension on some of the initial deadlines, but as a diplomate of the Board, I haven’t received that communication directly from them nor has it been posted on their website or in any other print media that I’m aware of. It’s understandably frustrating then for those of us who don’t want to fall behind but are somewhat stuck about what we need to do to be successful.
We’ll gather at AMIA, though, and see what kind of credits we can rack up and whether they’ll be enough to get us through the first checkpoint at the end of Year Three of our certifications. Hopefully some virtual offerings will be approved soon, or at least some recordings for those of us who aren’t willing or able to spend several thousand dollars (not to mention the time out of practice) to attend a conference in person.
It’s exhilarating to be on the cutting edge of things, but like being in the health information technology industry, it can also be frustrating and at times downright exhausting. I’m hoping that attending AMIA and networking with others in the field will help recharge some of my depleted energy and give me ideas for future projects. If nothing else it’s an excuse to visit San Francisco, which I’ve never done in the fall.
Joseph Pocreva, MD is an emergency physician at Keesler Medical Center at Keesler Air Force Base, Biloxi, MS. He is a colonel in the United States Air Force. His views and opinions are his alone and do not necessarily reflect the official policies or positions of the Air Force.
Tell me about yourself and your job.
I’m an emergency medicine physician. I’ve been practicing for about 15 years. I am in the Air Force. I have been working in various emergency departments, Special Operations, and different areas of the Air Force.
I have been here at Keesler for approximately five years and have had various roles while I’ve been here, including flight commander, medical director, and a practicing doctor on the floor.
How much of your career is more military than medical?
Sometimes it’s not very easy to answer that question. There are some physicians who feel like they’re more doctors than they are officers. Some feel they’re more officers than doctors. I have felt both ways.
Obviously when I’m on the floor and I’m engaged with patients, I’m a doctor. Yet when I walk away from the floor, I have to interact with other places, not only in the hospital but throughout the Air Force or with engagements with the Army or the Navy. Then my role oftentimes becomes more of an officer in the Air Force. That’s in my current position.
I’ve had other positions where I had no medical role at all. It was all about being in the military and functioning as an officer. It is a switch that gets toggled quite frequently. I’m not sure if I answered the question very well. I wouldn’t be able to give you a 60 percent, 40 percent answer — it all depends on the day and the demand.
You served on a humanitarian mission to Haiti, correct?
I was in Haiti. That was in 2010, just months before I was assigned here. I was the lead medical officer in Haiti when we went into the country to open up the airfield.
Have you had other assignments or deployments to other locations?
Oh, yes. If you’ve spent any time in the military in the last 20 years, you will have deployed.
My initial assignment was at Eglin Air Force Base in Florida. I deployed to Iraq in that timeframe. I was also stationed at Hurlburt Field, which is the Air Force Special Operations base. I did a lot of shorter missions, primarily to the Philippines. That’s where I went to Haiti as well.
I’ve traveled quite a bit doing a lot of diverse things. A lot of forward medicine, dealing out in the field without a lot of hospital support, just “what I can carry on my back” type of medicine.
How have you used that front line experience from Iraq in your ED job?
I was in a forward hospital there. We had a pretty decent sized staff, but we didn’t have a lot of resources. Practicing emergency medicine in today’s world is very lab- and radiology-intense. In those settings, we just don’t have those kinds of resources. You have to rely on your clinical abilities and your ability to make a decision, which is oftentimes paralyzing to the younger clinician who depends a lot on labs and radiology and their consultant staff.
If you don’t have it, you have to make decisions. Your decisions have serious implications, because if you want to transfer somebody in that setting, you have to get an aircraft to come in and take your patient away. If you can take care of them there versus putting them on a very expensive aircraft … You have to make those kinds of decisions. There’s a lot of differences between forward medicine and medicine back home.
What it’s like practicing in an Air Force hospital ED versus a civilian one?
Some very important key differences. We practice socialized medicine. We have a very captive patient population. They all have primary care doctors. They all have access to medications. There’s a social structure which is well defined. All of our active duty people have supervisors who we can call.
It’s a very different world from the outside. I’ve worked on the outside as well. I’ve moonlit for years at many different institutions and things.
There are advantages and disadvantages to both settings, but working inside the military is what socialized medicine is, in a nut shell. Actually, I would go on to say that, as far as I can tell, it is the best example of socialized medicine that we would be able to maintain.
People forget that military medicine isn’t just taking care of active service members, but their entire families as well, so you have pediatrics, oncology, and other services.
Right. The active duty population is only a small portion of who we take care of. The majority are their dependents and then our retirees as well. It’s everything from cradle to grave.
Is military medicine care at least comparable to what is offered in civilian settings?
It is somewhere in the middle. I’ve worked in plenty of hospitals that had nowhere near the capability that we have. Then you go to some of the major medical centers which have comprehensive care … When we have patients that are beyond our capability, then we will refer them to, in our case, the University of South Alabama or the Jackson Medical Center up in Jackson, Mississippi or over to Ochsner in New Orleans. We rely pretty heavily on them.
As far as the bread and butter basics of medicine, into surgery, into your medical specialties, and what have you, what we have is quite comprehensive.
What technologies and IT systems do you use in your practice?
We have CHCS, which is our basic underlying database., It’s been in place since the late 1980s and we’re still using it to today. That is where we record all of our labs and radiology and that’s where we do our prescribing from. As old as it is, it’s solid as a rock. It never goes down, ever. Everything else can go down, but CHCS still manages to keep plugging along.
On top of that, we have a graphical interface software solution called AHLTA. When it works, it works all right. [laughs] It is a program which is designed to interface with CHCS and pull data from it, as far as all of CHCS capability. But it’s also for record-keeping and and electronic medical records. We use it primarily just as an interface to get to the CHCS data.
In our emergency department, for our recordkeeping, we use T-System, which is hands down much better when it comes to data entry than AHLTA is. Much, much, better.
Those systems may be replaced in the DHMSM project. Are you looking forward to that or concerned by it?
I don’t really know a great deal about it. I understand that Cerner won the contract to provide the next generation. There’s generally the understanding that it’s going to be coming sometime in the future. After that, I think I know enough in my career that I don’t get too excited about dates of when it’s going to come, so I don’t know when we’re going to actually see that.
I would be very surprised if it has an interface which is more user friendly than T-System. Hopefully we can find a way to integrate T-System into it. But beyond that, that’s just all conjecture, and I don’t know — I’m not a part of that whole process.
I’ve read that 60 percent or more of care delivered to military members happens outside of military facilities. How do you communicate with external providers?
That 60 percent probably reflects most of the places not around the larger institution. Around here, we probably deliver considerably more than that in our facility. But so many of the smaller bases have been reduced to clinics. A lot of that referral work and surgical procedures and things are going to be done on the civilian side, so I think we do a great deal more of it here.
However, when we do refer people out to the community, they are not on our informatics databases. We have to rely on them doing a consultation and sending the reports back to us. Then our information people enter that data back into our system. It’s a rather slow and cumbersome process.
Do you have a lot of overlap in the information that you either need from or provide to the VA?
No. We see a lot of VA patients. We have a pretty robust interventional cardiology practice here, so virtually all of their cardiac caths come here. We have a lot of vascular surgery. A lot of the VA patients come here, but we don’t use their systems, nor do they use ours. If we want that data, we’ve got to go and request it old-school style.
How long do you plan to stay in the military?
I have been in the military for 23 years right now. I will be getting out next year. I’ve already put in my paperwork to retire. I should be retiring somewhere around the first of August in 2016. I will likely be joining a local practice here in the area.
What will you miss in not being part of the military?
The people, without a doubt. My grandfather was career Navy. My father was career Air Force. I’ve been on the Air Force welfare system since I was born. I don’t know anything different.
Not only taking care of this population, which is something that is very important to me, but working alongside a lot of people who really care about being here and doing the mission and being part of something much bigger than themselves is one of those intangibles that is very difficult, if not impossible, to find anywhere else.
It will be a sad transition for me, I’m sure. Although the local hospitals around here are wonderful by any marker, it’s going to be difficult to walk away from an institution like this.
People with no military connections admire the patriotism, discipline, and sacrifice involved. Is it equally impressive from the inside?
Oh, yes. Yes. You see people with talent and abilities and what have you. You look at them and you think, "Man, you could be making a million dollars on the outside, and yet you’re in here doing this job.” I really appreciate it.
That really comes through and shines when we’re deployed. When you’re out there and you’ve been away from your family for a couple of months and people are still putting their shoulders to the grindstone and just working hard.
Sometimes the situation and the environment we’re in is less than ideal. We’ve yet to go and occupy a really great place. [laughs] We tend to deploy to less-than-ideal locations. It’s very impressive when you see people step up and do the amazing work that they do. It’s an honor to be a part of that.
Athenahealth stocks jumped 28 percent on Friday after reporting better than excepted quarterly results. The company added 4,800 new physicians to its platform this quarter, a 40 percent increase. It also now has three critical access hospitals billing inpatient claims through AthenaNet.
AMA vice president of professional satisfaction Christine Sinsky, MD reports that EHRs are cited as the biggest driver of physician job dissatisfaction. She suggests utilizing scribes and medical students to reduce the amount of data entry required of physicians.
Walgreens announces that it will halt the roll out of Theranos blood testing centers within its stores until the startup resolves questions about its technology. Walgreens, which has an equity stake in Theranos, clarifies “We’re trying to figure out where we are and what we do going forward. We need to understand the truth.”
A revamped Healthcare.gov goes live Sunday, with updates expected to increase speeds by 40 percent and add features to help consumers compare the cost vs. benefit of each insurance plan.
October 25, 2015NewsComments Off on Monday Morning Update 10/26/15
Top News
Athenahealth shares jump 28 percent Friday after the company announces better-than-expected quarterly results. It’s now valued at $6.3 billion, with Jonathan Bush holding $51 million worth.
From the Athenahealth earnings call:
Jonathan Bush says three small hospitals are submitting inpatient claims via AthenaNet using what is basically an interface to the acquired RazorInsights hospital information system.
When asked about the company’s direction as HITECH winds down, Bush said, “The satisfaction and the feeling of being on-mission as opposed to on the tip of an Obama spear is phenomenal for us. No offense, Barack, I know that you’re Mr. President, but that’s just how it feels.”
Bush described telemedicine and the addition of Chiron to its “More Disruption Please” program as, “Imagine a store whose entire inventory rots instantly at the end of each day. That’s a doctor’s office … We’ve tried hammering them too much and that hasn’t been great, e-mailing and texting and auto-calling. We’re working on a partnership with a bunch of different makers of apps. We’ve got a small team that’s toying with a universal Athena app … I imagine someday the store brand of telemedicine for Athena will expand, of course. But right now, I think the right focus is getting those new players with their new energy into the tent.”
When asked to compare the company’s position vs. that of its competitors, Bush said, “We are the only company that’s selling a cloud-based service … No one has even a plan to think about starting to try in the sector that you guys think of as our competitors. I think of them as just a business model from a different era … That you run faster than a three-legged horse is not good enough. We really got to think about what’s emerging in the venture world and what’s possible in our business model and compare ourselves to that. We still feel like we have a long way to go on those results.”
Bush said of the impact of Medicare’s merit-based incentive program, “The thing about the MIPS program is it creeps up on you. This year’s performance is then submitted and the government takes a year to look at the performance. Then in two years, your rates are adjusted according to this year’s performance … It’s trickier to jolt the market with it, but it’s a really big deal. It’s an 11 percent, 12 percent swing in a doctor’s Medicare take-home pay based on how he performs, or she, on this program. So we should be able to sell against it. It’s just harder to explain and to create urgency around.”
Reader Comments
From Dixie Whistlen: “Re: top 25 blogs to read. Why did the magazine list Ed Marx on HIStalk but not the rest of HIStalk? Some of those they mentioned are not even popular.” You would have to ask the magazine. I don’t read those sites or pay attention because, like all such “awards,” it’s just a scheme to get people to click through the endless slide show to fool advertisers with a higher but meaningless metrics. One of the blogs that made the Top 25 hasn’t posted anything new since March 2011 and another winner’s newest post is from December 2013, which suggests a superficial editorial vetting process.
Speaking of junk health IT reporting and meaningless reporting intended to sell ads, I just noticed that US News and World Report is announcing its “Most Connected Hospitals” list, which it has apparently been running for years. That must offer competition to the equally pointless “Most Wired” list from H&HN that achieves little except allow CIOs to pad their resumes and hospital marketing people to place yet another logo on their ads that attempt to convince the locals of their organizational competence.
From Bob Wyer: “Re: cancelled sponsors. You said you would list them each month with the new and renewing ones, but I haven’t seen any.” I did promise to do that but I promptly forgot. Companies decide to stop sponsoring for a variety of reasons: they decide to spend their marketing money elsewhere, they are unreasonably obsessed with ad clicks, I wrote something unflattering but true that made them mad, they don’t have money in the budget, or the decision was made by a marketing person who knows nothing about HIStalk or the industry in general. Anyway, here’s the list of dearly departed sponsors going back several months. I appreciate their previous support, especially those that had sponsored for several years.
From Exotic Delicacy: “Re: Caremark. They won’t allow my prescription to be filled locally, so they ship by next-day air a 12×10 inch carton containing a 9×11 inch Styrofoam cooler packed with five ice packs. The actual meds are about 1×3 inches. Besides the cost, all of that (including the chemicals) goes into the landfill.” I was musing this week of what I call the Amazon Prime effect, where my near-daily Amazon orders create a never-ending mountain of boxes and packing material that I have to scrunch and tear to squeeze them into the large recycling bin that goes to the curb weekly. It reminds me of the department store stock boy job I had while working my way through college, in which the fun chore was feeding heaps of big, flattened boxes into the mall’s paper crusher deep in the bowels of the building. I also learned to hate Christmas gift wrap since it was stored in huge quantities in a truck trailer parked out back, causing me to freeze several times a day in November and December in bringing in more big boxes of it. It wasn’t nearly as fun as my summer job working at a public radio and TV station, which didn’t require me to do a whole lot except download satellite programs like “All Things Considered” to tape for later broadcast and to read the news for our infrequent live programming.
HIStalk Announcements and Requests
It’s apparently not just me that doesn’t see Dell as a significant healthcare IT player from my extra poll last week. Machete’s comment is an admirably concise interrogatory: “Dell’s in healthcare?”
The results of my regular poll are sobering, in which 6 percent of males and 52 percent of females say they’ve been sexually harassed at work in mostly unreported incidents. Woodstock Generation hopes a lot of the harassment happened in the 1990s when reporting was uncommon, while It’s Everywhere (Unfortunately) adds, “I was harassed by multiple attending physicians in medical school and witnessed them harassing other students and even patients. It was disgusting. As a practicing physician, I have been harassed by peers. Working with software vendor employees and consultants, I have seen entirely too much harassment, mostly fueled by alcohol and testosterone.”
New poll to your right or here: would you be willing to have your lab tests performed by Theranos?
I was interested after running a TV station’s photo of a hospital documentation sheet for a chemo overdose that a couple of readers complained that I had violated HIPAA, which is surprising since we’re supposed to be the HIPAA experts. First, the family took the photos and sent them to the TV station, presumably to bolster public opinion for their lawsuit against the hospital that was involved. Second, only covered entities (health plans, clearinghouses, and providers) are covered by HIPAA. Any other perceived breach of patient privacy can be addressed only through a lawsuit, which has nothing to do with HIPAA.
Reader Derek sent $50 for DonorsChoose, which thanks to the magic of matching funds from my anonymous vendor executive and The NEA Foundation, will provide four tablets that will be shared by three pre-K classrooms in Buffalo, NY, which they will use for math practice. Meanwhile, the photos above are of Mrs. Cole’s Minnesota first graders using the math games we provided and Mr. Burnitt’s Florida elementary school class working with the model rocketry equipment we bought.
Last Week’s Most Interesting News
Quality Systems sells its NextGen Hospital Solutions division to QuadraMed.
Lab upstart Theranos melts down after reports question the validity and limited use of its proprietary methods.
Vendors and providers agree on objective measures of interoperability, although not stating what those measures are or how they will be used.
IBM turns in another unimpressive quarter despite high-profile investments in Watson.
EClinicalWorks announces a cloud services platform, free client interoperability, and an Internet of Things cloud.
Webinars
None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Lab innovator Theranos continues to unravel as its highest-profile partner, Walgreens, says it won’t open any new Theranos testing centers until the company answers questions about its technology and why nearly all the samples it draws are full-volume ones that are analyzed by traditional lab equipment rather than its proprietary microfluidics machines. In more bad news for CEO Elizabeth Holmes, CMS says its surveyor found nothing innovative in the company’s facilities but did observe quality control problems; some of its claimed partners (Pfizer, GSK, Cleveland Clinic) say they’ve never actually done anything with Theranos; and records show that the company has hired poorly qualified lab directors, including a part-time dermatologist who is not certified by the American Board of Pathology. Questions are also swirling about why the Theranos board is made up of old, politically connected white men without scientific or medical expertise.
Huron Consulting Group shares dropped 24 percent Friday after the company turned in decent Q3 results but also lowered revenue guidance due to expected delays in two big academic medical center projects. The company also says it has “seen a softening in demand for our performance improvement solutions,” which it attributes to stabilized hospital margins due to ACA-insured patients such that “cost reduction work at some hospitals is no longer seen as an urgent concern.”
Fort Lauderdale, FL-based healthcare business services vendor Intermedix will open an operations center, innovation lab, and executive offices in Nashville, TN, creating 116 jobs. The company says the state and city “have welcomed Intermedix with open arms,” not mentioning the open taxpayer wallet that must have influenced its decision.
Announcements and Implementations
Westchester Medical Center Health Network (NY) opens its $7 million, 5,500 square foot eHealth operations center, which contains 20 telehealth monitoring stations that will be staffed around the clock by physicians and nurses.
Government and Politics
CMS goes live with an upgraded Healthcare.gov, saying the site will be 40 percent faster and will include the ability for users to see their estimated yearly costs for each plan. Features not yet ready will eventually allow consumers to filter the list of plans to those that cover a specific doctor, hospital, or drug.
Privacy and Security
A Springfield, MA gynecologist is indicted for accepting drug company bribes for prescribing its drugs and allowing its sales rep to dig through the medical records of her patients. The smoking gun is that as soon as the drug company stopped paying her, she stopped prescribing its products.
Local police in North Carolina speculate that scammers are using data from one of the recent high-profile healthcare data breaches to send unordered diabetic supplies by mail to people who who don’t need them. A recipient whose name, Social Security number, and doctor information was included on the unordered package tried to call the pharmacy number on the invoice, but it was phony.
The Miami-Dade division of Florida’s children’s medical services program mistakenly faxes a clinic roster to four vendors, exposing the information of 150 clients.
Technology
Israel-based MobileODT offers an $1,800 cervical cancer screening tool that connects a mobile colposcope to a cell phone, allowing clinicians to quickly take a cervical image that can also be sent out for a second opinion. The technology, which was trialed at Penn and Scripps, is being used in developing countries that can’t afford a traditional $15,000 colposcope. It will be sold in the US once the company obtains FDA approval.
Other
AMA’s VP of professional satisfaction says EHRs are the biggest driver of physician dissatisfaction. She cites studies that show doctors waste 80 percent of their time performing activities that don’t benefit patients, suggesting that they hire scribes.
A study of nephrology patients finds that patient portals are being used more widely but also more selectively, with less involvement by patients who are poor, black, and elderly.
Like that old Chicago song, nobody really knows what time it is in Turkey, whose government decides to push back the end of daylight saving time until after upcoming elections. The government doesn’t control computers and smartphones, which change time automatically based on rules rather than last-minute political pronouncements, so everybody is confused.
Centura Health SVP/CIO Dana Moore, whose ideas launched my DonorsChoose project during the last HIMSS conference, sent photos of the fundraising basketball game between the tie-dyed Centura team (which eventually won the game) and Epic. He said everybody had a great time and he’s sending me the $620 raised to fund more classroom projects, which will actually fulfill more grants when I apply the matching funds I have available. Good work by Centura, Epic, and Dana.
Weird News Andy deems Sunday’s Dilbert as “HIStalk worthy.” It’s a big panel – click the image to see it full size.
Sponsor Updates
T-System and Wellsoft will exhibit at the ACEP Scientific Assembly October 26-29 in Boston.
TeleTracking will host its client conference October 25-28 in Las Vegas.
Health Catalyst releases a documentary titled “Measured Outcomes: A Future View of Value-Based Healthcare.”
Valence Health will exhibit at the Arkansas HFMA Chapter Fall Conference October 29 in Little Rock.
Versus Technology helps cancer clinics nationwide enhance the patient experience with real-time workflow technology.
Huron Consulting Group will exhibit at the Connected Health Symposium October 29-30 in Boston.
Athenahealth reports Q3 results: revenue for the quarter was $236 million, up 24 percent, adjusted EPS $0.36 vs. $0.27, beating analyst projections on both.
Healthgrades publishes a report concluding that patients treated in a 5-star rated hospital have “a 71 percent lower risk of dying or a 65 percent lower risk of experiencing complications” as compared to patients treated in a 1-star hospital.
San Diego-based Imprimis Pharmaceuticals will begin selling a generic version of Daraprim for $1 per pill, down from its current price of $750 per pill, after national attention was drawn to the drug’s current manufacturer Turing Pharmaceuticals and its business model of buying the rights to rare but necessary medications with no generic equivalent and raising the price astronomically.
This week is one of those “you can’t make this stuff up” kind of weeks. It’s been filled with plenty of hard work, a fair amount of organizational dysfunction, and some pretty cliché observations.
Despite the challenges, I’m working with some genuinely nice people who seem to want to be successful and that makes all the difference. I’d rather work with people who know they have issues and want to try to be better than with people that think that everything is just fine when it’s not.
The practice I’m working with provides a fair amount of cash-based services (mostly cosmetic) and we dealt with some complaints about the lack of support for those workflows by their EHR vendor. It’s been interesting trying to explain why vendors have been spending all their time and energy on MU-related features and functions when the providers don’t care about being meaningfully used.
We did get some quick documentation templates done for a couple of their most common procedures, so that was a big win. One of the partners was so happy with the new workflow that he offered to give me some complimentary services. I wasn’t sure whether I should be excited about that or offended that he obviously thinks I need some work.
The physicians also have traditional primary care patient panels, but it feels more like a sideline rather than their focus. They’re trying to get in step with current primary care trends, but it’s a hard sell when you can make more money smoothing wrinkles, lightening dark spots, and making irksome leg veins go away.
Since they’re in a building on the hospital campus, several of the physicians hit the physician lounge for lunch every day even though they don’t admit their own patients. They’ve been taking me with them and it’s been enlightening to see what some of their peers think about the state of healthcare IT since I haven’t done much work in this part of the country.
I almost spit my sweet tea across the table when one physician said that since he was going to switch EHR vendors in the spring, he was going to go ahead and apply for a MU hardship exemption. He’s got connectivity issues with his current “lousy” system and has decided to just stop charting electronically. I’m not sure that qualifies as an extreme and/or uncontrollable circumstance, but he’s welcome to try. The vendor in question has tens of thousands of physicians who have successfully attested, so it’s an interesting position to take.
The practice is one of the first I’ve been in recently that still has pharmaceutical representatives call on the physicians. Most of the reps I’ve encountered over the years are hard-working and spend a lot of time dealing with cranky physicians as they haul samples from their company cars (used to be a lot of Ford Taurus-equivalent sedans, but now I’m seeing a fair number of minivans). The highlight of the week was the sales rep that pulled up in a new Maserati that cost more than my first house. He turned out to be EHR vendor’s regional sales exec. I guess he’s not hurting for business.
While I was fielding agenda changes from the client (who apparently thought of 20 other projects for me to work on during the time I was en route), I got a couple of emails from family members. My grandfather had a bone marrow biopsy last week and was told the results would be available in eight days. He dutifully called the office at the end of the eighth day after hearing nothing, only to be told that the physician would be out of town until October 29 and no one else in the office could give him results.
He sent his primary care doc a message through his patient portal trying to get the results, but was asking me for advice (as were his wife and my aunt). I thought it would be better to try to get in touch with the hematologist’s partners, who would presumably have access to his chart and would know what question the bone marrow biopsy was to answer or what condition was to be confirmed or ruled out. Even if he could see the results in the hospital system, I didn’t think this particular primary care physician would be likely to give them since he wasn’t the ordering physician.
I suggested that they call the hematologist’s office again and ask what the physician’s coverage arrangements are while he is out of town, and if they were told there aren’t any, that they mention the words “patient abandonment” and see what happens. This isn’t a question of a patient misunderstanding how he was to get the results – his discharge instructions clearly said to call for results in eight days. As a physician, I’m horrified at this kind of a process failure and the stress and worry it’s causing the patient and his entire family.
A couple of hours, later the PCP responded, basically saying he doesn’t know much about interpreting bone marrow results but that it “doesn’t look that bad.” That’s not exactly a vote of confidence for a worried patient. I saw the screenshot of the secure message and he definitely could benefit from a little coaching on how he explains things to patients. We’re still waiting to hear back from the hematologist’s office, who said their office manager would be calling to explain the cross coverage arrangements. Like I said, you can’t make this stuff up.
Turning my attention back to the client’s workflow issues, we identified several more commonly-seen conditions where the EHR didn’t fully meet their needs. I headed back to the hotel to get some additional custom templates built before selecting my next dining adventure. Several readers have commented or emailed about their BBQ preferences. The Carolinas are leading Texas two to one and I’ve received some suggestions I can’t wait to try. Tomorrow I’m finishing the day with a tour of the local Bass Pro, which promises to be something to behold.
Quality Systems sells its NextGen Healthcare hospital systems business to QuadraMed, which is part of Canada-based Constellation Software’s N. Harris Computer Corporation. QSI formed its hospital business by acquiring Opus Healthcare Solutions in 2010, ViaTrack Systems in 2011, and the Poseidon Group in 2012. It appears that NextGen will keep its Mirth interoperability product (the announcement didn’t say, but while the hospital solutions web pages are gone, the Mirth ones remain).
Meanwhile, Quality Systems reports Q2 results: revenue up 4 percent, adjusted EPS $0.21 vs. $0.13, beating Wall Street estimates for both.
Reader Comments
From The PACS Designer: “Re: HHD vs. SSD. The need for 500GB or 1TB hard drives for computers will start to diminish with the growth of cloud services. One option that could accelerate the replacement of HHDs is solid state drives (SSD). As the price of SSDs declines they become more attractive to manufacturers who will then shun the HHDs in favor of a 256GB SSD-4GB DRAM system. Western Digital’s acquisition of SanDisk seems to validate the SSD concept of lowering the purchasing costs of systems.”
From So Cal Surf Legend: “Re: Antelope Valley Hospital, Lancaster, CA. Has selected Cerner. Official announcement coming soon.” Unverified, but Cerner was their vendor of choice a few months back. It’s a 420-bed hospital.
HIStalk Announcements and Requests
HIStalkapalooza sponsorships are looking good, meaning I probably won’t have to write a personal (and thus NSF) check for many dozens of thousands of dollars to personally cover the cost. The remaining sponsorship slot is the top-level one I call “Rock Star CEO” that includes:
100 invitations.
A private lounge (capacity 100) with its own bar and food plus two VIP boxes for entertaining prospects, partners, and company executives.
The company CEO introduces the band, gets four all-access passes, and enjoys a meet-and-greet with the band back stage after their performance.
An on-stage banner.
Special recognition from the stage.
Contact Lorre if you enjoy the HIStalkapalooza vibe and want to play a key (and visible) role in producing it for the fun and influential attendees. She would be happy to consider any special needs our Rock Star CEO might have, right down to removing the brown M&Ms.
An anonymous reader donated $50 to my DonorsChoose project, to which I added double matching funds from my anonymous vendor executive and The NEA Foundation to fund a grant for Mrs. Smock’s elementary school class in Buena Park, CA that provides an Apple TV and external hard drive so that students can gain confidence and presentation skills by sharing their ideas with their classmates. Meanwhile, Mrs. Rice sent photos of her Washington third and fourth graders doing programming projects on the laptops we provided, noting particularly an increase in programming interest by the female students.
Early bird registration for the HIMSS conference ($765 for members) ends December 14, just in case you (like I) haven’t signed up yet. I was interested to see in the registration policies that attendee emails aren’t shared with exhibitors, so nobody should get promotional emails, instead having their snail mailbox filled with the usual junk that keeps coming weeks after the conference has concluded. The last policy acknowledges agreement of a condition involving photographic images that isn’t actually listed, so apparently you can take all the pictures you want, not that the old policy stopped anyone anyway. The cheapest hotel still available is Linq at $90. I’m pretty much dreading the conference, especially with the screwy Monday through Friday schedule driven by the overriding desire of casinos and hotels to fleece the weekend tourists.
My Twitter feed has been barraged this week with uninteresting cheerleading updates from Dell’s technology conference. I admit that I don’t think of Dell as a significant, committed healthcare player despite its previous acquisition of companies like Perot Systems and InSite One, any more than I think of other big hardware vendors like IBM and HP as anything more than low-margin vendors dabbling in higher-margin services du jour. I’m interested in whether I’m in the minority and thus created this special poll: how much healthcare influence does Dell have? You can explain what I’m missing in the poll’s comments.
This week on HIStalk Connect: KLAS analyzes interoperability across EHR vendors, naming the best technologies and vendors from a provider perspective. Jawbone wins an injunction against several key Fitbit employees in its suit alleging trade secret theft. Rock Health reports on consumer engagement, outlining which digital health categories are attracting the most attention. Theranos closes out its week of public feuding with the Wall Street Journal with a blog post confirming accusations that has stopped using its finger-stick lab test technology for the time being.
This week on HIStalk Practice: Healthcare.gov bashing ramps up. Virtual tools could be the panacea PCPs have been looking for. Hello Health CEO Nat Findlay explains what physicians need to know about getting paid for CPT 99490. Teladoc celebrates 1 millionth visit. American College of Cardiology members take their EHR usability woes to Washington, DC. Kenneth Iwuji, RN explains what med students really think about healthcare IT. Practice managers weigh in on how the rise in high-deductible health plans has fueled their technology spend. Hologram house calls become a reality.
Webinars
None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
PatientSafe Solutions acquires Vree Health, which offers patient engagement and care management tools. It was owned by drug company Merck.
Post-acute EHR vendor Netsmart acquires behavioral EHR provider Lavender & Wyatt Systems.
Athenahealth reports Q3 results: revenue up 24 percent, adjusted EPS $0.36 vs. $0.27, beating both revenue and earnings estimates. Share price jumped 8 percent in after-hours trading following the announcement.
Microsoft reports Q1 results: revenue down 12 percent, adjusted EPS $0.67 vs. $0.65, beating earnings estimates and sending shares up sharply after the market’s close Thursday.
The Milwaukee business paper covers the launch of Waukesha-based Intellivisit, which offers virtual diagnosis, triage, and appointment scheduling.
Sales
Behavioral Center of Michigan and Samaritan Behavioral Center (MI) will implement Medsphere’s OpenVista.
Jellico Community Hospital (TN) will implement Medhost’s clinical and financial applications.
People
Micky Tripathi, PhD (Massachusetts eHealth Collaborative) joins the board of The Sequoia Project.
Ed Caldwell (MediTract) joins CarePayment as chief revenue officer.
Announcements and Implementations
DrFirst announces myBenefitCheck, which offers prescribers real-time “what will this prescription cost this patient” advice that uses the patient’s drug benefit insurance coverage to display their out-of-pocket cost. It integrates with 300 EHRs via the company’s e-prescribing system.
TransUnion Healthcare’s eScan solution is named the #1 product in collections outsourcing and AR debt by Black Book.
The Delaware Health Information Network forms a joint program with ISpecimen that will allow researchers to search the de-identified medical information of patients whose lab samples are being stored by DHIN members. The researchers then request the samples that look potentially useful and the hospital ships them to the researcher. It’s an interesting funding source for DHIN, which will then discount its fees for participating members. ISpeciment founder and CEO Christopher Ianelli, MD, PhD was a managing director for investment bank Leerink Swann and co-founded Health Insight Technologies, which was renamed Humedica and then acquired by UnitedHealth group for an undisclosed but assuredly large amount.
Healthgrades research finds that one in six Americans received care in a one-star rated hospital, observing that had they chosen a five-star hospital instead, they would have had a 71 percent less chance of dying and a 65 percent risk reduction for complications. It also observes that hospitals may excel only in specific areas, such as the 14 Chicago hospitals that earned a five-star rating for heart attack treatment but had a one-star rating for total knee replacement, hopefully helping consumers understand the “focused factory” concept similar to the idea that you don’t order the steak at a seafood restaurant just because it’s on the menu.
T-System posts a conceptual video that will be presented to the ACEP Scientific Assembly next week that describes how cars equipped with GM’s OnStar system could send details of an accident to a T-System-equipped ED before the patient arrives. The OnStar system can predict severity of injury using vehicle, crash dynamics, and occupant information.
Imprivata Cortext is named in a KLAS secure messaging report as the most-considered product for physician-to-nurse communications.
Qualcomm’s Capsule subsidiary earns FDA 510(k) clearance of its SmartLinx Vitals Plus patient monitoring system.
Cedars-Sinai becomes the zillionth health system to get involved with a health accelerator, which would seem to be late in the game except for the fact that those that preceded them appear to have accomplished basically nothing anyway. It would be interesting to survey all of those eager startups who are seeing firsthand just how monolithic, indecisive, and change-resistant big health systems accelerator operators are.
A CoverMyMeds study finds that 70 percent of EHR vendors are committed to offering electronic prior authorization, up from 54 percent in March 2015.
Park Place International announces an expanded set of high availability solutions for Meditech and 100 other healthcare applications via its OpSus Healthcare Cloud and Microsoft Failover Clustering Services.
Privacy and Security
A Germany-based cybersecurity company says that 27 percent of all website malware attacks targeted healthcare-related sites so far in 2015.
Other
An unfocused article in left-leaning magazine Mother Jones blames left-leaning Judy Faulkner and Epic for lack of interoperability, blasting a blitzkrieg of marginally related facts that seem overly focused on how much money Epic makes and how elaborate its campus is. It observes that HITECH didn’t address interoperability. The reporter misses the fact that EHR vendors deliver what customers demand and few turf-protecting health systems are interested in sharing information with their competitors even if their EHR already supports that capability. The reporter concludes the piece by expressing his frustration that his multiple providers don’t share his information, conveniently not bothering to ask those providers why that’s the case. He also complains about the lack of information sharing by his hospital (George Washington University Hospital), which he fails to note uses Cerner, which he lauds elsewhere in the article for its interoperability as evidenced by the DoD deal and joining CommonWell. Lastly, he misses the point that providers weren’t required to buy anything from Epic, Cerner,or anyone else to collect HITECH bribes – they only had to use them in the prescribed manner. It’s valid that HITECH was mostly a waste of taxpayer money and that interoperability is nearly non-existent, but the market forces that created that situation aren’t nearly as simple as he describes.
The Albuquerque newspaper digs into the tax records of Presbyterian Healthcare Services to find that three of its highest-paid contractors are connected to its EHR. The health system paid Epic $14.5 million, T-Systems North America $9.9 million, and Leidos Health $9 million. Presbyterian has spent over $200 million on Epic. It has $1.5 billion in annual revenue and paid its CIO $429K last year.
Jamie Stockton of Wells Fargo Securities sent over their latest analysis of MU Stage 2 attestation. Epic led the hospital numbers with 97 percent of eligible hospitals attesting, while the lowest-performing vendors (in the 50 percent range) are Medhost, Allscripts, and Healthland. Epic and Athenahealth lead the MU Stage 2 physician attestations at just over 70 percent, while users of systems from Allscripts, NextGen, Greenway, Cerner, McKesson, and GE Healthcare have an extremely low attestation rate. All of this may be more of an indictment of the MU process than whose system they’re on.
Siemens Soarian user SoutheastHealth (MO) will move to Cerner Millennium, although they will stick with Soarian billing.
Prescription compounding firm Imprimis Pharmaceuticals will sell a generic version of Daraprim – the old rare-disease drug whose new owner increased the price 5,000 percent to $750 per dose – for $1 per custom-made capsule. The San Diego-based company says it will start making cheap versions of other one-source generics whose price has skyrocketed, exploiting the fact that compounding pharmacies are not required to submit their products through lengthy and expensive FDA approval. Shares of Imprimis are traded on the Nasdaq, where the company has a market cap of $57 million.
Cherokee Nation’s health services are live on Cerner.
A child at St. Christopher’s Hospital for Children (PA) is given a tenfold overdose of cancer chemotherapy due to a manual dose calculation performed from instructions on a custom roadmap that contained a typographic error.
Weird News Andy codes this story as W20.8XXA, as a man napping under a tree in a San Francisco park is struck on the head by a falling 16-pound pine cone. He’s suing the US Department of the Interior and the park for $5 million, which his attorney says he will need for long-term care.
Sponsor Updates
Experian Health will exhibit at the Healthcare IT Transformation Assembly October 25-27 in Miami.
PDS IT will exhibit at the Midwest 2015 Fall Technology Conference October 25-27 in Detroit.
Extension Healthcare will receive the Greater Fort Wayne Business Weekly 2015 Innovation Award in the technology category for its alarm safety and event response platform.
The local paper interviews retiring Healthwise founder and CEO Don Kemper and his wife, SVP Molly Mettler.
InterSystems is recognized for the second year in a row as a leader in the Gartner Magic Quadrant for operational database management systems.
Intelligent Medical Objects will exhibit at Netsmart’s Connections 2015 user group meeting October 25-28 in National Harbor, MD.
LiveProcess will exhibit at the 2015 Vermont Healthcare and EMS Preparedness Conference October 22-25 in Jay.
MedData will exhibit at the ACEP Scientific Assembly October 26-28 in Boston.
Phynd Technologies http://welcome.phynd.com/eBookoffers a new e-book, “The Benefits of a Unified Provider Management Platform.”
Navicure will exhibit at MedTrade Fall Conference October 27-29 in Atlanta.
Netsmart will exhibit at the Ohio Council Annual Conference October 22 in Columbus.
Orion Health hosts the 2015 North American Healthcare Collaborative October 26-28 in Scottsdale, AZ.
After a two-year hiatus, personal genome testing vendor 23andMe resumes offering direct-to-consumer reports on DNA-based risk for diseases like Alzheimer’s and cancer. 23andMe was shut down by the FDA in 2013 for marketing the service to consumers without approval.
Theranos CEO and Founder Elizabeth Holmes follows last week’s very public feuding with the Wall Street Journal by attending the WSJ Live conference this week, where she sat for an on-stage interview about the allegations being made about her company.
Karen DeSalvo, MD will likely have to wait for her assistant secretary for health at HHS nomination to be confirmed, as US Senator Ben Sasse (R-NE) promises to block consideration until the administration addresses the high rate of failure for co-op insurance plans established under the ACA.
There has been conversation about how the ICD-10 transition will impact unsuspecting patients. Maybe a procedure is delayed due to an inaccurate code or a bill is incorrect. These things will almost certainly happen. While the first days have gone by without significant disruption, it is inevitable that bumps will occur, as with any major technological implementation.
The real story is how much patients have to gain from the transition. ICD-9 was over 30 years old and didn’t keep pace with the dramatic advancements in the healthcare industry. Consider this short list of examples:
Laser and laparoscopic surgeries were not performed at the time ICD-9 was implemented, but are common medical techniques today.
Treating a heart attack 30 years ago was generally limited to medications to treat pain and an irregular heartbeat. Today, doctors can quickly evaluate what is causing the attack and treat accordingly – bust clots with new drugs, insert a stent to prop open a narrowed vessel, even sew new vessels into the heart during surgery.
The first HPV vaccine approved by the FDA in 2006 has significant potential to prevent cervical cancer and is widely recommended by the Centers for Disease Control and Prevention for girls and young women.
This is just the tip of the iceberg in terms of how far medical advancements have come in the last 30 years. There has also been significant change in our health with newly discovered medical conditions and the rate at which diseases are diagnosed. For example, the CDC reports melanoma rates have doubled over the past 30 years, but chickenpox cases in the United States have dropped sharply since the vaccine became available in 1995.
Clearly the healthcare landscape today is almost unrecognizable from where it was 30 years ago. Patients have different healthcare concerns and conditions and have many more options for prevention and treatment.
ICD-10 has about five times as many codes as ICD-9. The codes are much more specific in describing a diagnosis and treatment plan, allowing for providers and payers to have a more detailed and accurate conversation about a patient’s care. This will not only improve accuracy of statements and bills received by a patient, but also improve health safety and outcomes.
Here is an example of ways a patient may benefit from ICD-10 throughout the healthcare experience:
Diagnosis. During a routine medical exam, a spot is detected on a patient’s lung that requires additional investigation. The healthcare provider orders a series of procedures that require ICD-10 coding to be completed. Because ICD-10 codes are more granular, scheduling the procedure with the right resources is more likely, and therefore a more accurate and timely diagnosis is possible. The precision offered by ICD-10 will not only lead to a more precise diagnosis, it will also provide the provider with more insightful information to guide treatment plans.
Eligibility determination. This same patient has health insurance which requires testing, procedures, and treatment to be authorized. The ICD-10 codes provide the payer more specific information on the services being provided, which can result in a timelier eligibility determination. This can avoid unplanned cost to the patient and frustration working through a billing issue.
Quality outcomes. Improved clinical documentation under ICD-10 will help reduce medical errors and also lead to more meaningful discharge data that can help reduce readmissions.
In order to quickly navigate the hiccups caused by the massive transition and quickly get to the point where patients are experiencing real benefits, it’s critical for all stakeholders involved in the delivery of care to choose a partner who can successfully lead them through the complexity of ICD-10.
Ken Bradberry is chief technology officer of Xerox Commercial Healthcare.
The Benefit of Price Discrimination By James Foster
In his Monday Morning Update for 10/12/15, Mr. HIStalk first affirmed the effectiveness of the market in selecting among EHR vendors. Later, in response to a price survey, he expressed frustration with disparate costs of services, saying, "I still don’t understand why providers shouldn’t be required to offer their lowest prices to everybody." His complaint here is with what economists call "price discrimination.”
There are two general justifications for price discrimination: (1) differences in costs to the seller and (2) differences in value to the buyer. Cost differences may explain things like quantity discounts, since even if the widgets cost the same to produce, the marketing and sales costs are less if the seller has to deal with fewer buyers.
Even with the same quantity of what seems to be an identical product or service, there may be hidden costs that can justify a difference in price. For example, the price for a television purchased on credit in a poor neighborhood may be much higher than the price for the same model paid for in cash at a suburban Costco. Here the product is not just the electronics, but also the transaction costs involved in offering credit to poor-risk buyers.
Differences in value to the buyer are no less real and can be justified as a way to ensure that the goods are available at all. Most of us are familiar with the fact that adjacent passengers on the same flight can pay very different prices for the trip. On the one hand, this seems unfair ("I still don’t understand why providers shouldn’t be required to offer their lowest prices to everybody"). On the other hand, it is often the case that if everyone were charged the same price, the product or service could not be supplied at all.
That is, if the airline ticket prices were uniformly high, fewer people would make the purchase and the total revenue would not be sufficient to cover total cost. Likewise, if prices were uniformly low, the planes would be full (aren’t they already?) but the total revenue still would not be sufficient to cover total cost.
In order to provide air travel, airlines must segregate buyers into those that place lower value on the trip (vacationers who could drive or choose a different destination) and those that place a higher value on the trip (business travelers). This discrimination serves to benefit travelers who would not make the trip unless they still have some value over the price.
Healthcare providers face similar challenges as airlines: capital costs are high and marginal costs are low. Yet charging everyone the same (high or low) price would not yield enough revenue to pay for the equipment and staff. Therefore, quantity discounts are offered to large groups (represented by credit-worthy insurance plans) who can take their business across town, while unknown individuals who buy on credit typically face higher prices.
If this still seems unfair, before calling for more government regulation through price controls, we should investigate how government regulation might be contributing to problem. There are a few areas in healthcare where prices are standard, published, and declining over time, such as Lasik eye surgery. These typically are procedures where the consumer is responsible for the full price of the service and takes time to investigate before making a purchase.
Instead of imposing price controls (which have been disastrous in a variety of industries), we should look for policy changes that encouraged more consumer involvement and responsibility.
James Foster is director of operations for GemTalk Systems of Beaverton, OR.
It’s surprising that the therapist admitted to the patient the AI was used, although the therapist was so obviously frustrated…