A couple of reader comments on my piece about employer wellness programs caught my attention. I have to thank Al Lewis, who provided my laugh of the day when he asserted that, “There is no adult supervision in this field, so vendors can do things that doctors would get sued for doing.” He goes on to call out a vendor who provides carotid artery disease screening even though the US Preventive Services Task Force (USPSTF) specifically recommends against screening the general adult population. I didn’t know this was creeping its way into employee wellness programs, so thanks for the warning.
I have, however, seen mass carotid artery disease screening in a promotional offering for senior citizens that I can only describe as predatory. For an upfront cash fee, it touts the benefits of multiple “screening” tests that aren’t recommended. In addition to the carotid artery test, it also offers abdominal ultrasound screening (only recommended for men aged 65 to 75 who have ever smoked, and selectively recommended for men in this age group who have never been smokers). It also offers screening for peripheral arterial disease via an ankle brachial index (insufficient evidence to assess) as well as multiple blood tests that aren’t necessarily recommended for average-risk individuals.
When looking at the flyer and the number of tests offered, it may be easy for some to come to the conclusion that it’s a good deal based on the sheer volume of diseases they talk about. However, no test is without risk and just getting them because they’re cheap and available is a bad idea. Although we did tend to “shotgun” batteries of tests on our hospitalized patients when I was in medical school, by the time I reached residency training, the focus had shifted to doing fewer tests and only those that were evidence-based. That was good, because I can’t even count how many wild goose chases we went on due to abnormal labs that should never have been ordered in the first place.
The worst wild goose chase of my career still haunts me and I wonder if a different attitude (and better interoperability) would have prevented it. The patient was a delightful lady with significant and complex medical problems who had been my patient for three years during my residency. When I decided to stay in town and open a practice, she asked if she could follow me. Although I said yes, I cautioned her that there would be a two-week period between when I graduated from the training program and when I hung out my shingle when I would have no malpractice insurance and could not be her doctor. I advised her to remain with the residency clinic for continuity until my doors were open.
Unfortunately, one week into the gap (while I was cramming for my board exam) I received a call from the emergency department of my “new” hospital where the patient’s caretaker had taken her, not realizing I could not yet care for her. She was admitted and placed in the care of a hospitalist and three specialists who were working up her problems, unaware that they had been worked up thoroughly in the past. Because the patient was non-verbal, her ability to consent to the evaluation was limited. She had abdominal pain and her exam was challenging due to her other conditions, so someone ordered a cancer antigen test, which was positive. They didn’t realize it had been positive for some time with a completely negative workup and a previous informed consent decision to stop pursuing it.
I attempted to reason with one of the house doctors, begging them to request the chart from the residency program so they could provide good care. Unfortunately the goose chase persisted and the patient remained hospitalized, developing a life-threatening problem with her platelet function. This was in part due to the blood thinner injections she was given in the hospital to prevent blood clots due to her immobility. Oddly enough, the patient has been immobile for the better part of 50 years and survived without blood thinners, but the doctors were just following the hospital protocol for giving heparin to immobile patients.
The cancer workup was completely repeated, including several invasive procedures. By the time I assumed care of her barely a week later, she had suffered multiple complications, including a heart attack, and was being considered for bypass surgery.
Thank goodness I was able to corral things before that happened because the patient and I had previously discussed her surgical prospects and she had clearly indicated that she didn’t want anything like that done. I realized that for most of the hospitalization, she had been without the computer she uses to communicate with people (she has mobility of one hand and creates computer-generated speech using it) and probably hadn’t consented to most of what she had been through.
At that point, my goal was just to get her out of the ICU, and then out of the step-down, and then to the regular floors, and then home – one day at a time. Eventually we accomplished all of those and she did well despite the “care” she received. Even years later, just thinking about this scenario wants to make me track down whoever ordered that initial (inappropriate) blood test and give them a good talking-to. Whenever one of my students or supervisees orders an unnecessary test, they hear this story. I hope it sinks in.
Another comment was from John Lynn, who asks that if a patient showed up in my office and said they were healthy and wanted to stay healthy, what would I do? I agree with him that some doctors would offer a physical and try to find something wrong. However, many physicians (especially those trained in family medicine and other primary care specialties in the last two decades) would know exactly what to do. We’re well trained in health promotion and disease prevention, but many of us don’t get to use those skills often enough. My personal recipe includes the following:
Find out if the patient has any concerns about their health, even if they think they’re generally healthy. Those concerns should be addressed through additional history and a targeted exam and a specific workup if warranted.
Take a detailed family history to review the patient’s risk factors and discuss ways to mitigate those risks or avoid developing additional risk factors.
Discuss general health behaviors (diet, exercise, tobacco, alcohol, caffeine, sexual behaviors, seat belt use, etc.) and advise accordingly in line with current evidence. Refer to appropriate resources as needed (nutritionist, smoking cessation, psychology, social work, etc.)
Assess psychosocial and other determinants of health as needed (social supports, financial ability to get care if needed, etc.)
Targeted physical exam as recommended for evidence-based screenings and to establish a baseline rather than “looking for” something.
Recommendation for additional screening tests and preventive services as appropriate based on evidence-based recommendations. This may include in-office services such as vaccines or external testing such as mammograms, colonoscopies, etc.
There are more things involved, but you get the idea. It’s about the doctor and the patient sitting down and talking about things. Which in our system doesn’t get you paid very well, and because of that, we don’t have anywhere near the time we need to do it right.
Add in the fact that patients often have to change doctors every year or two due to insurance changes and it’s hard to develop the rapport needed to work together on some of the more challenging situations that come up when you actually talk to people and get to know them. I’d love to be able to have a solid hour with patients to do a wellness visit and to leverage proven techniques such as motivational interviewing, but that’s just not how it works.
In my ideal world, I’d not only have the time to do it right, but the resources – access to other clinical professionals as needed (psychologist, social work, nutritionist, health coach, etc.) at times that work for the patient so they don’t have to take off work. I’d also like to see these preventive services fully covered by insurance. Although the Affordable Care Act mandates coverage for preventive services recommended by the USPSTF, patients on so-called “grandfathered” plans may still not have coverage. Until recently, I was on one of these plans so know exactly what is involved.
I’d love to see all preventive services fully covered. Not only because it’s the right thing to do, but also because they have been proven to be cost effective. I remember the first time I realized that Medicare wouldn’t pay for blood sugar monitoring supplies for certain diabetic patients but they would pay for amputations. I was appalled.
If that ideal world existed, I’d likely still be a primary care physician rather than a mercenary CMIO and part-time emergency doc and blogger. It’s something for the politicians and pundits to think about when they talk about the shortage of primary care physicians and wanting to bend the cost curve. But unfortunately, I don’t think it’s anything I’m going to see in my lifetime.
Athenahealth forecasts a FY16 EPS of between $1.65 and $1.85 on $1.13 billion in revenue, topping analyst estimates on earnings but forecasting a lower than expected revenue. In a statement ahead of its investor day, the company explained that it planned to scale its operations to increase revenue and improve margins.
Health Affairs recaps a number of ACA-related reports, one from the CDC finding that the percent of adults struggling to pay medical bills is steadily declining, another from the CBO forecasts a 1.7 percent decline in labor supply caused by ACA coverage expansions, and a third from CMS announcing that one million new Healthcare.gov users have selected plans this year.
In an effort to alleviate pre-surgical anxiety and improve patient education, Tufts Medical Center (MA) will begin using virtual reality headsets to help prepare patients for surgery, giving them a 360-degree tour of the facility and introductions to the staff.
A report on physician job satisfaction between 2011 and 2014 finds that burnout is increasing across the board, but at rates that vary heavily between specialties. Burnout rates in the general population have remained flat over the same period.
Designing a New EHR User Interface: Telling a Story on a Timeline
In January of this year, my wife Karen — who is an artist and illustrator — and I came across an illustration from a children’s book for early readers which she had illustrated back in 1980.
The book tells the adventures of the very nice Brown family (Mr. and Mrs. Brown, Sam, Jane, and Grandpa) who somehow manage to accomplish and thoroughly enjoy their daily activities despite the fact that, or perhaps because, they are incapable of abstract reasoning.
In the chapter about bedtime, Sam explains his plan for the night:
About the same time we came across this illustration, I had been thinking about how to display EHR events visually on a timeline (see my posts from 11/09/2015 and 11/25/2015 for a description of the EHR TimeBar design). I was struck by how both Sam and I wanted to use length in order to measure time.
I started doing some reading in the cognitive psychology literature. It turns out that it’s not just Sam, but all of us (including the MIT undergraduates who were the subjects of some of the experiments and whose capacity for abstract reasoning is presumably better than that of the Browns) who use length and other spatial metaphors to think about time.
When we use expressions like “a long time ago,” “a short time later,” “back in time,” “the distant past,” “spring is far away,“ and so forth, they come to us so naturally that we don’t realize we are using our concepts of space to describe time.
To what extent we have to rely on spatial metaphors when we think about time turns out to be a hotly debated topic in cognitive psychology. According to the “strong version” of one theory, the human brain just can’t intuitively grasp the concept of time. This theory holds that the human brain, like the brains of all other animals, evolved to help us perceive and interact with the physical world.
When humans subsequently acquired the capacity for abstract reasoning, we had to use our existing sensory and motor systems – the ones we use for seeing, hearing and touching things and moving around in the real world – in the service of understanding abstract concepts. In other words, according to this theory, we are mentally incapable of understanding the concept of time without thinking of it in concrete terms. For instance, by visualizing it as a physical path.
If this theory (or even a weaker version of it) is true, it has profound implications for designing EHR user interfaces. If we can present a sequence of clinical events as points in space along a visual timeline, we should be able to grasp this time-based data with little cognitive effort.
In other words, we can “co-opt” the parts of our brain — including our high-bandwidth visual processing system — that have been finely honed by millions of years of evolution to intuitively grasp the physical world in the service of grasping abstract concepts. In doing so, we spare our finite cognitive resources for patient care issues.
Consider two alternate ways of representing the sequence of clinical events (documents) in my data set for the months of March and April, 2014. Note that for clarity, in both views only the time-based (temporal) information about the documents is represented; the subject matter of the documents has, for now, been omitted.
Chronological List of Events – Numeric Format
Timeline View of Same Events – Graphical Format
We can then begin to ask which view better supports the following tasks:
Accurately shows the precise date of each event
Here, the numeric chronological list does better. In the timeline view, an interactive gesture such as a mouse hover would be required to cause the precise date to display. On the other hand, if the precise date is not important, the numeric list of precise dates can cause visual clutter.
Shows the events in the correct temporal order
Both views show the events in the correct temporal order.
Makes it easy to see how events are clustered
Here the timeline view does better. We can intuitively see how events are clustered and the time intervals between them. In contrast, with the chronological list, it takes cognitive effort to get this same information.
Makes it easy to see how many events occurred on the same day
Again, the timeline view does better. To get the same information using the chronological list requires cognitive effort.
Makes it easy to see how events relate in time to the present
In one sense, the present – that is, “today” – is always the most important point in time when taking care of a patient. The timeline view incorporates a symbol for today. In this example, it is as if we are viewing the timeline on April 30. Of course, today could just as easily be inserted into a numeric chronological list, but most EHRs do not support this option.
It’s important to remember that this comparison makes a huge presupposition. It assumes that your EHR is, in fact, capable of providing you with a single chronological list of all clinically relevant documents (notes, labs, reports, imaging, procedures, and so forth) regardless of their category.
As I discussed in my last post, many major EHRs, both ambulatory and inpatient — at least as they are usually configured — do not provide this option. Without such a view, some of the tasks above become nearly impossible cognitive challenges (see my very first post, Human-Centered versus Computer-Centered Design).
In summary, both the chronological list of events and the timeline view have advantages and disadvantages. We are so used to working with chronological lists of EHR events in numeric format that the advantages of timeline-based views remain largely unexplored.
Rick Weinhaus, MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.
Karen DeSalvo, MD and acting assistant secretary of health discusses the need for increased public health funding, noting that 97 percent of funds are spent on care delivery, while 80 percent of people’s health needs are influenced by what happens outside of the doctor’s office.
A review of McKinsey studies focused on healthcare consumerism finds that patient satisfaction is most influenced by nurse empathy and keeping patients informed about their treatments.
Brigham and Women’s Hospital falls $53 million short of its projected 2015 surplus, blaming in part its Epic implementation, which was expected to cost $47 million but ultimately ran $27 million over budget due to lower patient volumes and coding issues.
ZocDoc and Oscar Health have both been contracted to begin running Healthcare.gov ads in hopes of bolstering sign ups as the final weeks of open enrollment wind down.
Acting Assistant Secretary for Health and National Coordinator Karen DeSalvo, MD, MPH tells a group that US public health is “marginalized and under-funded” as 97 percent of available federal money is spent on delivery of medical services even though 80 percent of health factors don’t involve hospitals and doctors’ offices. She adds, “The notion of population health doesn’t end with a geographic boundary … it’s everybody in the community,” giving the example that parts of Baltimore have worse health than North Korea.
Reader Comments
From The Freshman Whisperer: “Re: Hour of Code. I was at a ninth-grade career fair last week telling students the story of technology and how the healthcare industry needs help. As a part our booth, we had students try Hour of Code. I was happy to hear that many students had tried coding before (lots even enjoyed it) and were considering a career in computer science. I wasn’t offered any coding classes in high school. Thumbs up for teachers teaching young coders. My company can’t hire enough of them!”
From Health Dataphile: “Re: HCA’s inpatient and outpatient facilities in the Southeast. Meditech went down over the weekend and, as far as I know, is still down as of Monday morning.” Unverified. Usually an outage of that magnitude would be related to data center communications or some type of network failure, which HCA might be prone to since it deploys Meditech and other systems regionally. That might be a lesson for everyone anxious to get out of the operations business and move to a cloud provider – cloud systems are probably better architected, but they can still go down or you can lose access to them if something happens to your real-world connectivity. A reader in an HCA hospital in Florida says the ICU nurses didn’t know the downtime protocol they were supposed to be following, but on the bright side, doctors fell back to writing and dictating orders instead of entering them into the computer, allowing them to leave for home earlier than ever. The nurses were worried about medication reconciliation between the MARs and Pyxis machines.
From This Is Just Silly: “Re: Judy Faulkner’s letter on exhibit at the Smithsonian. I would have rather seen the letter or email she sent to George Halvorson at Kaiser Permanente when she turned down KP’s interest in buying Epic.” The National Museum of American History’s just-opened “Giving in America” exhibit includes the letter Faulkner wrote in pledging that she will donate 99 percent of her $3 billion fortune to charity. I was just thinking that Epic must be one of very few hugely valued companies where both top executives studied computer science.
From Unscheduled: “Re: McKesson’s scheduling software. I’m hearing it is ending support. Do you know if that’s true?” I don’t, but anyone who does is welcome to comment.
From Ground Pounder: “Re: salary survey. Cute infographic hides terrible methodology.” It’s puzzling why reasonably smart people will believe a dumbed-down graphic instead of paying attention to what it’s based on, although far less puzzling why crappy “news” sites run the graphic as clickbait. The members-only report is based on a survey of only 700 people who were apparently self-selected, meaning any conclusions it attempts to draw are not believable, especially when it tries to segment the responses into subcategories. Here are some headlines the self-promoting report drew by sites that simply reworded the press release, with extra points for the first entry (which turned it into a “listicle” like you’d see on celebrity gossip sites) and the last entry (which seems to attempt a Donna Summer song pun):
Health IT professionals think they’re underpaid: This and 9 more findings on IT salaries
Average healthcare IT salary tops $87,000, job tracker survey finds
Average Health IT Salary Down, but Job Satisfaction Up, Report Finds
Health IT Professionals Report High Salaries, Job Satisfaction
Survey: HIT workers get lower salaries than desired
Infographic: Health IT workforce paid well, but perhaps not enough
Health IT Pros See High Salaries Due to Increased HIT Needs
Working Hard for the Money
HIStalk Announcements and Requests
HISsies nominations will remain open for a few more days. The best nomination I’ve received so far is in the “smartest vendor action taken” category, where someone offered, “Hiring hookers to seduce my COO.” Athenahealth has obviously put the word out to employees as indicated by both boilerplate nominations in several categories and repeated IP addresses that are dominating the responses, but that’s OK since the final ballot will be delivered by the unstuffable ballot box of direct email.
Ms. Lam from California says she assigned her first graders, most of whom are from immigrant families in which English is their second language, to work with fourth-grade partners using the hands-on Make Wonder programming and robotics kit we provided by funding her DonorsChoose grant.
I wrote earlier this week about a friend who keeps working for her vendor employer even while fighting the cancer that will almost surely kill her because she’s worried she isn’t replaceable at work. It resonated with a reader who sent me an internal executive email exchange from a few years ago. An employee of a large health IT vendor was determined to keep working despite having cancer (of which she died shortly after) so that her retirement plan could vest for her surviving family. I’m paraphrasing the exchange below:
[Executive to CFO]: The employee thinks she needs to push through and keep working even though it will be one of the last things she will do on this Earth. Without being too nosy, can we vest the retirement even though the dates haven’t arrived?
[CFO] I want to make this happen and will approve the change under my board-delegated authority. Consider this as my approval. This is the only time I have ever approved such an action, but it seemed appropriate. A great example of why it feels great to work at [vendor name omitted].
[CEO] I am in complete agreement. Today is a gift – that is why they call it the present.
Webinars
December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.
December 9 (Wednesday) 1:00 ET. “The Health Care Payment Evolution: Maximizing Value Through Technology.” Sponsored by Medicity. Presenter: Charles D. Kennedy, MD, chief population health officer, Healthagen. This presentation will provide a brief history of the ACO Pioneer and MSSP programs and will discuss current market trends and drivers and the federal government’s response to them. Learn what’s coming in the next generation of programs such as the Merit-Based Incentive Payment System (MIPS) and the role technology plays in driving the evolution of a new healthcare marketplace.
December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.
December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.
December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
San Diego-based MD Revolution raises $23 million. It offers a patient engagement platform that allows providers to bill Medicare for delivering chronic care management services.
UL acquires InfoGard, an IT accreditor whose offerings include certification of EHRs and electronic prescribing of controlled substances systems.
EClinicalWorks will spend $30 million in India to build a data center and increase its 1,000-employee headcount there by at least 300 in the next three months. The company will offer consumers in India an app to view lab results, find doctors, maintain personal health records, and schedule appointments. The company has already signed 40 hospitals and 20 practices in India.
The Wall Street Journal summarizes the strategy behind the turnaround of Valeant Pharmaceuticals that has brought criticism as well as a 4,000 percent share price increase that gave its CEO $2 billion in holdings:
Cut research and development expense.
Take over dozens of drug companies.
Buy undervalued drugs and raise their prices.
Focus on skin treatments, mostly just redesigning old ones rather than researching new ones, knowing that dermatologists are responsive to drug salespeople and prescribe by habit.
Sell its dermatology products through a now-closed mail order pharmacy that used aggressive sales tactics.
Twine Health, which offers health coaching software developed at MIT, raises $6.75 million.
San Francisco-based concierge medicine provider One Medical Group raises $65 million to expand its service area and to further develop its enterprise and mobile technology solutions, increasing its total to $182 million.
Google has renamed many of its business and does the same with Google Life Sciences medical device group, now known as Verily. Meanwhile, GV (formerly known as Google Ventures) says it is less interested in seed-stage investing and will instead pursue more mature companies, with an ongoing emphasis on healthcare and life sciences firms.
Harris Computer Systems relocates its QuadraMed EMPI Solutions business to a high security office in Plano, TX that can house up to 100 employees.
Sales
Weirton Medical Center (WV) chooses Besler Consulting’s Transfer DRG Revenue Recovery Service.
Scripps Health (CA) chooses the Health Gorilla Clinical Network to provide patients with access to imaging and lab information.
Announcements and Implementations
Intelligent Medical Objects announces GA of its 2.0 release that includes silent terminology updates, support for natural language processing, quarterly refreshes of major dictionaries, and a CQM dashboard.
PatientPay announces that customer Greenwood Pediatrics (CO) reduced its billing costs by 47 percent by switching from paper to the company’s online bill review and payment.
Cloud hosting provider Infinitely Virtual announces that it has passed the HIPAA audit that allows it to offer health IT hosting plans, including a $10 per month option for full-disk encryption for each virtual machine.
Telemedicine services company Virtual Radiologic announces that it has applied artificial intelligence to data from the 90,000 head CTs it performs monthly to create a real-time warning to its teleradiologists that a patient might be experiencing intracranial hemorrhage.
A Finland-based software vendor licenses a web-based geriatric assessment system developed by the University of Queensland in Australia. The software records and monitors the progress of elderly patients before, during, and after hospital stays and can be used to deliver telehealth services. The CeGa Online system is already offered by Queensland Health. The same researchers have also developed a residential care version.
SAP announces software for medical data analysis and clinical trials recruitment.
Government and Politics
The White House enlists ZocDoc and Oscar Health Insurance Corp. to provide free advertising that will urge uninsured people to buy insurance via Healthcare.gov in the final week of open enrollment. ZocDoc will target customers who have paid cash for the appointments they booked through its scheduling service, while Oscar chas reated an explainer video that it will distribute in the handful of states where it sells plans.
Privacy and Security
A physician-written editorial in the Journal of American Physicians and Surgeons says that patient privacy is an illusion because of electronic medical records that make data available without patient consent for oversight and research. The psychiatrist, Susan Israel, MD, wants EHRs redesigned to give patients control of their information via consent requirements “regardless of cost and complexities involved.”
Innovation and Research
Google patents a needle-free blood draw system that uses compressed gas to pierce skin and then draw the resulting blood into a collection chamber. The patient covers two possible devices, one for diabetic finger-sticks and the other worn as a wristband. Companies seem to be enchanted with the idea that patients need an alternative to needles and the collection volume of standard blood draws, but for me, that’s far less important than avoiding the inhospitable long waits at LabCorp and Quest drawing centers full of people whose NPO stomachs growl as they watch awful TV shows that working people rarely see.
Technology
Carequality releases its interoperability framework (legal terms policies, technical specifications, and governance processes) that allows organizations to quickly establish data sharing agreements with partners.
Other
Brigham and Women’s Hospital misses its budget surplus target for FY2015 by $53 million, which it blames on weather, employee retirement costs, and the cost of transitioning to Epic. The hospital had budgeted $47 million for its Epic conversion, but instead spent $74 million. Revenue also fell short by $13.5 million as employees didn’t code cases correctly on Epic.
A summary of McKinsey’s previous healthcare consumerism studies concludes that while patients say their outcome is the most important factor in their satisfaction with providers, it’s actually clinician empathy (especially from nurses) and the information they are given before and after treatment that is most closely correlated to satisfaction. Access to medical records wasn’t all that important and neither was the perception of value received. A study also found that while 40-50 percent of patients aged 18-34 want to use technology to speak to their provider by phone, schedule appointments, and check health status, the percentage drops sharply for those aged 35-55. Respondents are also willing to share health monitoring data capture with their PCPs, but not very many would do so with friends, family, insurance companies, and employers.
Researchers mine EHR databases at two hospitals to detect a previously unknown correlation between the use of androgen deprivation therapy and later development of Alzheimer’s disease. The study used text-based data mining methods developed by one of the authors that were patented by Stanford University. The hidden value of a study like this is that researchers can look at the entire patient population of a health system rather than just individual patients who opt in for a study that was designed to test a particular theory.
A study in England proves that patients are as clueless about antibiotics as doctors keep saying. Two-thirds of them expect to get an antibiotic prescription for a cold or flu, one-third think they should stop taking antibiotics once they feel better, and three-quarters believe it’s the human body rather than bacteria that grow resistant to the drugs. Doctors who apply sound science to writing antibiotic prescriptions are seeing their patient satisfaction ratings fall, with a 3- to 6-percentile drop for every 25 percent reduction in prescriptions. The other GPs just keep cranking them out to keep patients happy, with half of those patients receiving an inappropriate antibiotic prescription.
A Florida woman is jailed for hit and run when her car’s crash-triggered electronic monitoring system automatically calls 911. The operator, suspicious of the woman’s insistence that nothing had happened when the device clearly showed that it had, dispatched police, who found her car damaged with the airbag deployed.
Sponsor Updates
Forrester Research ranks AirWatch as an enterprise mobile management leader.
TransUnion Healthcare announces that its eScan product has found patient insurance coverage worth $1 billion in hospital payments that would have otherwise been written off to bad debt and charity care.
Sixteen Influence Health clients receive eHealth Leadership Awards.
LiveProcess exhibits at the National Healthcare Coalition Preparedness Conference through December 4 in San Diego.
Oneview Healthcare launches an internship competition.
The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.
My 2016 HISsies Nominations Recommendations
I live in Los Angeles. Folks around here think the big awards are the Oscars, Golden Globes, Emmys, or Grammys. But in HIT, the nomination ballots have been released for the coveted HISsies, so I thought I would fill mine out publicly. Here it goes.
Smartest vendor action taken
CVS and Walgreens, for partnering with Epic to obtain a leading EMR for their retail clinics and enabling them the ability to partner with a large array of leading health systems.
Stupidest vendor action taken
IBM’s acquisition of Phytel. I think IBM is a great company that is undervalued in the market. They have a history of acquiring some great organizations. Among the best they have picked up in healthcare is probably Initiate. But in a yet-to-be-established population health IT market, any company is destined to get lost in the portfolio of a giant like IBM.
Best healthcare IT vendor or consulting firm
I’m admittedly biased. Epic. The scope and scale of what they have accomplished continues to be amazing.
Worst healthcare IT vendor or consulting firm
I’ll interpret worst as most underachieving. I’ll award this to GE and Philips for their lack of ability to leverage their market share in medical devices into something meaningful in the health IT space.
Best leader of healthcare IT vendor or consulting firm
One word : Judy.
Best provider use of healthcare IT (hospital, practice, etc.)
I admire the hard-working folks from my organization, so I’ll name Cedars-Sinai. But I’ll call out a few others Kaiser, Ochsner, Mercy, and Memorial Hermann.
Most promising new technology (in general – not a specific vendor product)
I’ll name three: the field of non-invasive diagnostics, biosensors (not wearables for well people, but technology that can monitor the chronic and acute), and actionable clinical decision support that can leverage the historic investments we have made in EMRs and data warehouses.
Most overrated technology
EMRs. Don’t get me wrong — they are essential and are the foundational agile technology base on which most of our health technology aspirations will ride. But the potential of the EMR alone has been overrated and over demonized.
Most overused buzzword
Pilot. A software pilot is supposed to be feasibility study, but instead has become a phrase to represent the first phase of a project that has already been decided and is seeking to start slowly in hopes of gaining engagement.
Most influential person in healthcare IT, i.e. “When ______ talks, people listen.”
As the late Tip O’Neill said, “All politics are local.” The most influential person in health IT is the CEO, so get him or her on board with any important initiative.
Most effective healthcare IT executive in a provider organization
I’m privileged to get to work with some great peers from all over the country, so I’ll name a few to offer some choices. Stephanie Reel, CIO at Johns Hopkins, is widely regarded among the best around and for good reason. Her list of accomplishments is long and admired by many (myself included). Scott Joslyn, CIO at Memorial Care in Orange County, CA installed Epic before it was the obvious choice and helped pioneer much of what we all take for granted today. It is worth noting he also led his system to be the first in the country to go live with Care Everywhere. It was available to all customers at the time, but he had the vision to see the benefits that now seem obvious to the rest of us. Daniel Barchi, new CIO at New York Presbyterian, knows how to get things done. He has accomplished great things at not one complex system, but two large systems, Carilion and Yale. it is clear NYP is now destined for great things ahead under his leadership.
Most effective clinical informatics professional in a provider organization
I’ll again name three. All are triple threats — they are effective clinical informatics professionals, effective healthcare IT executives (CIOs), and super smart. Pravene Nath, MD, CIO at Stanford; Mike Pfeffer, MD, CIO at UCLA; and Jeff Ferranti, MD, CIO at Duke.
Industry figure you’d most like to see on stage at HIStalkapalooza
Jonathan Bush, to hear what he might say. I love the irony that he is playing the Donald Trump role in the EMR debates.
Industry figure with whom you’d most like to have a few beers
Carl Dvorak.
Industry figure in whose face you’d most like to throw a pie
I’m with Judy – I don’t like to waste good pie.
HIStalk Healthcare IT Lifetime Achievement Award (recognizing a life-long body of industry work.)
Ivo Nelson. If you need an expert in healthcare, a mentor, a connector, or just some great advice, Ivo is your guy.
HIStalk Healthcare IT Industry Figure of the year
I’ll go with a controversial pick: Elizabeth Holmes.
Make your nominations here and subscribe to the HIStalk email for your chance to vote.
Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.
A Commonwealth Fund study comparing care coordination across ten developed nations finds that only about 30 percent of family providers in the US are “always notified” when a patient is seen in the ED or discharged from the hospital. The report concludes that US physicians are “among the least prepared to manage conditions associated with aging outside of hospital or nursing home settings.”
Rock Health announces the winners of its Top 50 in Digital Health, a summary of the most influential people and businesses working in the health IT startup space.
A small HealthITJobs survey finds that the average healthcare IT professional earns $87,000 a year in the US, a drop from 2014’s $89,000 average. Respondents were largely dissatisfied with their earnings and more than 50 percent reported that they would change jobs within a year.
December 7, 2015Dr. JayneComments Off on Curbside Consult with Dr. Jayne 12/7/15
A Tale of Two Articles
I subscribe to quite a few news digests, including some from the AMA and other professional organizations. The headlines are always attention-grabbing, so “Framework evaluates 20 top EHRs – and they don’t quite measure up” definitely caught my attention. It links to a usability analysis done by the AMA and MedStar Health’s National Center for Human Factors.
Using an EHR User-Centered Evaluation Framework, they looked at data that 20 vendors (15 ambulatory and five inpatient) provided to meet ONC certification requirements. The Framework goes “beyond the ONC’s criteria… to encourage the ONC to raise the bar for usability certification.”
Being a good clinical informaticists means being a critical reader and making sure that one understands the information being presented before coming to conclusions. That approach has served me well when providers would storm into my office with “conclusive evidence” that our EHR was bad, waving copies of articles in my face such as a reader survey that had a grand total of 13 respondents using our product from a nationwide sampling.
In reading the introductory information carefully, one can see that they’re somewhat comparing apples to oranges. They looked at what vendors submitted for certification, not the totality of what a given vendor did or did not do with regards to user-centered design.
I have several friends who work for vendors and have heard that providing more than what is required for certification is the equivalent of being on the witness stand and offering more than a single-word answer to a yes or no question. The “just the facts, ma’am” approach seems to be preferred.
You can’t blame them. Vendors don’t want to get tangled up in showing something not required that might lead to questions. The certification process is already onerous enough.
The AMA blurb goes on to conclude that, “Out of those 20 products evaluated, only three met each of the basic capabilities measured.” I’m not surprised by this since they were measuring information from a data set that was designed for a different purpose than that for which they decided to use it.
I fully understand that they’re trying to make the point that they think the ONC certification process for usability best practices isn’t robust enough. Unfortunately, it seems to tar and feather some of the vendors despite the process they’re actually doing (but didn’t include in the ONC documentation because it wasn’t required).
The AMA blurb also didn’t include clear language that was included in the actual MedStar Health documentation on the User-Centered Design Evaluation Framework. It clearly says it is not designed to look at actual usability by clinicians, but to look at vendor practices as reported to ONC on the eight required patient safety capabilities.
I’ve personally used many of their top-scoring systems and found them to have major usability issues. Casual readers aren’t going to dig into the details. This piece is likely to be misleading.
I found the whole thing even more interesting when I opened this month’s JAMIA to find an article by the same lead author, Raj Ratwani. This time the researchers actually visited 11 EHR vendors to look at their user-centered design processes. I found this data much more interesting (not to mention peer-reviewed).
Six of the vendors visited have more than $100 million in revenue, with the top three being over $1 billion, so you can guess who they are. Interestingly enough, four of the six were found to have “well-developed UCD” processes and another was found to have “misconceptions of UCD.” I actually laughed when I read this, likening it to delusions of grandeur somewhere in the back of my mind.
The specifics of what the researchers define as misconceptions include that, “vendors do not have any UCD processes in place although they believe they do.” This also includes vendors who cite being responsive to user complaints and feature requests as evidence of UCD.
The overall distribution of the vendors was four with well-developed UCD, four with basic UCD, and three with misconceptions of UCD. The authors go on to cite the fact that even the “misconception” group is certified by ONC, illustrating why certification requirements may need an adjustment. They do at least mention the challenge of creating requirements that lead to improvement for the poor performers but don’t hamper those that are already doing well.
My favorite quote of the article is one vendor who stated, “Our product is used by thousands of people every day. So if it was that bad, it would already be out of the market.”
I certainly prefer the scholarly approach of the latter article, although I’m sure it didn’t get anywhere near as much press as the first one. I was trying to figure out what category my EHR vendor fell into. It turns out they weren’t one of the participants.
How does your vendor perform on UCD and what do you think about it? Email me.
I started working in healthcare in 1992 for our predecessor company, Peritronics. I left that company in 1997 and started a service company, Clinical Computer Systems. In 2001, we acquired Peritronics and have grown it since then. Today we are a 100 percent employee-owned company that is focused on OB data systems. We have about 100 employees and plan to grow that another 10 percent this year.
How does an employee-owned company work and how does that impact the company’s philosophy and strategy?
We can focus on the things that we think are important to our company culture, to our customers, and to our employees. We don’t have outside shareholders or an exit strategy that we have to worry about with a three- to five-year horizon. We can do what we feel is right for customers and employees at different times without the constraints of outside capital. I don’t think outside capital is wrong — we have evaluated outside capital at different times for ourselves — it just has to be done at the right time for the right reasons.
Obix is FDA approved as a medical device. How does that change how your developers work?
I don’t know that it’s a massive change, but it definitely does introduce a different level of internal review and consideration of what we’re doing for the patient, for the customer. It also helps to define the market a little bit more, where it is a market that has some risk that sometimes a larger company or a different type of company wouldn’t want to enter this space. There are some differences that it does create and it’s risk. You have a government entity that could basically walk in at their choosing and shut down or challenge the company’s premise at any time.
I think we have a more stringent review process and a more stringent testing process that goes out. Also, it gives our customers another voice. If they’re not happy with how we perform, we also have to be aware that there’s a government regulatory body that they can go to to complain about us, challenge how we do things and how we’re satisfying them. Risk review and risk evaluation.
What are the clinical and legal issues faced by your perinatal technology users that are different from the rest of the hospital?
It’s one of the few, if not the only, area of healthcare where it’s really not an illness. Having a baby, having a pregnancy in and of itself is not something that is not a defined illness. A patient goes into a hospital in that condition and exits usually even happier.
The risks that go with that, though, are that it’s also one of the most litigious or most expensive areas of the hospital. The last stat I I saw behind anesthesiology is that it’s the most litigious part of the hospital in terms of settlements and risk management. It’s an area where they have to make sure they’re covering their bases and making sure that they’re doing the right things not to create exposure for the hospital. We help with that, making sure the care protocols are right, that they’re following the right care paths, and are evaluating the patients appropriately.
Do most L&D areas use software to assist them in the perinatal process or do some still use paper?
It’s a replacement market for us. I would say probably ninety percent of hospitals that have a labor and delivery department have a central monitoring system. We maybe run into one or two a year that do not.
Where does Obix go from here?
Our history has been focusing on services and integration with enterprises. The last few years with ACA and Meaningful Use, we’ve been focusing on trying to create a product that’s fully integrated, where you almost can’t tell the difference between our product and what is … everybody’s driving towards a single source of truth type of product and trying to support that strategy and make that useful for the users.
The enterprise products, many times, aren’t developed for the work flows and some of the unique situations for certain critical care areas of the hospital, L&D being one of those. We try to tailor our product to help support the user, support that big investment that the hospital has made in the EMR.
How do you convince a hospital that it’s a good idea to go with Obix rather than a product from their EHR vendor?
Other than Cerner, the other primary vendors really don’t have an OB product. Our competition at that level isn’t the EMR, but other perinatal specialty companies or companies that have perinatal products.
We work at messaging what the strength of our product is in terms of uptime and in terms of service and support. Service and services are a big part of what the company was founded on, has evolved with, and will always work to stay with in the future to make sure that it’s not just about dropping a product in place and saying, “There you have it” and walking away, or, “Issue a purchase order for more services.” We have a very integrated solution where it’s purchase the product, issue a support agreement, and we provide all the services around that. That’s really all a hospital has to provide.
Who makes the decision to buy your product?
That’s a trend that has changed a lot over the time I’ve been in the industry. When I first started, it was a lot of the doctors. Then it went to the nurses, nursing staff, went to IT. Now, honestly, we’re mostly in administrative decisions because of the purchasing cycles that things are bought in. We are starting to see physicians to have a larger voice again, but that’s a more recent trend.
You mentioned malpractice. Do you have plans to integrate a video record of what happens in the delivery room?
Not for us. I would suggest that’s another specialty area. When you get into recording the actions of what happens in the room, there’s a whole different set of issues that a hospital’s concerned about that I think are best dealt with a different specialty company and product if that’s a direction a hospital would decide to go into.
Is remote access important?
Oh, very important. I don’t know that we even think about it as remote access any more. It’s just access to information. The access to the information has to be the same in the patient room as it is for a doctor that’s at home at three o’clock in the morning trying to access the information.
Our biggest challenge around that is keeping customers up to date with our most current releases that have the better functionality around that. We have a number of customers that implemented software 10 years ago and really struggle to encourage them to keep upgrading the software and keep it current.
Obix has won the KLAS rankings quite a few times in a row. How do you use the feedback from users that KLAS provides?
It’s a big part of the sales process. It’s a big part of our business process, though, too.
We take a look at the KLAS comments. It’s not just the comments about us., it’s the comments of our competitors. We try to learn from everybody ourselves and our competitors and see what the industry is saying because it is a good way to get an unvarnished set of information and feedback from customers. To pay a market research group to do your own research sometimes gets some biases involved with it, where you’re looking for some specific things. I don’t always agree with some of the things that KLAS comes out with, but it does give us some good feedback to change how we operate as a business and to try to provide the services and functions that our customers are looking for.
Where do you take the company from here? Do you just keep working to gain market share or start thinking about developing other products?
We’ve considered a number of different avenues down that path. We have decided to stick with being a niche vendor in the obstetrical space. We are looking at other products and functions down this line, but I don’t see us growing out and trying to become another multi-disciplinary, multi-area vendor. I think it’s important for us to try to hold on to our specialty and focus on creating a best product and best services in that area.
Do you have any final thoughts?
I’m very thankful for the people that we have in the company. Of all the things that we deal with — with people, industry, and customers — finding and recruiting good and talented people within the company is one of the most challenging things we do. We work at improving that every day.
I see a lot of challenges coming forth, though, for our hospitals and healthcare organizations that we support. You’re seeing consolidation or trading of organizations in enterprises to consolidate market share. That’s going to create some new and different challenges both for the hospitals and the vendors that support them. Some of it’s good, some of it’s bad in terms of what that concentration does to different companies. We are making changes in our organization to support that. We’re trying to make our product lighter, faster, and easier to implement.
We just brought a new feature online called Obix University, which is an LMS platform that allows us to change our education process to be a continuous education process that’s online all the time, or it will be shortly. It’s something that helps reduce the implementation cost as well. There’s a number of other services that we’re looking at to do that. Again, trying to support that enterprise view, because part of it is about getting new customers, but part of it is also about retaining the customer base that we have and making that upgrade path a lot easier for them.
Comments Off on HIStalk Interviews Kim Sell, President, Clinical Computer Systems, Inc.
Kaiser Permanente will acquire Seattle-based insurer and provider Group Health Cooperative for $1.8 billion upfront, plus an additional $1 billion paid out over the next several years.
The Economist reports on the US health insurance industry in the post-ACA marketplace, noting that all five major insurers have seen triple-digit stock price growth since the law was passed.
India-based Indegene Lifesystems acquires population health analytics platform SmartCare from Vantage Point. Financial terms of the deal were not disclosed.
Kaiser Permanente will acquire Group Health Cooperative, a Seattle-based provider and insurer with 600,000 members and annual revenues of $3.5 billion. Kaiser will pay $1.8 billion upfront and says it will spend another $1 billion over the next several years in creating its Washington Region. The 70-year-old Group Health offers innovative member technologies, but has struggled with budget cuts and layoffs for several years.
Reader Comments
From Billy Gladstone: “Re: HIMSS. You pulled their self description from their latest press release. What happened to it being a “mission-driven not-for-profit?” This announcement contained more ambitious wording that aggressively pitches its data services. The latest Form 990 I could find for HIMSS was for FY2013, in which it reported a loss of $2.6 million on revenue of $82 million, of which $30 million came from the annual conference, $16 million from publishing and conferences, and $10 million from membership dues. It paid some big salaries for an organization of that size, many multiples of what a tiny hospital with $82 million in revenue would pay its executives.
HIMSS paid consultant Jack Beaudoin, formerly of HIMSS Media: $567,000. It also paid $1.4 million to Armin Scheuer Consulting, which I assume is related to its 2011 acquisition of his former company, Berlin-based So2say Communications. It reported $250,000 in lobbying expenses. HIMSS finished its acquisition of MedTech Publishing in 2013 and made it a disregarded entity to protect its own tax-exempt status, with the renamed HIMSS Media bringing in $14.4 million.
From Not From Me: “Re: Charles Sorenson, CEO of Intermountain Healthcare. Will step down as CEO effective fall 2016.” Unverified.
From RegularReader: “Re: Daughters of Charity in California. Gets AG approval to sell itself to a for-profit company.” A hedge fund will be allowed to invest in the struggling non-profit health system with the option to buy it outright after three years in the largest non-profit hospital transaction in California history. The hedge fund names its management company Integrity Healthcare without apparent intentional irony (although the “charity” part of the name would be equally ironic under its involvement). Looking on the bright side, yet another example of unapologetic, bare-knuckles profit-seeking on the backs of sick people just might — as in the case of Martin Shkreli’s Turing Pharmaceuticals — force the country to realize what a mess it made of its healthcare system starting in the mid-1960s and where that’s left us 50 years later.
From Sunquester: “Re: new Sunquest offices. I’m really looking forward to the new office. During the dark days of being private equity owned, little was done for employees.” I agree – other than an extended commute for some employees, it’s nice to get a fresh workspace with a view. Google Earth shows the new building in the foothills of some 8,000-foot Tucson mountains near many plush resorts and restaurants, which should upgrade the lunch options quite a bit. I’ve inhabited everything from a windowless hospital basement to a private office with a beautiful lake view, and while you quickly lose awareness of your surroundings through familiarity, it does indeed give you a sense of your value to your employer and their priorities. My one non-hospital job was working for a vendor whose ever-deepening financial distress was caused by ever-deepening management incompetence. Maintenance to our beat-up old office building was always being deferred until future good times that never came. Our salvage yard-quality cubicles were constantly being reconfigured to support the latest executive emissions that dribbled down from their top-floor, mahogany-walled bunker. The director of my area decided that we would all become energized by staying after work on our own time (it was mandatory) to paint the interior walls of our floor, complete with the jaunty stripes that he envisioned as being reflective of our newfound swagger and inevitable success. The company provided the paint and a terrible fried chicken dinner that — not surprisingly given our executive track record of cluelessness and questionable allocation of resources — was ordered in insufficient quantity to feed the people who gave up hours of their free time to perform menial labor, suffer through faux camaraderie, and elbow each other aside in a vulture-like attempt to snag a chunk of poultry carcass before it ran out (which was probably an apt metaphor for what it was like working there – those in the back of the line who found the chicken bowls empty heatedly accused those who preceded them of taking extra pieces). One week later, the company conducted its next round of layoffs and reorganizations, leading one of the managers who was fired and forcibly marched out of the building to declare bitterly afterward, “The worst part is that I wish I hadn’t painted those damned walls.”
HIStalk Announcements and Requests
Ninety percent of poll respondents will get their medical insurance through their job or via family coverage, with just five percent buying it directly from insurance companies or Healthcare.gov. Mak says he had to postpone retirement for a year because individual health insurance is now so expensive, adding, “Like all massive government programs, the cost is astronomical when compared to the number of individuals benefitting.” Lgro’s employer doesn’t offer a group plan, so he’s paying $14,000 for family insurance whose coverage doesn’t kick in until he has spent $8,000, doubling what he paid in his previous job that offered insurance. Jeff says Obamacare isn’t perfect but at least he can get family insurance from Healthcare.gov until a better option becomes available.
New poll to your right or here: what role does your job play in your existence? Vote and then click the poll’s Comments link to explain since I’m really interested in how people view their work as part of their overall lives.
Speaking of work and life, a friend who has barely survived repeated, horrific bouts of cancer was telling me that she plans to keep working at her health IT vendor employer because she’s worried that the large company can’t replace her even though her remaining lifetime will probably be short. That’s the saddest thing I’ve heard lately — expressing unconditional employer devotion under the misguided belief that such fealty is mutual and not recognizing that “irreplaceable employee” is an oxymoron regardless of your org chart altitude. You might be surprised at how quickly you are forgotten and how little difference your absence makes if strategies change, money gets tight, or you run afoul of someone who outranks you. I’ve never mistaken a paid job for a loving, supportive relationship and I hope others don’t – life is too short to place your entire identity and sense of well-being in the hands of a company (for-profit or otherwise) that is by definition incapable of returning the favor. Tombstones don’t contain job titles and hearses don’t pull U-Hauls full of meaningless company awards and unspent retirement funds. I recall the answer Ivo Nelson gave me in a 2009 interview when I asked him why he was starting another company (Encore Health Resources) when he was already immeasurably wealthy from selling Healthlink to IBM:
This is nothing more than me doing what I love to do. If it leaves a legacy, I think that’s OK, but I’m not sure what you really get out of that. When I’m hopefully up in my 80s or 90s and I pass away, the people that are going to come to my funeral are going to be my family. It’s not going to be clients. It’s going to be people that are close to me personally in my personal life, my kids and my sisters and a handful of friends probably that I have. That’s a legacy. You say, "What kind of legacy would I want to leave?" and it would be a legacy that’s more related to being a good father to my children and being a good husband to my wife. That kind of stuff. Not anything I do professionally.
I’m thinking about hiring someone part time to critically review journal articles related to health IT. Ideally it would be an informatics grad student with a clinical background, access to an online medical library, and the ability to critique research methods and conclusions for a general audience. Email me.
HIStalkapalooza
People are already emailing me about the February 29 event. Here’s what is happening.
“I want to come” signups will start very soon for HIStalk sponsors, then for everyone in early January.
We won’t be able to accept new event sponsors after next week because we need to move our focus to planning.
I am still looking for a single “rock star CEO” sponsor who wants a significant HIStalkapalooza presence and involvement with private space, bar, and food to entertain 100 people or so.
Have you ever dreamed of playing your music on a big music hall stage in front of a bunch of cheering people screaming “Free Bird?” We’re exploring the idea of starting HIStalkapalooza early with music provided by volunteer health IT people who also have a significant musical history. Send Lorre a link to your video or audio and tell me what you would play on stage if chosen. You’ll have to bring any instruments you need unless we can work something out with HOB or the band. I remember years ago at HIMSS when the opening session started with a really good band that turned out to be Dave Garets, Jonathan Teich, and some other industry folks who had at one time paid the bills as musicians.
One last item: HISsies nominations are open. Nominate your choices and I’ll put the most-nominated ones on the final ballot that will be emailed to HIStalk subscribers in a couple of weeks. It’s like the presidential primary: vote now or don’t complain about the choices made by more responsible voters. I’ve added a new item just for fun, “Industry figure you’d most like to see on stage at HIStalkapalooza,” figuring maybe I can get someone famous if they know readers want to see them there.
Last Week’s Most Interesting News
Welltok acquires Silverlink to expand its patient engagement capabilities.
Private equity investor and former Vitalize Consulting Solutions Chairman and CEO Bruce Cerullo joins Nordic Consulting as chairman and CEO.
MIT Hacking Medicine announces that it will publish reviews of digital health tools.
The Health IT Policy Committee’s API Security Task Force holds its first meeting.
NantHealth postpones its planned IPO because of unfavorable market conditions.
Webinars
December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.
December 9 (Wednesday) 1:00 ET. “The Health Care Payment Evolution: Maximizing Value Through Technology.” Sponsored by Medicity. Presenter: Charles D. Kennedy, MD, chief population health officer, Healthagen. This presentation will provide a brief history of the ACO Pioneer and MSSP programs and will discuss current market trends and drivers and the federal government’s response to them. Learn what’s coming in the next generation of programs such as the Merit-Based Incentive Payment System (MIPS) and the role technology plays in driving the evolution of a new healthcare marketplace.
December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.
December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of innovation lab and VP of clinical development and informatics for clinical software solutions, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.
December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
India-based Indegene Lifesystems announces the acquisition that I mentioned was imminent last week, the SmartCare population health analytics platform from Vantage Point.
The Economist observes that despite the competition that the Affordable Care Act was supposed to create, America’s five biggest health insurers have seen their share prices triple in the past five years and all are making huge profits that are still trending upward after ACA’s implementation. They’re being helped by the federal government, which is handing off Medicare and Medicaid healthcare to insurance companies. The article concludes, “The vast expense and unintelligible complexity of American healthcare may be a national disgrace, but they are a huge opportunity for firms that can navigate the system and minimize costs.” I graphed the five-year share performance of Cigna (blue, up 273 percent), Humana (red, up 202 percent), Aetna (teal, up 244 percent), Anthem (pink, up 130 percent), and UnitedHealth Group (purple, up 221 percent) vs. the S&P 500 (blue, up 68 percent). Don’t bet against statistical experts.
Lee Equity Partners sells PDR Network to Genstar Capital. PDR Network was formed from Physician’s Desk Reference, Healthcare Notification Network, and LDM Group in moving the print-based publication to a digital business.
People
Premier, Inc. names David Vorhoff (Deloitte Corporate Finance) as SVP of corporate development and strategy.
Ingenious Med names David Lamm (United Allergy Services) as CFO.
Southeastern Health (NC) names consultant Steve Milston as CIO.
Announcements and Implementations
The American College of Cardiology, Geisinger Health System, and xG Health Solutions will develop software based on ACC’s guidelines and Geisinger’s methodology.
Allscripts and TeleTracking will integrate their products and sell each other’s offerings.
Privacy and Security
@CandidCIO found a fascinating security breach buried in the SEC filings of wireless networking vendor Ubiquiti Networks. The company discovered a phishing attack in June 2015 in which $47 million of its money had been transferred to the overseas accounts of scammers. Its ever-vigilant auditors concluded after the fact that, “the Company’s internal control over financial reporting is ineffective due to one or more material weaknesses.”
University of Rochester Medical Center will pay $15,000 to settle HIPAA charges after it gave one of its nurse practitioners a worksheet containing the names, address, and diagnoses of the 3,400 patients she had treated there. She gave the worksheet to Greater Rochester Neurology, at which she had accepted a new job, who mailed the patients letters announcing that the NP was joining them. URMC received patient complaints about the letters and fired the nurse practitioner.
Technology
I use Bitdefender and received an email pitching its Bitdefender Box, a router-attached, smartphone-controlled security appliance that protects every device that’s connected to a home network in what the company calls the “Security of Things.” It costs $199 upfront and then $99 per year for updates, which is a pretty good deal since it theoretically replaces a houseful of individual antivirus and firewall subscriptions. It works on Windows, Apple, and Android devices and also provides a personal VPN service to extend its security to wherever a mobile device is being used. I won’t buy it just yet until they get the bugs worked out, but I think this is the future of malware protection. It might be something hospitals make available to employees or doctors that work offsite or on personal mobile devices since they are often the network’s weak link.
Other
Cerner and several Kansas City groups are sponsoring programming events for 400 female students this week, hoping to change their perceptions of technology careers. Two of the six locations are Cerner campuses. I hadn’t heard of the non-profit Hour of Code, but it’s pretty cool: anyone can organize an event and 150 million students worldwide have participated as the organization strives to improve diversity in computer science.
A Wells Fargo Securities report titled “Does Epic Own the Future?” finds that while the average physician EHR user is 49 years old, Epic’s user base is a little bit younger (by a year or so) and Practice Fusion has the highest average age of 51.7. The report theorizes that recent graduates are increasingly going to work for big, Epic-using health systems, while Practice Fusion’s free EHR attracts older doctors who don’t want to spend money or effort on an EHR close to their retirement. I don’t disagree with the theories, but the age spread isn’t enough to get too excited about, I doubt it signals anything important, and it doesn’t distinguish between inpatient and ambulatory use or physicians who are forced to use multiple systems. Slightly interesting is the statement that Epic has more than a 25 percent market share among new graduates vs. all of its competitors that are bunched up at between two and 10 percent.
The EDs of Cleveland’s hospitals will phase out ambulance diversions, which should be interesting presuming they occasionally had valid reasons for not taking new ambulance patients in the first place.
Flooding in the technology hub of Chennai, India causes its premiere, 1,000-bed hospital to lose power and life support systems, killing at least 18 inpatients in a Hurricane Katrina-type situation. Caregivers kept some patients alive by ambu bagging them for up to 48 hours. All communications were down and roads to the hospital were submerged under six feet of water.
This is fun: world traveler and Dell CMO Nick van Terheyden, MD tweets from Dubai that the United Arab Emirates government has blocked Internet access to HIStalk.
A Harvard Business Review article by Frederick Cerise, MD, MPH, CEO of Parkland Health and Hospital Systems (TX) says large, publicly supported safety net health systems like Parkland have an advantage because they are driven by community needs and give clinicians a greater voice in decision-making. He says Parkland has been operating like an ACO since 1989, receives 36 percent of its budget as a county allocation rather than for billing more services, and can resist the financial temptation to offer high-paying but questionably beneficial services. He mentions that the hospital’s tele-dermatology service loses money since half of its patients are uninsured, but it still offers an efficient way to deliver services.
Sponsor Updates
HealthLoop publishes “5 Things You Need to Know About CMS’s First-Ever Mandatory Bundled Payment Program.”
TierPoint will host an open house December 10 in Marlborough, MA.
Visage Imaging debuts several products and enhancements at RSNA 2015.
VitalHealth Software and Zynx Health will exhibit at the IHI National Forum on Quality in Healthcare December 6-9 in Orlando.
Voalte releases a new case study, “How Avera McKennan Achieved Efficient Caregiver Communication with Voalte Platform.”
The Journal of Bone & Joint Surgery presents survey data highlighting the gap in EHR satisfaction scores between clinicians and hospital IT professionals.
Community Health Systems contracts with American Well to begin offering telehealth visits to residents served by its 198-hospital, 29-state area of operations.
Patient engagement technology vendor Welltok acquires consumer communications company Silverlink, also announcing $45 million in new funding to support a portion of the acquisition.
Reader Comments
From Sport Pepper CMIO: “Re: EHRs. This is an interesting article which highlights what many of us know already.” The article in The Journal of Bone & Joint Survey looks at the post-implementation gap in EHR satisfaction, where IT people and administrators are happy but clinicians aren’t. That’s not too surprising since those non-clinicians have the most influence on which systems are chosen and how they are implemented. The article hints and what I’ve always claimed – it’s not so much that clinicians hate the concept of EHRs, they realize that both internal and external non-clinicians employ them as a blunt instrument (sometimes with the best of intentions, at least based on their own agendas) to create and enforce new rules that deliver minimal patient value. Few people enjoy using technologies intended to control their behavior – that would be like a prisoner loving their ankle monitor.
From Zealous Zygote: “Re: news. I always get what I need from your site. As an educator, I also note that it is presented so I remember it well.” That’s my goal. I use these methods to hopefully make myself and everybody who reads what I write a little bit smarter about healthcare IT:
I choose only newsworthy stories that provide reader value. Curation takes probably 80 percent of the time I spend on each post as I wade through the mountains of poorly communicated junk. Unlike other sites, I have no fixed space to fill and I’m not paid per word, so I have no incentive to pad out a one-sentence story into 12 paragraphs that waste reader time.
I summarize each item as succinctly as possible and make it as highly readable as I can.
I add context where it provides value, whether that be a back story or my own opinion.
I use illustrations when they make sense (no stock photos, in other words).
I provide a link to a source when possible for those who want to read more.
I provide a cynical, sometimes sarcastic point of view that doesn’t otherwise get much airplay in the fizzy, self-congratulatory world of health IT.
From Beeper King: “Re: smartphone app for secure communications. We tried one vendor’s solution. The big issue was that you couldn’t shut the thing up when you were with a patient by pushing a button in your pocket like you do with a beeper — you had to take out the phone, open the app, and engage with it. Then you lost the reminder for later. Also, there was no way to turn on or off your call status or transfer to another within the app itself. You had to call a paging company number, follow a phone tree of commands, and, if you were transferring call to someone else, to remember their damned number. The hospitalists rejected the thing out of hand.” It sounds as though it was designed by technologists rather than clinicians.
HIStalk Announcements and Requests
I received generous donations for my DonorsChoose project from Carla, Mike, Chris, and an anonymous reader totaling $1,650, to which I applied matching funds from both my anonymous vendor executive as well as private foundations to fund this rather amazing list of teacher grant requests in their entirety:
Math manipulatives for Ms. Brown’s elementary school special education resource room in Harper Woods, MI
A Chromebook and accessories for math instruction for Mrs. Shaw’s fourth grade class in Philadelphia, PA
Two Amazon Fire tablets for math and science self-study for Ms. Lacey’s elementary school class in Houston, TX
Five tablets for Mrs. Chavis-Ramirez’s elementary school science class in Houston, TX
An iPad Mini and programmable robot to create a Kids Coding Club for Ms. Carbo’s first grade class in Atlanta, GA
A STEM early learning kit for Mrs. Almiron’s kindergarten class in Port St. Lucie, FL
Four tablets and cases for math and science learning centers for the special education class (Down syndrome, cerebral palsy, traumatic brain injury, etc.) of Ms. Munoz’s Grades 5-6 in Pasadena, TX
Five animation software and hardware kits to produce science movies in Ms. S’s elementary school class in Houston, TX
A 3D printer for the high school science class of Mr. Swedman in Keaau, HI
An anatomy model and learning kits for Ms. Wilson’s special needs class in Richmond, VA
Two Chromebooks for targeted math study in Mr. Colasacco’s sixth grade class in Brooklyn, NY
A programmable robot to create a makerspace in the school library and a learning club by Mr. Lincheck’s elementary school in Houston, TX
Two tablet keyboards for Mrs. C’s elementary school class in Houston, TX
Two Chromebooks for the high school physics class of Mr. Lewis in Houston, TX
20 sets of headphones for the elementary school inclusion class of Mrs. Ortego in Lake Charles, LA
Seven sets of headphones and cables for computer learning in Mrs. Allen’s learning disabled class in Heath Springs, SC
Microbiology lab equipment for the four full (and waitlisted) classes of the first microbiology course ever offered by Ms. Westover’s high school in Norcross, GA
A science library for the elementary school class of Ms. B in San Bernardino, CA
40 portfolio binders for the gifted class of Mrs. Perez in St. Petersburg, FL
A STEM bundle for the elementary school class of Mrs. Huynh in Houston, TX
Mrs. Kay from Wisconsin (near Epic, in fact) says that she and her elementary schoolers “love our Samsung tablet” that we provided via DonorsChoose that allows them to check out public library books electronically, some of which include audio files so the students can follow along. She says they use the tablet every day in reading block, adding, “I have truly seen a deeper love of reading from many of these students who we might think of as reluctant readers.”
The best reason to buy travel insurance for non-domestic trips is medical evacuation coverage that will pay to fly you back to a US hospital if you experience a medical catastrophe in a location with limited medical resources. I was thinking that someone should offer a US-only plan that will evacuate people with narrow-network insurance from the 99 percent of the country their policies don’t cover back to their home location to avoid otherwise likely financial ruin. An analysis finds that many 2016 plans do not have a maximum cap for out-of-network expenses they don’t cover, meaning a heart attack in another state is the patient’s financial responsibility at full list price. Of this I have zero doubt: medical bankruptcies are going to balloon in 2016 and many of the folks involved will be middle-class people with insurance they purchased through Healthcare.gov thinking it would protect their family just like employer-provide plans. The uproar will commence just in time to be a hotly debated topic in the 2016 presidential election. The only hope — and it’s a slight one — is that next year’s ACA enrollment will grow to reflect a more typical customer pool, i.e. healthy people will sign up and help pay for the unhealthy ones who quickly jumped on board last year.
This week on HIStalk Practice: Arizona’s Practice Transformation Institute leverages HIE capabilities. A physician’s propensity for EHR eye lock boils down to gender. Dr. Gregg gives thanks for HIT. Blue Cross and Blue Shield of Alabama begins covering telemedicine visits. Family physicians have trouble seeing the ROI of value-based payments. Two Point expands data-conversion services to providers. Physician awareness of prescription drug monitoring programs is surprisingly low. CVS Health EVP Andrew Sussman, MD discusses the company’s partnership with Epic and Health is Primary, plus plans for telemedicine.
This week on HIStalk Connect: Welltok raises $45 million in new funding and announces the acquisition of patient engagement vendor Silverlink for an undisclosed sum. GOQii raises a $13 million Series A to ramp up its personal wellness coach and activity tracker platform. Propeller Health signs a new R&D agreement with GSK to develop medication utilization sensors for its Ellipta dry-powder inhaler. Scripps Translational Science Institute will recruit 6,100 volunteers to wear a heart rate monitor for four months as part of a study designed to improve atrial fibrillation diagnosis in high-risk populations.
Webinars
December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.
December 9 (Wednesday) 1:00 ET. “The Health Care Payment Evolution: Maximizing Value Through Technology.” Sponsored by Medicity. Presenter: Charles D. Kennedy, MD, chief population health officer, Healthagen. This presentation will provide a brief history of the ACO Pioneer and MSSP programs and will discuss current market trends and drivers and the federal government’s response to them. Learn what’s coming in the next generation of programs such as the Merit-Based Incentive Payment System (MIPS) and the role technology plays in driving the evolution of a new healthcare marketplace.
December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.
December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenter: Stephen Claypool, MD, medical director of innovation lab and VP of clinical development and informatics for clinical software solutions, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.
December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Here’s the recording of Wednesday’s VMware-sponsored webinar, “The Patient Is In, But the Doctor is Out: How Metro Health Enabled Information Decision-Making with Remote Access to PHI” by Josh Wilda, VP of IT at Metro Health (MI).
Acquisitions, Funding, Business, and Stock
A Washington Post investigation finds that the Department of Defense questioned the lab technology of Theranos in 2012, passing on its fingerstick methods. CEO Elizabeth Holmes asked four-star Marine General James Mattis, who later joined the company’s board, to dispel the DoD’s “blatantly false information.” Mattis pushed hard to have Theranos tested in Afghanistan, drawing a Marine Corps caution that he needed to stop personally pitching the company.
Seamless Medical Systems, which offers a mobile device check-in app for medical practices, closes a $2.5 million investment.
Sales
Baystate Health (MA) chooses Imprivata Cortext for secure communications.
Community Health Systems will offer $39 virtual doctor visits to patients in the communities where its 198 hospitals are located. It will use American Well’s telehealth platform.
Broward Health (FL) chooses Cerner HealtheIntent for population health management.
The UK Defence Medical Services chooses CGI to provide an integrated EHR for its 400 sites, which will be based on the PCS system from EMIS Health. CGI will host the system and manage its help desk.
For-profit Manipal Hospitals (India) chooses IBM’s Watson for Oncology for its 15 hospitals.
People
MedSys Group names P.J. deRijke (Warbird Consulting Partners) as VP of client relations.
Fairfield Medical Center (OH) names Alan Greenslade (Greenslade Consulting) as CIO.
Hal Wolf (McKinsey & Company) joins The Chartis Group as director.
Private equity investor Bruce Cerullo, formerly chairman and CEO of Vitalize Consulting Solutions that was sold to SAIC/Leidos in 2011, joins Nordic Consulting as chairman and CEO. He replaces Mark Bakken, who left the company in March 2014 to start an early stage venture capital fund.
Announcements and Implementations
Catalyze announces Redpoint, a set of EHR integration tools for digital health vendors that includes pre-configured scripts, EHR connectivity tools, and workflow components.
Health station vendor Higi will use Validic’s digital health platform to capture real-time consumer biometric information as part of its patient monitoring and wellness programs. Chicago-based Higi was founded by Chicago Sun-Times Founder Michael Ferro of Merrick Ventures,former chairman of Merge Healthcare. He’s credited with saving Merge in 2008, with the company’s $1 billion acquisition by IBM putting around $200 million in his pocket in return for his $15 million investment.
Quality improvement, cost containment, and clinical content technology vendor LogicStream Health graduates from the accelerator program of TreeHouse Health, the first of its portfolio companies to achieve all transition milestones. The Minneapolis-based company was co-founded by a pharmacist and a physician and counts Texas Health Resources among its customers.
HIMSS announces its Value Score measure of the value of healthcare IT, which I assume it will sell since the announcement didn’t indicate otherwise and its self description seems ambitious (although one might quibble at the inconsistent use of the essential Oxford comma in the announcement’s first sentence and spelling KPIs as KPI’s in the accompanying graphic):
HIMSS is a global voice, advisor and thought leader of health transformation through health IT with a unique breadth and depth of expertise and capabilities to improve the quality, safety, and efficiency of health, healthcare and care outcomes. HIMSS designs and leverages key data assets, predictive models and tools to advise global leaders, stakeholders and influencers of best practices in health IT, so they have the right information at the point of decision.
Zynx Health announces integration between its ZynxOrder evidence-based order set development system and Epic inpatient.
Government and Politics
CMS analysis finds that US healthcare spending jumped 5.3 percent in 2014 after years of low growth, which it says is primarily due to expanded coverage under the Affordable Care Act and increased drug spending. The $3 trillion in annual expense represents 17.5 percent of GDP and $9,523 per person. The increased rate of growth is still less than before the Affordable Care Act, which the White House touts as evidence that ACA is insuring more Americans without large cost growth increases. Critics point out that the modest spending increase may be masked by insured Americans who are being forced to pay ever-higher deductibles or who avoid seeking care they can’t afford even with insurance. Somehow hospitals evaded being named as being significantly responsible for higher healthcare costs. I maintain that if you want to see who is most responsible for high US healthcare costs, follow the money and check the 1040 tax forms of the individuals involved – you’ll see a lot of drug company executives, hospital administrators, high-powered surgeons, insurance company suits, and healthcare vendor executives who became millionaires (even in working for a supposedly non-profit organization) from the mess that is our healthcare system.
Privacy and Security
Centegra Health System (IL) exposes the information of 3,000 patients when the mailing equipment of contractor MedAssets was misconfigured to send two statements per envelope instead of one, with each patient receiving their own statement plus one from another patient.
Cottage Health System (CA) notifies 11,000 patients that an incorrectly configured server exposed their records to Google searches at the end of October. The problem was discovered by a cybersecurity firm hired to perform a security audit, which I suppose means the engagement’s ROI was substantial. Or maybe not – the cost of the breach response and any resulting fines or lawsuit awards might be the same regardless of who found the problem or whether it actually exposed any information.
Technology
MIT non-profit spinoff institute MIT Hacking Medicine will publish in the next few weeks a “best apps” list and consumer reviews of digital health tools. It says expert reviews are important because most apps have few downloads and reviews and don’t use good design practices. The institute’s co-directors are students: Tatyana Gubin is studying mechanical engineering at MIT with a focus on medical devices, while Christopher Lee is a Harvard-MIT PhD student and co-founder of a company that developed a disposable drug reconstitution system.
Other
Several patient advocacy groups launch Partners for Better Care, which seeks manageable out-of-pocket costs, cost transparency, adequate provider networks, reasonable healthcare costs, and equitable access to drug therapies. That last item justifiably raises a red flag given that the group’s initial funding came from drug maker Novo Nordisk, which took heat for jacking up the price of its Levemir insulin almost exactly in tandem with that of competitor Lantus to over $300 per vial, leading to questions about whether the brand name drug marketplace is really competitive. Shareholders of Denmark-based Novo Nordisk probably like Levemir’s pricing a lot more than the patients who use it – the company’s stock is up 22 percent in the past year and 161 percent in the last five, giving the company a market value of $145 billion. I couldn’t find a listing of the officers or board members for Partners for Better Care except that the announcement referenced without detail its executive director, Mary Richards, who I assume isn’t the WJM Minneapolis beret-tossing one.
Turing Pharmacecuticals CEO Martin Shkreli says he was wrong to increase the price of old but critical drug Daraprim by 5,000 percent – he wishes he had increased the price even more. He says, “Our shareholders expect us to make as much money as possible … the idea that pharmaceuticals are exempt from capitalism is insane.” As I’ve said, Shkreli is a saint in finally showing the true colors of drug companies as cartoonishly evil villains rather than the dulcet-toned suits who pretend to exude concern for patients rather than profits. Their indefensible prices, especially here in the US, speak for themselves.
BIDMC CIO John Halamka, MD concludes in his year-end review that “ICD-10 benefited no one” and expresses his hope that the industry moves to bundled payments so that ICD won’t be needed for billing, replaced for analytics purposes by natural language processing translation of unstructured text into SNOMED-CT codes. He’s optimistic about 2016, as he indicated in my interview with him a couple of weeks ago, now that the “weights around our ankles (ICD-10, MU) are finally coming off.”
Weird News Andy would have headlined this story as, “I bet you’re stupid.” A man in China desperate to raise rent money takes a $1,200 bet that he wouldn’t swallow a five-inch saw blade and a five-inch nail. The good news is that he won the bet, but the bad news is that the evacuation of the hardware occurred surgically rather than naturally, with the medical costs exceeding his winnings.
Sponsor Updates
Sixteen Influence Health clients receive eHealth Leadership Awards.
Valence Health publishes “Helping Solve the US Healthcare Crisis: The Provider’s Guide to Building a Successful Plan.” The 292-page electronic book is available on their site or on Amazon.
An InterSystems survey of lab professionals in Australia finds that laboratory information systems aren’t equipped to deliver the desired cost savings and efficiencies.
LiveProcess exhibits at the National Healthcare Coalition Preparedness Conference through December 4 in San Diego.
Oneview Healthcare launches an internship competition.
LogicStream Health is exhibiting at the IHI National Forum in Orlando, FL next week.
Pediatric Associates of Dallas reduces billing costs after implementing the PatientPay paperless payment solution.
Former L&D nurse and clinical analyst Darcy Dinneny discusses her experience with PeriGen’s PeriCalm solution.
Qpid Health will exhibit at the IHI National Forum on Quality Improvement in Health Care December 6-9 in Orlando.
Streamline Health will exhibit at the HIMSS Revenue Cycle Solutions Summit December 7-8 in Atlanta.
I engaged this week in what might become my favorite annual holiday event – crashing the medical staff Christmas party at a hospital where I’m not on staff. My good friend Anjali called, again asking me to be her rent-a-date. Last year her husband had to travel, but this year he’s apparently studying for final exams for his master’s program. I think it sounded like a convenient excuse to avoid being around doctors talking shop, but was happy to go with her again even though last year’s party had more EHR discussions than social time. Now that I’m freelance, it doesn’t hurt to network when I can.
Last year there were some, shall we say, “senior” physicians wearing some rather loud plaid jackets. I almost died laughing when I saw that some of the more junior physicians had taken the trend to an ironic new level, sporting so-called “Ugly Christmas Sweater” suits. The first gentleman was wearing the blue and red number above with a pair of white patent leather shoes. I tried to get a photo, but with the dim lighting, it was impossible and I didn’t want to be too conspicuous with my flash. Several of his companions had similarly awful ties and cummerbunds and I can’t help but think that this is going to be a new trend and I’d better secure my invite for next year’s party early.
I ran into a couple of old friends who recently moved from my previous employer to this hospital’s medical group. It was somewhat gratifying to hear that they found the grass wasn’t really any greener in their new positions and that they find their new EHR just as awful as the one I used to be responsible for. Given some of the major shifts going on with value-based care and new reimbursement models, it will be interesting to see if physicians begin shifting alliances or if we start to see even more consolidation among the employed physician ranks.
My other excitement this week was the quarterly provider meeting at my practice. Because of travel conflicts, it’s the first one I’ve attended. Given some of the news that was announced, I was glad to be there in person so I could see my colleagues’ faces. Effective immediately, we are opting out of the Meaningful Use incentive program. There was actually applause and a couple of high-fives. This weekend the EHR will be modified to disable all the extra screens that were added so we could check all the boxes that ended up not being all that relevant to our model of care. The providers were ecstatic to say the least.
The practice owners are extremely process-oriented and determined that the changes to the system will remove literally hundreds of thousands of clicks for users over the next year. I admire their dedication to detail and their gutsiness in deciding to just say no. Our patient volumes have grown dramatically since I started working with this group and it’s fair to say that the revenue from additional patients we’ll be able to accommodate if we can work more efficiently will more than cover any penalties. Having been in the EHR driver’s seat for so many years, it’s been very interesting to work with them as an end-user.
They asked me to stay after for a few minutes. I’m the most part-time of all the physicians and work the fewest hours each month, but had previously volunteered to work some of the less-desirable shifts to allow the full-time staff to have more time with their families. I suspected that they were going to ask me to pick up a couple of extra shifts over the holidays since I had mentioned to the COO that I’m not traveling this month. What I did not suspect, however, was that they would offer me a leadership position in the organization.
I would be going back to formal CMIO duties with a bit more operational authority than I’ve had in the past. I’d also be spending dedicated clinical time at one of our expansion locations, which the organization plans to use as a pilot site for new initiatives and for vetting workflow changes. Our workflow is already pretty serious as far as quality, efficiency, and patient satisfaction are concerned so I’m very flattered by their belief that I could help take it to the next level. I have to say that the idea of being able to return to a CMIO position without dealing with Meaningful Use or hospital politics is seriously tempting.
Although I’ve enjoyed doing more consulting this year and have learned a tremendous amount, the travel quickly becomes less than fun. Based on what I’m being offered, they’ve done an outstanding job of figuring out what makes me tick and what I might find compelling enough to give up my frequent flyer status. They know me well enough to not expect a quick decision on such a weighty matter and I’m sure we’ll have additional discussions over the next few weeks. A wise man once told me that you should spend 10 percent of your time looking for your next gig. Sometimes I guess your next gig might just fall in your lap, though.
The CMS Office of the Actuary publishes new data showing that healthcare expenditures rose 5.3 percent in 2014, after five consecutive years of historically low growth. Health spending now accounts for 17.5 percent of national GDP.
UnitedHealth CEO Stephen Hemsley says the company will lose about $500 million on public insurance exchanges between 2015 and 2016. He explains, “It was for us a bad decision. I take accountability for sitting out the exchange market in year one so we could in theory observe, learn and see how the market experience would develop. This was a prudent going-in position. In retrospect, we should have stayed out longer.”
Harvard Business Review analyzes the role a “value management office” would play in health systems migrating to new value-based reimbursement models, citing MD Anderson Cancer Center (TX) and Hospital for Special Surgery (NY) as examples of organizations where such offices are working well.
Internal emails from Theranos reveal that the DoD reported the company to the FDA in 2012 after evaluating the technology for use in theater. CEO Elizabeth Holmes called on Theranos board member and four-star Marine Corps General (ret.) James Mattis to intervene on the company’s behalf.
Last time I checked, hospitals have a lot on their plates. Remember October? ICD-10 ring any bells?
In case you haven’t heard, another new set of regulations — under section 501(r) of the Affordable Care Act — is set to take effect in 2016 for all 501(c)(3) non-profit hospitals. The implications: comply or lose your tax-exempt status.
It’s a hard truth, but the healthcare industry is facing more regulations than nuclear power—look it up. These new regulations are far from straightforward. Compliance with 501(r) can be incredibly complex. The entire process can take anywhere from several months to a year, depending on how smart your people are.
Not to mention expensive. Staff, signage, documentation, training, etc. are all crucial elements of effective 501(r) compliance. What’s more, you may need to hire a new employee or two just to manage the task.
In a nutshell, 501(r) requires that you satisfy new regulations around CHNA, FAP, ECTP, AGB, and EAC. (Go ahead and look up those up after you read up on nuclear power—or just read on.)
Here’s what you need to know about 501(r):
Congress passed the Patient Protection and Affordable Care Act (PPACA) in 2010.
Prior to this, some non-profit hospitals had been engaging in aggressive billing and collections efforts that brought their “charitable” status into question.
This led to the enactment of section 501(r), which requires non-profit hospitals to demonstrate the benefits they provide to their patients and community from a financial standpoint.
As part of 501(r), non-profit hospitals must now meet four specific requirements in order to maintain their tax-exempt status:
Conduct a periodic community health needs assessment (CHNA).
Provide written financial assistance and emergency care policies (FAP, ECTP).
Establish limitations on charges for emergency or medically necessary care (amounts generally billed or AGB).
Set policies and procedures related to billing and collection activities (extra ordinary collection or EAC).
There are three basic approaches you can take when it comes to compliance:
Ignore it, do nothing, and assume that you’ll handle it when something happens.
Check with the experts in your organization to see where you stand.
Take a proactive approach, put a team together, perform an assessment, and establish an action plan. (Hint: choose option 3 if you want to bolster your charity status, prevent poor patient experiences, ensure your tax-exempt status, and maybe even reduce future expenditure.)
Here’s how to get 501(r) right:
Measure the pros and cons, risks and rewards of tax-exempt status against the costs of 501(r) compliance. I the juice worth the squeeze? Personally, I think it is for a variety of reasons, but it’s still helpful to understand what you’re in for.
Document, document, document. Proper documentation is a crucial requirement of 501(r), but it can also be used to show that you’re making a good-faith effort to comply with the rest of the requirements.
CHNA. This may actually help support your strategic plan. Are the programs offered by your hospital meeting most of the needs of your community? Are all your resources in sync with the community? Have community wellness and health in general become better, worse, or stayed the same?
Reputation insulation. Compliance can actually help you avoid negative patient experiences and minimize bad press. Along with the “worth” of your non-profit status in the community, in hard and soft costs, the fines can pile up quickly.
Use third-party data to presumptively determine eligibility for FAP. 501(r) clearly permits the use of presumptive eligibility, which enables you to assess a patient’s financial health early in the revenue cycle. By streamlining this process with third-party data, you can realize increased or accelerated cash flow as well as save time and money by converting manual workflows into automated processes.
Documented standard work. The use of third-party data can help facilitate a consistent (unbiased) and efficient method for identifying which patients are eligible for financial assistance, effectively taking the guesswork out of the equation. Additionally, 501(r) requires that you thoroughly screen patients for eligibility before sending them to collections or initiating extraordinary collections actions. Again, by using third-party data, you can identify which self-pay accounts can be pursued for collections and which accounts can be presumptively qualified for charity care. This allows for an accelerated segmentation of aged self-pay accounts into payment, charity, and bad debt buckets.
At the end of the day, it’s important to evaluate your patient mix and adjust policies to fit any changes, as well as track and measure your results. Be sure to establish measureable goals to ensure that your FAP-reporting processes are meeting 501(r) standards as well as your patient population mix. Setting a specific number of goals will help keep the focus on the high-priority tasks, ensuring that your processes can be measured more effectively. Are you ready for this?
Jonathan Wiik is principal, revenue cycle management, with TransUnion of Chicago, IL.
Clinical Decision Support: Are We Ready to Invest? By Jaffer Traish
Sometimes great ideas are just ahead of their time. Microsoft launched a smart watch in 2004. Digital currency received 100M in venture funding, but collapsed in the dotcom era. Google Glass has come and gone – or has it?
Evidence-based medicine and the marriage with technology is another open playground. Opportunities abound to create interactive, engaging clinician workflows to support real-time decision-making and enhance not just clinical outcomes, but the patient experience and revenue integrity.
The Hearst Corporation’s portfolio includes efforts to improve real-time medication decision support, maintain the currency of order sets and care plans, as well as drive care team and care transition communication. Wolters Kluwer is similarly working on the above, as is Elsevier in their respective product portfolios. The CMS value-based purchasing and other HITECH act incentives provide some soft carrots to push forward.
EHR vendors also provide significant clinical content (sometimes including specialties as well) that provide a very practical head start, though with no assessment of evidentiary integrity. Some startups like Stanson Health are also tackling niche areas of decision support.
The meta-analysis, categorization, and dissemination of evidentiary information is not a hard science. Teams of clinicians and coders together can review hundreds of articles and publish findings relatively quickly. Most healthcare systems have enterprise subscriptions to evidentiary libraries to consume these findings. Even as there is disagreement among communities over studies and trials, that very disagreement is the impetus for further study.
Some EHR vendors support communities of clinicians coming together to bridge the gaps in knowledge and best practice findings, especially in pediatric care.
Healthcare systems aren’t software development shops. Most don’t develop teams to tackle this opportunity. Instead, they hire analysts to manually manage the change (painful and expensive). The evidence subscription vendors have been trying, though they aren’t the EHR experts – the integration approach has been flawed. Groups like OpenCDS are refreshing and bring attention to standards development and process, though still ahead of its time. Last but not least, implementation, rollouts, ICD-10, and other priorities have taken the spotlight.
Clinicians are adjusting to their systems. Are they be ready to do focused collaboration on their (ex.) 200 order sets with evidence depth?
EHRs are maturing their decision support tools. Are they ready to participate more fully in sharing public specifications for standard decision support ingestion?
Evidence vendors have grown revenue streams on non-integrated IT tools. Are they willing to wipe the slate and start fresh with new API models?
Revenue cycle teams have been focused on SBO models, centralization, and patient satisfaction, but there is a strong link to revenue integrity with the reduction of unnecessary tests and improved standards of care. Is the CFO ready to demand this value?
In talking with many CXOs, some truly want to insource this activity while others would prefer to pay – to have content and evidence managed externally and reap the lessons and value from others. Both models could prove effective. Today, the costs are high dollar subscriptions. Perhaps these costs need to be part of a risk strategy and not paid without successful implementation.
Today, if an African American would have better outcomes with a different antibiotic, the clinician should have this information at his/her fingertips in the workflow.
Today, if a drug is removed from the market, it should be removed from the clinician’s selection in swift manner without much manual intervention.
Today, if the several major children’s hospitals wanted to jump online and compare their pediatric specialty order sets, they should be able to do so with ease and share the best.
Today, if there are 500 opportunities to improve clinical content with evidence supported changes within an organization, the CFO should know what the patient outcomes and related costs/savings may be.
The list goes on, and we can do all of this today – manually.
The challenge is not dissimilar from the interoperability debate. Just as we need a national patient identifier, adopted patient security measures, and implementation cost-sharing that includes practices, hospitals, patients and providers, the same theme can be found here. We need public specifications through collaboration, a change in the way evidentiary information is so proprietary today and closer partnerships with innovation teams.
Organizations each pay $50k-1.2M for decision support systems today in existing budgets. Various market analysis projects decision support to be a market of $550M by 2018, and upwards of $2B in the future. Let us demand more for our healthcare dollars.
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