All Aboard the Analytics Train! Next Stop, ROI! By Jeff Wu
HIStalk-ers may be familiar with Zubin Damania, MD (aka ZDoggMD), a primary care physician turned health pop star. ZDoggMD has been featured on TED and produces parody videos on YouTube of our dysfunctional healthcare system.
Dr. Damania’s videos are loaded with hilarious and witty lyrics with often deep and powerful commentary on what it’s like to practice medicine in the US. His most recent video pokes fun at EHR implementation and highlights a laundry list of relevant complaints about what EHRs have done to negatively impact many providers’ care of patients. Dr. Damania’s criticisms aren’t so outlandish as to propose going back to paper, but he does make the case that we need a new and better EHR environment.
While he makes a valid argument, we also need to consider that the greatest value that EHRs provide has barely been touched.
As of September 2015, CMS’s Meaningful Use program has doled out approximately $31.6 billion in incentive payments for the adoption of Certified Electronic Health Record Technology (CEHRT). While EHR implementations have proven valuable immediate effects — such as reduction of adverse drug events and medical errors — it would be difficult to make the case that these benefits would provide the magnitude of ROI necessary to justify their costs. CMS’s own projections and several post-MU studies have demonstrated that the types of immediate benefits achieved from CEHRT will recoup only a fraction of the MU program’s cost.
What gives? Why would CMS knowingly implement a program that they knew would not provide the immediate ROI necessary to pay for its implementation?
The intention was never to achieve ROI purely on efficiency gains, optimized billing, or reductions in medical errors. What CEHRT provides is data – to an unprecedented degree.
The real value in CEHRT is the way we are getting insights into how disease and injuries progress and react to treatments. The vast volumes of data mean that we are seeing things in novel ways for the very first time. Advances in both hardware and software means that the old days of manual chart abstraction or fragmented tables in antiquated or siloed databases are being replaced with dynamic analytical platforms that can be leveraged cheaper and more effectively.
Analytics is the way to ROI and the industry is finally moving to embrace this. Several industry reports are already seeing an influx in investments into analytics. Big tech players including Google and Microsoft predict healthcare analytics to be a key area of growth over the next few years.
This is a logical next step in healthcare’s technology maturity that we’ve been talking about a lot, even here on HIStalk. While analytics is a hot topic, who it benefits is surprisingly overlooked.
Our discussions of ROI have to be with our end users in mind. Analytics offers us an important opportunity to re-engage our disenfranchised healthcare workers. Our doctors, nurses, pharmacists, and desk staff all have contributed to the data we now have. They should be the ones to chiefly benefit from the coming data harvest. I have yet to meet a doctor or nurse who didn’t have a dozen questions they knew could be answered from data within the EMR, but did not have the tools to do so. That simple fact should be both a mark of shame and a call to action to every health IT worker.
We are on the verge of shifts in practice that can be truly groundbreaking. The information revolution started by the dot-com boom in the 1990s paved the way for companies like Amazon and Zappos to transform whole industries. These adoptions of technology and analytics are being implemented by other sectors at an even faster rate (Uber, Airbnb, Square). If we in healthcare can embrace the power of analytics and purposefully drive their output to end users, we can start tapping an endless supply of ROI.
The optimism behind analytics does not diminish the challenges the next evolution in healthcare information technology will present. All the “big data” and “data governance” buzzwords are valid, but not insurmountable, and the insights we stand to gain are priceless.
The next buzzword is already circulating—closed-loop analytics. It’s the intentional, purpose-driven effort to get analytics to end users for decision making as near to real time as possible. It’s the attempt to engage end users to a degree that the outputs of our analytics serve purposeful functions in their actual practice rather than a retrospective review of what’s happened.
This progression in healthcare technology is the necessary (and hopefully welcome) change that can make the biggest difference in rejuvenating our staff and demonstrating some much-needed value.
The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.
Left or Right?
I recently participated in a panel discussion on the topic of collaboration tools in healthcare. While I was probably invited to extol some wisdom as a so-called expert, I found myself instead being educated by others on the panel and the audience.
I was reminded that as EMRs get little love in a crowd of doctors, CIOs equally get little love in a mixed crowd of venture capitalists, digital health CEOs, and the usual big vendors in the “helping healthcare move from fee-for-service to value” game.
The lack of love actually extended beyond just the CIO — it was aimed at the whole IT enterprise. The words “disruption” and “innovation” were thrown around in a context that implied the establishment (enterprise IT led by a luddite CIO) just needs to get out of the way.
My first reaction was of course to minimize the feedback and chock it up to folks that don’t understand the nuance and complexities of healthcare delivery. But as the panelists spoke and the audience reacted, it was not so easy. The trouble was, these folks were making great points.
I often get asked what I do as a CIO. My well-rehearsed answer is that I manage teams that help translate workflows and build engagement to advance our organization’s use of enabling technologies. My old answer was I fix computers, so the new one is better, right?
Anyway, when I break down the work our teams do and really think about how much time we spend on change management and building engagement, I’d say that easily more than half of the time is spent around some form of convincing people to adopt technology. Contrast that with users choosing to use new technologies on their own. You start to wonder: can corporate users as consumers bring their own adoption to work alongside their BYODs?
I heard someone say a while back that we love new technologies at home and hate them at work. My fellow panelists made this same point. When technologies emerge that make your life easier, corporate users — who are consumers at home — will choose them and use them across their digital lives. I always try to remember that I used Dropbox before it was allowed by corporate policy.
Below is a chart that shows the most-blacklisted and deployed apps in the workplace. While not a perfect lineup, it is not a coincidence that the ones on the blacklist (left) are consumer driven and the ones most deployed (right) are enterprise sponsored. Again, not perfect alignment by each company listed, but I bet in a straight up poll the blacklisted would win the popularity context by a wide margin.
I’d offer up a few observations. The first is that productivity tools are different from rich-functioning workflow applications. The list includes primarily collaboration tools — you don’t see vertical applications, line of business transaction systems, or customer-facing business apps.
The second is that “land and expand” works. If you give people what they want, they will use it, and once a tipping point is achieved, the solution morphs into an enterprise one. Let’s give Aaron Levie, CEO at Box, a ton of credit for building a really credible enterprise business from early roots of “land and expand.” I bet if you asked him, he would tell you how hard it was and how many nuanced features had to be built that not a single consumer would appreciate.
Translating this to the landscape of digital health, I think it means that enterprise IT needs to better recognize emerging tools that consumers are driving into the company and find ways to adopt them – faster! I also think it means that vendors with a “land and expand” approach need to think about how they will transition from the left side of the chart to the right. While consumers seek instant usefulness from point features, healthcare organizations — like all corporations — need a lot of integration and complete feature sets.
My advice to left-side digital health companies is to find an enterprise partner, a healthcare organization that loves the idea of your product and wants to help you learn the nuance and complexities. But most importantly, one that will help you understand how to architect for a complete feature set. It may take a while, but the hard work and the longer road taken will pay off. The overnight success healthcare software vendors I meet all tell me they became an overnight success after years of hard work building the product.
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.
Private equity firm Pamplona Capital Management acquires MedAssets for $2.7 billion, absorbing its revenue cycle management business and selling its group purchasing and consulting business to the VHA-UHC Alliance.
A task force sent by the VA’s headquarters to help reform the Phoenix VA medical center, which was at the center of the patient wait-time scandal last year, was sent back to Washington DC by the hospital’s director. The team reports that the Phoenix VA is being run by “a leadership team that displayed obstructionist attitudes, and clearly lacked integrity.”
Telehealth vendor Teladoc announces Q3 results: revenue is up 83 percent to $20 million, EPS –$0.37 vs. –$2.68, meeting expectations on both. The company booked a quarterly net loss of $13.2 million. Share prices fell 10 percent in trading Tuesday.
Pamplona Capital Management will acquire MedAssets for $2.7 billion, announcing plans to divest the company’s group purchasing and performance improvement segments to VHA-UHC and merge its revenue cycle business with another of Pamplona’s recent acquisitions, Precyse. Pamplona says the new, privately company will be a national leader in outsourced revenue cycle, technology, and education, explaining:
Existing and prospective customers of the new, realigned company should expect a business that is dedicated to investing in integrating our technology both internally and with EMR software providers; improving the visualization and utility of our data; scaling our front, middle, and back-end services businesses; and, developing offerings in patient payments and value-based reimbursement. MedAssets and Precyse employees will be part of a growing, focused business that prioritizes long-term value creation
Pamplona will pay a 30 percent premium for shares of MedAssets. MedAssets said this summer that it was exploring strategic alternatives even as an activist investor called for it to replace some of its board members due to questionable acquisitions and undervalued shares. It also lost a key customer and and announced plans to lay off 5 percent of its workforce just a few weeks ago.
Pamplona acquired Precyse in July 2015 for an undisclosed price from Altaris Capital Partners and NewSpring Capital.
HIStalk Announcements and Requests
Want to connect with me on LinkedIn? I’m here, as is Dann’s 3,649-member HIStalk Fan Club.
Mr. Graham in Illinois sent photos of his students using the STEM materials we provided, saying, “The students have shown a great interest in science. They enjoy working with these activities and do the research that goes along with them. They have learned more from these kits than I would have ever been able to teach them using our science textbooks. It is very rewarding for me to see how much they enjoy science now and how engaged they are with these activities. We would like to thank you for supporting our grant and putting these awesome materials into our classroom.”
HIT Geek donated $100 for my DonorsChoose project, which with double matching funded $400 worth of classroom projects:
Eight scientific calculators for Ms. Tyler’s Algebra 2 class in La Mesa, CA.
Green screen broadcasting equipment for Mr. Ventura’s classes in Omaha, NE to allow students to produce morning news broadcasts and video projects.
A field trip to the Wildlife Science center for Ms. B’s Grade 6-8 class of emotionally disabled students in Brooklyn Park, MN.
HIT Geek likes reading about my funding choices. For others who would like to donate, here’s how to do it:
Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
I’ll be notified of your donation and you can print your own receipt for tax purposes.
I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects.
Webinars
November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Cerner reports Q3 results: revenue up 34 percent, adjusted EPS $0.54 vs. $0.42, meeting earnings estimates but falling short on revenue expectations. The company projects Q4 revenue and earnings lower than consensus, sending shares down 9 percent in after-hours trading following the announcement.
EClinicalWorks announces the opening of a London office and the signing of its first UK customer, the 1,700-store Specsavers optical chain. ECW says it booked $100 million in international business in the past year.
Teladoc reports Q3 results: revenue up 83 percent, EPS –$0.37 vs. –$2.68, with its loss meeting expectations and its $20 million in revenue beating slightly. From the earnings call:
The company touted future potential given its 60 percent telehealth market share in a market that’s only 1 percent penetrated.
Subscription fees made up 85 percent of the quarter’s revenue, with the remaining $3 million coming from telehealth visits.
The company will raise its visit fee from $40 to $45 on January 1.
Teladoc spent $1.6 million in the quarter on its legal fight with the Texas Medical Board and expects to spend up to $750K more in Q4.
The company emphasizes that customers get what they pay for, with some lower-priced offerings failing to deliver value.
The company says health systems are using its product to acquire patients, while health plans are using it for population health and care management.
Teladoc believes CMS will allow fee-for-service telehealth payments via Medicare and Medicaid.
The company is working with health systems to design a post-discharge program.
Two co-founders and a former executive of travel and expense management system vendor Concur (sold to AP last year for $8.3 billion) join Accolade. The Plymouth Meeting, PA company offer Health Assistants who work with technology and analytics to engage with consumers to reduce utilization and costs. The company claims a 98 percent user satisfaction rate, contacting healthy members an average of five times annually and reaching out to the least-healthy ones 24 times per year.
Referral and access management technology vendor SCI Solutions acquires Clarity Health, which offers authorization and referral management services.
Meditech announces Q3 results: revenue down 3.5 percent, EPS $0.37 vs. $0.50 as product revenue dropped 16 percent year over year due to lower sales. Nine-month net income slid to $51 million vs. $104 million in 2014. Here’s the five-year change:
Product revenue: $60,102,900 (2010) vs. $37,004,099 (2015) – down 38 percent Service revenue: $58,368,348 (2010) vs.$82,102,999 (2015) – up 41 percent Total revenue: $118,471,248 (2010) vs. $119,107,098 (2015) – flat Net income: $31,957,358 (2010) vs. $13,591,077 (2015) – down 57 percent Earnings per share: $0.89 (2010) vs. $0.37 (2015) – down 58 percent Shareholder equity: $408,525,252 (2010) vs. $529,738,300 (up 30 percent)
People
Best Doctors names Peter McClennen (Allscripts) as CEO.
HealthMedx founder Charlie Daniels (CS Funding) will return to the company as COO.
Sam Miller, former CIO at Massachusetts General Hospital and University Medical Center (AZ), died last month in Canada. He was 77.
A reader reports that Graham King, former president of Shared Medical Systems and McKessonHBOC’s IT business, passed away this week.
Announcements and Implementations
A two-year Geisinger study finds that patients given online access to their clinical documentation via OpenNotes have a slightly higher rate of adhering to their medication regimens. It’s an unimpressive finding, but perhaps asked the wrong question in the first place since the two observations don’t seem to have much intuitive correlation.
Wheaton Franciscan Healthcare’s southeastern Wisconsin operations will join Ascension Health, which already had 150,000 employees and 131 hospitals. Ascension pays big salaries: the CEO made $8.5 million, the CFO $4 million, the chief medical officer $2.7 million, and quite a few executives at $1.5 million and up.
In England, Addenbrooke’s Hospital is testing an online tool that allows prostate cancer patients to set PSA testing reminders and to track their own PSA levels.
A small study of outpatient diabetic patients finds that use of Glytec’s Glucommander insulin management software reduced the average A1C level from 10.4 percent to 7.4 percent within 30 days.
Middle Park Medical Center (CO) will implement Epic via Centura Health, replacing Healthland.
Government and Politics
The just-announced 2016 work plan for HHS’s Office of the Inspector General includes examining the effectiveness of the FDA’s oversight of medical device security to determine if it adequately protects patients.
The FDA seeks input on how technologies such as apps, telemedicine, and biomedical sensors might be used in performing clinical trials for drugs. FDA wants to know what technologies are being used, how FDA can encourage their use, and what challenges need to be overcome, especially regarding the use of patient-owned devices.
I’m bored with taxpayer trough-lappers biting the hand that feeds them, including the AMA, which announces that the Meaningful Use program is “doomed” unless Congress lowers the bar. It says the market needs new EHRs to support the way doctors practice, not mentioning how many of its members bought whatever a salesperson stuck in front of them in their zeal to pocket a seemingly easy $44,000 taxpayer bribe. AMA blames Meaningful Use for physician data entry time, the requirement to collect pointless information, and for creating interoperability barriers. AMA concludes that physicians embrace new technology, but are stymied by bureaucracy. I hope they are right, actually – it would be just fine with me if Meaningful Use went away.
Medicare will eliminate higher payments for medical practices acquired by hospitals starting in 2017, lowering their payments to be the same as for non-hospital owned practices and saving $9 billion per year. However, the change isn’t retroactive, so it effects only newly acquired practices, meaning hospitals may buy practices even more aggressively to lock in their high Medicare rates. The AHA is predictably lobbying against the change, saying it will reduce access to care. The change may have limited impact anyway depending on how far value-based care has progressed by the time the change kicks in.
Two senators are investigating why 12 of 23 non-profit state co-op insurers funded by $2.3 billion in ACA loans have failed. The senators also express concerns that the surviving co-ops may be using “creative accounting” that may lead to even more failures. A report from a few weeks ago found that all but one co-op is struggling financially, with some of their leaders blaming Republican-led funding cuts. Observers say the co-ops set their premiums too low and had to use their federal loans to pay medical claims.
A national human resources team sent by the VA’s national headquarters to help fix widespread problems (including extended wait times) and massive employee shortages at the Phoenix VA hospital was sent home by the hospital’s acting director, who told them that he “calls the shots.” The team says hospital management was “obstructionist” and “clearly lacked integrity.” The Phoenix VA’s HR department uses paper-based systems with no tracking capability, hampering its hiring efforts. The team observed chronic abseentism that left clueless people in charge and noted that several HR employees refused to learn new IT systems because they would then be held accountable for completing tasks.
Privacy and Security
An unnamed hacker earns a $1 million prize for creating a Web-based exploit for iOS 9, which is mostly interesting because company that sponsored the challenge sells hacks non-exclusively to the highest-bidding world governments and to the NSA. An ACLU technologist referred the earlier company as a “merchant of death” that sold “the bullets for cyberwar.” The new company, Zerodium, will undoubtedly sell the hack many times for far more than $1 million to governments interested in performing electronic surveillance.
Innovation and Research
The Birmingham business paper covers Alabama Eye Bank’s self-development of a FileMaker iPad app for collecting information from cornea donors. The CIO likes that developers only need to learn one tool to deploy to both mobile and to the Web.
Technology
The Glow fertility app comes under scrutiny after the company presents data that claims women who use it to track their fertility cycles are 40 percent more likely to conceive. Researchers immediately pounced on that assertion since the analysis proved correlation but not causation. The study also didn’t control for important variables such as prior fertility treatments. An expert says the results most likely reflect selection bias rather than an app-inspired change in behavior.
Other
The Boise newspaper digs up old news from 2012 saying that the implementation of Epic at St. Luke’s caused provider productivity problems. It appears that the reporter was just playing in some legal databases and decided to throw some factoids together to create a non-story.
Here’s an infuriatingly stupid and insulting comment from an oncology site that also declared the ICD-10 switch to be “much ado about almost nothing.” I suppose the next time an oncology intervention saves someone from dying of cancer we should just say the tumor “blew over” instead of thanking the oncology team for saving them.
A small survey finds that people prefer receiving their lab results via a patient portal rather than by email, traditional mail, or voice mail.
In England, NHS launches its digital maturity self-assessment that trusts are required to complete. NHS England created its own assessment in which trusts will rate themselves on how well they use their systems. NHS declined to use the HIMSS EMR Adoption Model, saying it measures use only within a given organization and NHS wants to focus on interoperability.
A New York business paper delves into the expensive and not universally loved “rebranding” of North-Shore LIJ Health System to Northwell Health, chosen because it’s a neutral name that won’t limit the system as it expands. The system rejected similarly dull, feel-good names such as Laudica Health, Dedication Health, and Northstar. It will spend $20 million to roll out the new name.
Experts debate whether surgeries should be recorded on video as a “surgical black box” that could be used for learning or to defend malpractice lawsuits. Naysayers don’t like the possibility that recordings could be used to prove malpractice, would increase costs, and would expose the sometimes secretive goings-on of a typical OR.
Weirton Medical Center (WV) protests the $1.5 million an arbitrator awarded to a management company the hospital hired to turn its finances around, saying the company miscalculated payment rates and failed to prepare it to earn $1.8 million in Meaningful Use money.
Weird News Andy leans on the bar and starts his story with, “A deer walks into an ER …” An injured deer walks through the automatic doors of Strong Memorial Hospital’s ED and wanders down the corridor. Unlike other ED patients, the deer was taken out to the parking lot, where animal control officers killed it.
Sponsor Updates
Medicity celebrated Halloween with an ICD-10 graveyard titled “You Don’t Want to Die on This Hill.”
Fox Business profiles AirStrip’s integration with Apple Watch and its use at Montefiore Medical Center.
Wellcentive wins the “Emerging Company of the Year” award presented by the Metro Atlanta Chamber of Commerce.
Aprima will exhibit at the American College of Rheumatology Annual Meeting November 8-10 in San Francisco.
Awarepoint will exhibit at the iHT2 Health IT Summit November 3-4 in Beverly Hills, CA.
Bernoulli will exhibit at the American Association for Respiratory Care Congress November 7-9 in Tampa, FL.
Besler Consulting wins a 2015 Bright Bulb B2B Marketing Award for best small team in-house campaign.
CenterX will exhibit at the NCPDP Workgroup Meeting November 4-6 in St. Louis.
Sunquest will exhibit with GeneInsight at AMP 2015 November 5-7 in Austin, TX.
Nordic releases a video titled “After ICD-10: Minimizing pain, increasing gain.”
Direct Consulting Associates sponsors the HIMSS North Ohio Chapter Conference November 5 in Akron.
Connected for Care introduces its telemedicine solution and integrate it with HealthMedx’s LTPAC EHR.
Divurgent will exhibit at the Virginia HIMSS Fall Conference November 5-6 in Williamsburg.
EClinicalWorks and Healthwise will exhibit at the mHealth Summit November 5-6 in National Harbor, MD.
FormFast helps hospitals move away from paper documentation.
The Colorado Technology Association nominates Healthgrades EVP/CIO Douglas Walton for Apex CIO of the Year.
Researchers working with the Open Notes project at Geisinger Health System report a small improvement in medication adherence among patients with access to their doctors notes. Lead investigator Eric Wright, PharmD and MPH, explains “Providing patients access to their doctors’ notes and reminding them to read them before visiting their doctor is key to reinforcing the doctors’ rationale for prescribing specific medications and dosage."
Researchers from Boston Children’s Hospital and Harvard University have combined data from Twitter, Google, Athenahealth, and Boston Children’s Hospital’s HealthMap project to create a machine learning algorithm capable of tracking national flu trends with a 90 percent accuracy compared to CDC reports of actual flu activity.
CMS released its final Physician Fee Schedule rule, which adds several new telehealth billing codes and limits CQM performance data from being published to the Physician Compare website until each metric is proven to be reliable and appropriately risk adjusted.
I attended a continuing education seminar the other day. It was a rare treat since I’m usually on the speaking side of continuing education engagements. I get most of my continuing education from online sources, reading my specialty society’s journal, and answering continuing ed quiz questions.
The seminar I attended was put on by one of the local hospitals. It targeted physicians who have been using their EHR for some time, but who need tips and tricks to make documentation faster.
A friend of mine was teaching the class and invited me to attend. She is relatively new to being a clinical informatics administrator, although she’s been an end user for a very long time. This was her first time teaching a “techy” class and she was looking for feedback on her delivery. She also wanted my opinion on whether she had prepared a good blend of clinically relevant information and technical suggestions.
I’m not on staff at her hospital, but wanted to help her out. Not to mention it was an easy way to get CME while getting a sneak peek at their state of the art (aka “hundreds of millions of dollars”) system and hear feedback from users of a system I don’t usually work with.
Physicians tend to think the grass is always greener on the other side of the fence. Being able to peek under the hood of another system usually shows that although the grass may be different, it’s not always greener. Many of the physician comments made during this class were the same ones I hear when working with users of other systems: not enough user-level configurability, alert fatigue, too many clicks, etc. Half the physicians in the room might love a particular features while the other half hate it.
This group was no different. Some of the lines of disagreement split as anticipated, whether specialists vs. generalists or procedural specialties vs. cognitive specialties.
My friend did a great job covering some of the nuances of the EHR. Whenever she covered an area where physicians were particularly struggling, she was not only able to show the best practice workflows, but often provided commentary on why the system was set up in a particular way or why a feature might or might not be enabled. Many of the attendees were in agreement that understanding the “why” behind a given feature can make it seem less clunky if it’s clear the benefits outweigh the annoyances of the workflow.
This allowed for a lot of dialogue among the end users, the IT department, and the administrators. Usually I don’t see IT or administration attending sessions like this and it went a long way towards convincing the providers that their organization really does care what they think about the EHR and that they are committed to making the workflows as good as they can possibly be. It also allowed them to hear directly from the physicians without the help desk or a physician services liaison trying to translate or summarize the concerns.
My friend did a fantastic job with her training. After the initial lecture portion of the class (which granted continuing education hours), there was a 45-minute lab time where trainers were available to work with attendees on particular workflows or sticking points. That way, any outstanding questions could be addressed immediately and the learners could also practice and solidify the new workflows they had used in class. She also incorporated hot button clinical issues into her examples, leading several of the providers to go in and update their order sets or modify their preferences accordingly.
Having immediate lab time after the formal lecture is something that many workflow classes lack. Attendees are often excited about learning, but then have to go back to their department or patient care area and have difficulty finding the time needed to try new workflows in a protected environment or to update system configuration. It was also great having trainers to work one on one with attendees so that those who might have been struggling or had more questions knew that they would be able to get help and didn’t derail the rest of the class with questions.
I met with my friend after and gave her a couple of ideas for changes to her presentation style as well as a heads-up about some speech habits that might be distracting to learners. As a clinician who was thrown into the administrative and training realm without a lot of formal support, I know that kind of feedback can be valuable. I have a mentor who sits in on some of my presentations from time to time and does the same thing for me and the advice I’ve received has been extremely valuable.
Depending on the medical school and residency training program a physician attends, there may be solid presentation skills training or none at all. I remember my first presentation as a student, using overhead projector transparencies and a carousel projector. I may be dating myself, but that required a lot more advanced preparation to get slides organized and transparencies created. I definitely appreciate being able to throw together a presentation on the fly, but sometimes we lose the formality we had when we were lower tech.
Hospitals that don’t offer this kind of ongoing EHR training and optimization sessions are short-changing their end users. They don’t always have to be this formal and with this many resources involved, but having them available to users on an ongoing basis (whether live or recorded) is critical to long-term success and user satisfaction.
Does your hospital offer ongoing EHR training? Email me.
November 2, 2015Readers WriteComments Off on Readers Write: Financial Health of Patients Is an Afterthought
Financial Health of Patients Is an Afterthought By Jonathan Wiik
Most healthcare providers offer exceptional levels of care to their patients. After all, we patients expect it. But what most patients don’t expect is the rising cost of healthcare, and unfortunately, financial health is often an afterthought for both parties.
The average deductible for a single person enrolled in an employer-sponsored health plan reached $1,217 in 2014, just under a 7 percent increase over the previous year, says a 2014 study published in JAMA. What’s more, the Affordable Care Act (ACA) Bronze Plan—the new 2015 HDHP (high-deductible health plan) entry plan for patients—establishes its average annual deductible at $5,203.
By 2019, providers could see a 50 percent increase in the amount of revenue requiring a collection from patients. Of that amount, 30 percent (as much as $200 billion) will be written off as uncollectable, according to estimates from Citi Retail Services, a division of Citigroup. Among households with incomes over 400 percent of the poverty line, almost half cannot afford the higher deductible amounts.
For these reasons, many healthcare consumers are reluctant to pursue adequate and timely medical care. The fact is, they simply cannot afford it.
Consider these facts:
A recent report issued by the Consumer Financial Protection Bureau (CFPB) found that medical debts account for a majority of debt-collections actions appearing on consumer credit reports.
An earlier Kaiser Family Foundation report found that one in three Americans struggle to pay medical bills, in spite of 70 percent of them being insured.
Unpaid medical bills are the highest cause of bankruptcy filings, outranking both credit card and mortgage debt.
Once in debt, many people may delay or forego other needed care to avoid incurring further unaffordable medical bills.
The number one complaint from patients typically concerns confusion with their medical bills, an issue that could be alleviated with proactive, data-rich discussions on the front end of the cycle. Accordingly, financial clearance—an industry term—is gaining momentum. Screening patients for eligibility under their insurance plan, confirming benefits are payable for the services they are about to receive, and ensuring they can afford to fund their out-of-pocket costs are paramount processes that should occur as early as possible.
Similarly, 501(r), a component of the IRS tax code covering not-for-profits, is garnering a lot of attention. The rule, which takes effect in January 2016, requires that not-for-profit hospitals demonstrate the effectiveness of their financial screening for charity programs, among other initiatives.
Additionally, under certain provisions in the law, providers must offer charity care to qualified patients and refrain from pursuing aggressive collection actions for those who would have otherwise been eligible. Documentation of charity assistance, processing, discounting, and collections must all occur prior to billing.
From a high level, financial clearance helps ensure three important things:
That patients are paying within their financial means and are receiving financial assistance where possible.
That providers and government programs are maximizing their scarce resources for charity and other programs.
That bad debt, bankruptcy, and collection issues are reduced for provider and patient alike.
A patient’s financial health is becoming increasingly important in healthcare. Providers, for their part, must ensure that they have sophisticated tools and workflows to put both parties on the same page from the start.
CPS reports Q3 results: revenue is down 16 percent at $44.6 million, EPS $0.31 vs. $0.83. Stock prices fell 15 percent after the results were published.
Peer60 publishes a report on the UK EHR market, finding that Epic, Cerner, and Allscripts have replacement vendor mindshare among hospital executives, with Epic leading among the three. Epic’s only live customer in the UK is Cambridge University Hospital, where its $300 million implementation resulted in the resignation of the hospital’s CEO and CFO, and an investigation from the NHS Monitor.
Medication management technology vendor Omnicell will acquire Aesynt, which offers pharmacy robotics, for $275 million. As reader WhoKnows points out, McKesson bought the former Automated Healthcare in 1996 for $65 million and then sold it in late 2013 to Francisco Partners for a rumored $52 million. That’s either horrible McKesson mismanagement or a truly spectacular performance by Francisco Partners, which gets a five-bagger in just two years. The only acquisition I recall Aesynt having made was Italy-based Health Robotics, which was having limited success with its IV room robotics technology. FP didn’t even change the CEO when it bought the company – Kraig McEwen came on board in November 2011 and remains to this day.
Reader Comments
From All Hat No Cattle: “Re: John Glaser. I noticed his CV lists his HIStalk Lifetime Achievement Award from 2011. I wonder if any of the other HIStalk award winners list theirs?” Probably not, but someone new will have that chance in around four months when we do it again.
From Over Easy: “Re: Hoag Hospital in Orange County. Rumor is another senior IT leader was released or resigned, which makes the third in the last four months. The hospital has implemented drastic budget cuts in IT and overall in the past two years.” Unverified. I don’t think I know anyone there.
From Wayne Tracy: “Re: VA-DoD interoperability. As a retired Naval Officer having commanded a field hospital (Fleet Hospital 13B) I have come to the conclusion that until Congress holds the Surgeon Generals of the Army, Air Force, and Navy as well as the head of the VA personally responsible, nothing is going to change. Give them a two-year deadline and withhold all medical computer budget funds until they are fully interoperable in real time (say, using HL7’s FHIR) or the budget goes away. It seemed to work when the railway system was not going to meat the end-of-year (2015) deadline — the New York to Washington line miraculously got done in two weeks. Somebody with big brass ones needs to be put in charge. Congressional oversight hasn’t worked to date, just more deadline extensions. Congress, grow some!”
From Wealthy and Wise “Re: Highmark. As patients grovel for care and medications, these guys are raking it in. No wonder they are struggling financially and cutting care and services. Shameful and despicable.” It’s big money in Pittsburgh healthcare, where Highmark Health’s former CEO earned $10 million in 2014 having worked there less than two years before he was paid to go away. Highmark paid its human resources chief $2.7 million and its treasurer $3.3 million. The CEO of arch-rival UPMC made $6.4 million.
From Purple Hay: “Re: UnityPoint Health System, Iowa. VP/CIO Joy Grosser is gone.” Unverified. Her LinkedIn profile is unchanged, but her patch of real estate on the health system’s executive page is now vacant. I searched their site for information and found only that she was paid $591K last year, with other fun information from their Form 990 being that their largest-expense contractors were all IT related: Epic ($7.8 million), McKesson ($4.7 million), and IBM ($4.5 million). Fifth-highest was a “branding agency” that earned $4 million for doing whatever vital, patient care-focused work that branding agencies are known for doing.
From Maven PR: “Re: headlines. You need sexier ones to bring more attention to what you write. I can help you.” I won’t stoop to the level that many or most sites do in shamelessly fooling readers into clicking over to crap stories by using CNN-type click-bait headlines, mind-numbing slide shows, pointless stock photos, and “listicle” articles that start with a number (in the form of “6 Tricks You Won’t Believe that Lame HIT Sites Use to Suck In Readers.”) I would hope that health IT people and advertisers are smart enough to realize that the steak they hear sizzling is usually just cotton candy, but regardless, I would rather have 100 smart, influential, engaged readers than 1,000 who mindlessly click on whatever shiny object is thrust in their face without recognizing that they’ve been had.
From Atom Heart CIO: “Re: DonorsChoose. I think your legacy will be more about the charitable work you have done than with HIStalk, which is amazing given how successful HIStalk has become.” I don’t seek or expect a legacy either way, but it’s exciting thinking about how the donations readers make to DonorsChoose might, through some unlikely chain of events, help some kid become a legacy themselves. One of these days I’ll either decide to quit writing HIStalk or just die in the saddle, in which case I’ll fade away with my planned or unplanned final post being the only artifact of my anonymous existence (and leaving Weird News Andy homeless).
From The PACS Designer: “Re: ICD. With our first month under ICD-10-CM with no major issues, it’s time to focus on the next aspect, ICD-10-PCS (Procedure Codes). Since it will be done first here in the US, it gives us the opportunity to choose where we do it initially. TPD proposes that we do it with the VA and DoD so that a breakdown occurs to the barriers each of them currently have against each other working together to improve healthcare for our military and veterans.”
HIStalk Announcements and Requests
Poll respondents were evenly split on whether they’d want Theranos running their lab tests. I agree with Don, who said that using the company’s services has nothing to do with a pinprick blood sample and everything to do with convenience and pricing. I enjoy visiting LabCorp and Quest about as much dealing with the people at the driver’s license office. New poll to your right or here: if your customers (or patients) knew what you know about your employer, would they be more impressed or less impressed?
Mrs. G sent photos of the printer supplies, reading games, and early literacy books we provided to her Los Angeles pre-kindergarten class via her DonorsChoose grant request, adding, “There are no words to describe the impact this has had on my life. My students and I feel so blessed for your kind donations.” Ms. G from Oklahoma sent photos of her students using the earbuds we provided to her elementary school class for online math intervention work.
I thought sure Facebook would collapse this weekend under the weight of every single parent in America posting pictures of their costumed children. Speaking of which, I was also thinking that people seem to like spending Halloween prowling around old buildings where people have died, making any former hospital an ideal choice since the number of deaths inside any of them must be huge.
Last Week’s Most Interesting News
A diverse group of lawmakers slams the VA and Department of Defense for their expensive and stubborn failure to integrate their electronic medical records systems.
Theranos restructures its board and takes another hit when the FDA labels its proprietary Nanotainer blood draw system as an uncleared medical device.
CMS reports a quiet, non-eventful October following the ICD-10 switchover.
The AMA and MedStar Health rank EHRs on user-centered design without actually doing any research or measuring usability.
Xerox and Lexmark announce poor quarterly results and announce plans to review and possibly restructure their operations.
Athenahealth shares jump sharply after beating quarterly expectations, while those of Huron Consulting tank on lowered guidance due to delays in two academic medical center projects.
Webinars
November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Quality Systems Inc. will acquire cloud EHR vendor HealthFusion for up to $190 million. QSI announced just over a week ago that it sold its NextGen hospital business to QuadraMed.
CPSI announces Q3 results: revenue down 16 percent, EPS $0.31 vs. $0.83. Shares took a 15 percent dive Friday on the news. The company seems to be struggling now that HITECH-fueled hospital EHR sales are drying up, leaving it to hope that a replacement market emerges. Above is the one-year share price chart of CPSI (blue, down 39 percent) vs. the Nasdaq (up 9 percent).
People
Sarika Aggarwal, MD, MHCM (Fallon Health) joins XG Health Solutions as SVP of population health and chief medical officer.
LifeImage names Matthew Michela (Healthways) as president and CEO. He replaces co-founder Hamid Tabatabaie, who will move to EVP and remain on the board.
Former Siemens Healthcare North America President and CEO Gregory Sorenson, MD takes a minority interest in Deerfield Imaging, which offers image guiding technology, and will become its executive chairman.
Jim Macaleer, co-founder, chairman, and CEO of Shared Medical Systems until he sold the company to Siemens in 2000, died last Thursday.
Announcements and Implementations
Fitch Ratings holds its rating of MetroHealth’s bonds as stable, concluding that the Ohio health system “has demonstrated the ability to be profitable with its challenging payor mix due to its longstanding electronic medical record (Epic), closed medical staff, and care management processes.”
Other
Peer60 publishes “Healthcare IT Trends in England.” NHS hospital executives say their top challenges are physician and nurse shortages, care coordination, and managing and analyzing data. Allscripts, Cerner, and Epic hold high mind share in both EPR (above) and PAS, suggesting they are well positioned to gain business in both clinical and administrative areas.
Greencastle Associates Consulting is named as one of three finalists for the US Chamber of Commerce Foundation’s “Hiring Our Heroes” award for hiring veterans and military spouses. Malvern, PA-based Greencastle was founded by Army Rangers and its three primary executives are all veterans.
Struggling Kinston Hospital (NC) ends its shared services agreement with Novant Health — which included IT improvements — after less than a year,
In Northern Island, Belfast NHS Trust underpays 1,500 employees due to a software error. The union declares the situation to be “totally unacceptable,” apparently finding it even worse than just “unacceptable.”
A healthcare IT entrepreneur says entrenched software vendors are stifling innovation by refusing to open up their systems to startups, causing new companies to burn through their seed rounds without sales to sustain them. He concludes that patients are harmed because “interoperability into the legacy systems of their customers still remains a primary roadblock.” To which I would offer a counterpoint: rightly or wrongly, we’ve defined healthcare (and therefore healthcare IT) as a business. As with any business, it’s irrational to expect competitors to behave in any way that isn’t self-serving, as much as we like to pretend that everybody’s primary motivation is altruistic patient care. Provider or vendor, you are naive and likely to be insolvent if your business plan assumes that your computers will voluntarily lower your barrier to entry.
I asked Vince Ciotti if he would write something about Jim Macaleer in way of tribute for the folks who knew him and who may not have heard that he passed away.
Sponsor Updates
DataMotion publishes an infographic titled “A Brief History of Data Breaches and Security Regulations in Healthcare.”
Ear, Nose and Throat Associates of Texas describes its easy implementation of Talksoft’s RemindMe application.
Vital Images will exhibit at HIMSS Latin America November 4-5 in São Paolo, Brazil.
VitalWare SVP of Operations Doug Picatti is featured in a CNBC report on key issues in the presidential debate.
Huron Consulting Group releases the latest edition of its clinical research management briefing.
ZeOmega will exhibit at the TAHP Managed Care Conference & Trade Show November 2-3 in San Antonio, TX.
Zynx Health will exhibit at the Meditech Physician and CIO Forum November 5-6 in Foxborough, MA.
The Government Reform and Oversight Committee met alongside the House Veterans Affairs Committee to hear the testimony from DHMSM and GAO representatives on why the VA and DoD has failed to integrate its EHR systems, despite having spent billions in taxpayer dollars.
McKesson repots Q2 results: revenue up 10 percent to $49 billion, adjusted EPS $3.31 vs. $2.79, beating analyst expectations on both. McKesson also announces that its board has approved a $2 billion stock buy back plan.
Theranos announces a restructuring of its board of directors, reducing it from 12 to just five members and establishing a supplementary board of counselors and another board that will give medical advice.
October 29, 2015Dr. JayneComments Off on EPtalk by Dr. Jayne 10/29/15
October is finally coming to an end, and with it, Breast Cancer Awareness Month. Several of my clients did population health outreach campaigns around mammograms and breast cancer screening. It’s rewarding to see that so many patients were reminded of the need to stay on top of preventive health care.
I literally ran across one of these pink carts on my morning jog, with its “Kick Cancer to the Curb” slogan. Definitely an interesting campaign, but I’m wondering how long it will be until a veritable rainbow of carts for other diseases starts to appear. They could probably get some traction with medical offices and shredding services, replacing the standard boring carts with disease-awareness ones.
I’m a big fan of focused population health outreach campaigns, which we used to refer to as “disease of the month” at my practice. With the advent of unquestionably powerful population health applications, it can be overwhelming to start robo-calling or texting patients who are overdue for multiple screening and interventions.
I recommend that my clients gradually work their way into full-scale reminders, selecting first a disease or condition that is either of high prevalence in the community or of key importance to the practice. Once the staff is familiar with managing patients who respond to the outreach messages and can handle the volumes it may bring in, it becomes easier to incrementally add additional outreach campaigns.
I also recommend they put signage in the offices and provide relevant patient education material as well as educating the staff through in-services. That way everyone in the office can assist as patients respond. It’s tempting to fire up multiple campaigns at the same time, but unless your system is sophisticated enough to combine reminders, it can quickly become annoying. Even if the reminders are combined, I’m not sure I would want to be a patient on the receiving end of a laundry list of preventive services being read to me by a disembodied computer voice.
I’ve spent a fair amount of time over the last decade helping practices redesign their offices, not only from a workflow perspective, but also architecturally. Transitioning to an EHR works best with appropriate exam room layouts. Getting rid of the chart room usually frees up space that can be used either for employee engagement or revenue generation.
I’ve worked with quite a few office designers and am always interested in looking at computer carts and other equipment at HIMSS. One of my designer friends shared information on the Beam Virtual Playground, which is a ceiling-mounted projector that creates a “touch screen” on the floor for games. I like the idea, and the fact that it’s germ free is a big plus. I’m always astounded when I see well-chewed books and slobbery toys in medical waiting rooms.
‘Tis the season for vendor user groups, and apparently I’m attending all the wrong ones. This week’s IBM Insight conference featured an exclusive performance by Maroon 5, sponsored by Rocket Software. Talk about a client appreciation event. And for those working the show from the vendor side, not a bad day at the office.
I had a couple of days off this week and spent most of them trying to tame the email monster and complete long-overdue tasks. Thank goodness for being able to work anywhere. As I was hanging out at the car dealer having my oil changed, I got a glimpse behind the scenes at something that resembled a medical chart room. I was surprised since this is a high-tech dealer who appears to do everything electronically from checking you in with the electronic code on your car key to sending email reminders. Apparently they have a dark secret, however. I’m glad that the people who make chart tabs and other filing accessories found another line of business since we don’t need them very much any more in medicine.
I’ve got two conferences to attend in the next three weeks, so it will be good to get things squared away before I go back on the road. The only thing left to do is purchase candy for Saturday night. Thanks to Travel+Leisure magazine for providing these wine pairings for Halloween candy. I’m not sure I agree with some of their selections (Hot Tamales and Riesling, anyone?) but I can definitely get on board with Raisinets and Merlot.
What’s your favorite candy and beverage combination? Email me.
Rep. Tammy Duckworth (D-IL), a former Army helicopter pilot who lost her legs when her Black Hawk took rocket-propelled grenade fire in Iraq, joins several other members of Congress who are fed up that the VA and Department of Defense still haven’t integrated their systems. Lawmakers are reviewing VA-DoD progress in a joint hearing of two House committees this week. Duckworth says that as a former VA employee, she regularly saw the DoD stonewall the VA’s projects in defending its turf. She’s also still mad about her first VA visit where she was asked to take her clothes off to prove that she was still an amputee since the VA wasn’t allowed to accept her DoD medical records, to which she replied to the physician assistant, “I’m not a gecko. They don’t grow back.” Chris Miller, who runs the DoD’s DHMSM project, testified that connecting the VA with DoD is harder than it seems, while the GAO’s IT director observed that her watchdog agency still doesn’t understand why the DoD and VA decided not to build a single system together in the first place. The GAO still wants that answer, but says that neither the VA nor DoD are responding to its inquiries. The GAO suspects that the VA and DoD have spent more than billion dollars in trying and failing to share information, which doesn’t even include the countless mega-billions of taxpayer money that was spent building and supporting their systems.
Speaking of the VA-DoD imbroglio, some members of Congress are convinced that the only way to get the VA and DoD play nicely together is to have the President personally make them. Rep. Dan Benishek (R-MI) says of his peers, “We can’t stand the fact that we’re spending a billion dollars on integrating healthcare and you tell us it can’t be done. We get sick of this.” DHMSM’s Chris Miller says the organizations weren’t ready in 2011 because while the IT part is easy, nobody wanted to address the people and process issues. He opined that interoperability is worse in civilian healthcare, raising the ire of Rep. Gerry Connolly (D-VA), who scolded him by saying that both agencies deal with a specific population but “can’t get their acts together on behalf of the men and women we’re serving.”
Reader Comments
From Don’t Mess with Texas: “Re: vendors pressuring clients. I heard that the day Texas Health Resources issued its press release blaming Epic for its improper treatment of its Ebola patient, Judy and Carl flew to THR that night to pressure the CEO into putting out a retraction, which they did. Epic plays hardball – they’ve done it at our site, too. I don’t blame Epic for being unhappy with the press release, and while veteran CIOs like me knew to take the release with skepticism, flying down in person to get a retraction is pretty heavy handed. I’m sure Epic’s spin is that they care so much for their clients that they wanted to show up in person and offer their help.” That entire process was bungled, although nothing in the THR recap describes a visit by anyone from Epic. THR leadership appears to have thrown Epic under the bus as a knee-jerk reaction without even talking to their own IT folks, who would have been involved with the configuration of the system that was blamed incorrectly (given their quick retraction) for missing their patient’s travel history. Any EHR vendor would have protested and asked for proof of their customer’s claim, although I agree that Epic is among the most vigorous enforcers of its own interests and I’m sure calls were made. THR wasn’t great at managing the Ebola virus, but it was much more aggressive in trying to manage the viral spread of unfavorable publicity.
From Uneasy Detente: “Re: vendor gag clauses. I’ve never seen them pre-loaded into one of my contracts, but I’ve signed a few with a major health IT software vendor as condition of contract settlement, where software doesn’t work and we refuse to go live, for example. The vendor may offer concessions or a refund conditional on signing a number of terms, which generally includes not going out and talking about the problem we’ve discovered. Here’s an example for your eyes only.” I can see why both parties would approve that condition given that they are reaching agreement on either a parting of ways or deciding not to implement a specific application. I’m on the fence about whether that’s a gag clause, but leaning toward no since the customer never actually went live. You would think that customers who did actually implement the application would see and report the same issue, but that’s wishful thinking. That leads us back to the same challenges we have with interoperability – as much as we as patients would like providers to publish and share information that might benefit us, there’s no incentive for those providers to do so and therefore they don’t bother. In fact, going public with software problems introduces the near-certain risk of creating an adversarial relationship with the vendor to which they’ve expensively hitched their wagon. I don’t know of any solution except maybe FDA-type oversight that requires companies to report the patient-endangering defects they discover. Just about any solution that requires providers – competing or otherwise – to voluntarily share information is not likely to succeed. Replace “providers” with “attorneys” or “car dealers” in the previous sentence to put it into a less emotional perspective.
From QM Employee: “Re: NextGen Hospital Solutions. Can anyone explain why QuadraMed acquired it? QuadraMed has not sold their current solution for three years and their product has so many holes (surgery, emergency, scheduling, etc.). There are constant layoffs and some really great employees have left. NextGen customers are in the under-100-bed hospital range and their product is unstable.” The Canada-based parent of QuadraMed (Constellation Software) seems to have broken its own acquisition rules in buying both QuadraMed and NextGen Hospital Solutions since it claims to be interested only in companies that are #1 or #2 in their market, have at least “hundreds” of customers, and face “unimposing” competitors. I can see why QSI wanted rid of its failed hospital business, but agree that it’s puzzling why someone else would want it, although that brings up the strong possibility that it was basically given away just to eliminate distraction and appease torch-wielding QSI shareholders.
From Erstwhile ICD-9er: “Re: Georgia Medicaid’s stance on ICD-10 coding specificity. The CMS leniency was limited to Medicare. Medicaid was given the authority to make the decision for themselves. Georgia is the first to come out with aggressive messaging around their acceptance of ICD-10 specificity. An important distinction is that they related all of their ICD-10 edits for UB claims, but are holding firm on CMS 1500 claims. They have posted notice of this to providers along with a list of codes that will likely be denied. They are accepting feedback from providers about which codes should be accepted.” Thanks for that clarification.
From Kilt Lifter: “Re: ICD-10. Select Health Medicaid in SC refused to do any user testing prior to implementation. They are now telling practices they will not pay any claims until the end of November at the earliest.” The company’s ICD-10 FAQ page brags confidently about their testing, remediation efforts, and overall readiness for October 1.
From Public Health Helpful: “Re: public health. I’m a long-time HIStalk fanboy, but you hit it out of the park with your comment that we ‘irrationally celebrate advancements that are very narrow in scope.’ We should be doing what will benefit the most people in the most significant way – immunizations, blood pressure control, weight loss, cancer screening, following preventive guidelines, and using proven treatments.” The only way to fix “healthcare” is to embrace public health as other countries have done rather than tinkering with how we deliver reactive health-related interventions. We don’t like thinking about that because it requires uncomfortable discussions about social services and the role of government that quickly degrade into political divisiveness. It’s easier and much more profitable to focus on expensive interventions that benefit a small percentage of the population while the far larger population suffers (and drags down economic growth) with chronic conditions whose management standards are well known, just not well practiced by either providers or the patients themselves. We have all the knowledge we need to make the country healthier and therefore more economically competitive, just not the will to use it.
HIStalk Announcements and Requests
I put the $750 raised by Dana Moore’s Epic vs. Centura basketball game to immediate use, applying matching money from my anonymous vendor executive as well as from other charitable organizations to fund these DonorsChoose projects:
A document camera for Mrs. Marler’s third-grade class in Phenix City, AL.
A video camera and accessories for recording advanced placement calculus and physics lessons so that absent students can review them later for Mr. Blachly’s high school class in Indianapolis, IN.
A STEM bundle for Ms. W’s elementary school class in Englewood, NJ.
An iPad Mini to support STEM studies in Mrs. K’s middle school class in Brooklyn, NY.
Four science activity tubs for Mrs. N’s elementary school class in Dothan, AL.
Two tablets for Ms. S’s first grade class in East Haven, CT.
A laptop and accessories for Ms. M’s class of eight emotionally disturbed first grade boys in South Bronx, NY.
Hands-on materials for Ms. M’s advanced placement statistics seniors in Denver, CO.
This week on HIStalk Practice: The wave of physician "Just Say No to Meaningful Use" movements rolls on. American Well digs further into the employer market. AdvantageCare Physicians achieves Stage 6 EHR adoption. ZocDoc and Kareo top the list of US-based deals with Q3 VC funding. A GAO "sting" results in further Healthcare.gov scrutiny. The Interstate Medical Licensure Compact Commission meets for the first time. Maine ups its healthcare price transparency efforts.
This week on HIStalk Connect: the FDA releases its inspection findings from an unannounced visit to Theranos, concluding that their nanotainer technology is an uncleared medical device. IBM Watson will debut on the Apple Watch in 2016 within a patient engagement app being developed by Welltok. Carnegie Mellon University researchers create an app that uses iBeacon technology to provide navigational support for blind users. The team behind the app hopes to add facial recognition features in the coming years. HealthTap launches a suite of new patient engagement apps in a bid to move into the enterprise healthcare space.
Webinars
November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
McKesson announces Q2 earnings: revenue up 10 percent, adjusted EPS $3.31 vs. $2.79, beating Wall Street expectations for both. The company raised guidance and announced an additional $2 billion in share repurchases. Technology Solutions revenue dropped 6 percent, much of that due to “our decision to exit the Horizon hospital software business,” with good performance from payer solutions and RelayHealth.
Theranos continues its fascinating, overly defensive implosion by eliminating seven of its 12 board member positions – including those held by Henry Kissinger and George Shultz – but creating a new board of counselors (which includes all of the old board members) and a medical advisory board. CEO Elizabeth Holmes claims the changes were made in July, although as in the case of the company’s proprietary lab methods, she provides no data to back up that assertion. The company’s new board includes Holmes, her COO, a billionaire who inherited his grandfather’s construction business, a retired general, and a wealthy lawyer who sues big companies. Some speculate that the departed board members wanted to distance themselves from the company and any potential litigation that may result. Meanwhile, Theranos, which has already raised $752 million, authorizes new shares that will value the company at over $10 billion, although that happened right before the critical Wall Street Journal came out.
Leidos reports Q3 results: revenue up 2 percent, adjusted EPS $0.71 vs. $0.65, beating expectations for both.
Sales
Carilion Clinic (VA) chooses Sagacious Consultants, now owned by Accenture, for revenue cycle improvement.
People
Timothy Johnson, DO, MMM (Children’s Mercy Integrated Care Solutions) joins Valence Health as SVP of pediatrics.
Ingenious Med names Scott McClintock (Have Marketing, Will Travel) as chief marketing officer.
Corepoint Health names Dan Simenc (3M HIS) as sales VP.
Announcements and Implementations
Analysis by The Advisory Board Company finds that hospitals are increasingly implementing CDC-recommended antibiotic stewardship programs to reduce inappropriate use, but many of them are too short on staffing and data to be effective. Most organizations have pharmacists rather than the prescriber review orders, most don’t record monitoring overall antibiotic use by prescriber, and few have adequate data to determine whether their programs are improving patient outcomes.
UV Angel announces an ultraviolet-powered patient room IT device disinfection system that automatically runs a cleaning cycle up to 40 times per day when it detects that a targeted device has been used.
Atlantic Medical Imaging (NJ) goes live on patient self-scheduling from OpenDr.
Hackensack University Medical Center (NJ), which self-styles itself with the annoying one-word nonsense of “HackensackUMC,” will integrate Gauss Surgical’s iPad-powered Triton blood loss estimation system with Epic.
Government and Politics
A study finds that the FDA is approving cancer drugs based on short-term patient response rather than their effect on overall survival, with the agency often neglecting to require manufacturers to perform the post-marketing studies that FDA required as a condition of approval. That means many of the most expensive and most important drugs on the market haven’t proven that they actually work, which has been a problem with oncology drugs for decades – drug companies, oncologists, and hospitals make tons of money pumping them into patients with soothing optimism but no guarantee that the patient will live longer or better.
While deaths from overdoses of heroin and prescription narcotics are skyrocketing – the former because addicts are switching from expensive and heavily marketed prescription drugs to cheaper heroin – 80 percent of addicts couldn’t get treatment even if they wanted it because capacity is lacking. I was talking to a first responder the other day who said exactly the same thing – in his tiny, rural town, heroin deaths are common since addicts can buy it on the street for a few dollars per dose vs. the high cost (no pun intended) of oxycodone and other prescription narcotics. The so-called war on drugs has been lost as prisons and morgues fill up and suppliers get even richer as reduced availability drives up prices (a lesson possibly learned from their legal but equally morally challenged pharma counterparts). As usual, these studies are coming from public health experts (Johns Hopkins Bloomberg School of Public Health in this case) since it’s not considered a healthcare or medical issue that provides a business opportunity.
The Department of Justice arrests the former president of drug maker Warner Chilcott, owned by Allergan, for conspiring to pay kickbacks to doctors who prescribed its drugs. The company will also pay $125 million in fines and plead guilty to criminal charges. Meanwhile, Ireland-based Allergan and competitor Pfizer begin merger talks in what would create the world’s biggest drug company with a combined market value of $340 billion, making that $125 million fine look like a valet tip. It would also provide a way for US-based Pfizer to dodge US taxes in declaring the headquarters of the newly created company to be Ireland.
CMS announces that it’s been a quiet October for ICD-10, with the number of claims submitted due to incomplete or invalid information remaining unchanged at 2 percent. The denial rate and percentage of claims rejected due to invalid ICD codes also hasn’t changed much. It a bit early to declare ICD-10 victory, but CMS seems to have defied the naysayers who didn’t believe its optimistic testing status reports.
Other
The AMA and MedStar Health publish their review of EHRs for user-centered design, which instead of looking at actual user usability or testing anything against standards, simply reviewed ONC’s certification test results for use of best practices. The top-scoring products were Allscripts Enterprise, Allscripts Sunrise, McKesson Paragon, McKesson IKnowMed, and Athena Clinicals. Bottom-scoring products are EClinicalWorks Version 1.0, Dr Systems, Greenway PrimeSuite, Epic EpicCare Ambulatory, and NextGen Ambulatory. The analysis used factors such as the vendor’s self-reported UCD process, the involvement of clinicians in testing, and the design of rigorous use cases for testing. It’s a puzzling list when the ancient Meditech Magic finishes one spot behind Cerner in the top 10. I also wonder how meaningful it is to critique user-centered design process by repurposing certification submissions for individual products – you would think a given vendor would use the same design and testing methods for all of their products. The end result will be what it always is in healthcare IT: the top-ranked vendors will brag loudly about the results while glossing over the methodology and applicability, while the low-ranked ones will criticize the methodology and applicability while glossing over the results.
Santosh Mohan, a management fellow at Stanford Health Care and long-time HIStalk reader, sent over this photo if the IT department’s Halloween celebration, in which the three folks above are dressed up as the (a) electronic (b) medical (c) record. I like subtle humor like this because once you get it, you can feel superior in imagining folks who didn’t get the joke.
Meanwhile, PatientSafe Solutions tweeted out this photo of its team. It brings back not-so-fond memories of my hospital’s IT department Halloween celebration, which despite featuring nothing more interesting than pumpkin bowling and orange-iced cupcakes, had to be renamed to the politically correct “fall festival” when a couple of employees complained that it celebrated devil worship.
Weird News Andy cries, “Bring out your dead” as he reads how New York’s health insurance exchange enrolled 354 dead people for health insurance, paying out $325,000 in claims to 230 of them. Design flaws, including people having multiple identification numbers, caused another $3.4 million in overpayments in the program’s first year.
Sponsor Updates
Healthcare Data Solutions publishes a white paper titled “Understanding the Opportunities & Challenges of Telehealth 2015.”
Impact Advisors sponsors an article titled “A Unique Approach to Business Analytics: The Scottsdale Institute Health IT Benchmarking Program.”
Stella Technology and DataMotion will participate in the interoperability showcase at the New Jersey and Delaware Valley HIMSS chapters conference in Atlantic City October 29-30.
InterSystems CEO Terry Ragon is featured in MIT’s Spectrum Magazine.
PDR and Leidos Health will exhibit at the NextGen User Conference November 1-4 in Las Vegas.
LiveProcess will exhibit at the New England Rural Health Round Table November 5-6 in South Bridge, MA.
Wellcentive CEO Tom Zajac will present at the inaugural meeting of The Leader’s Board for Population Health Management November 5 in Dallas.
MedCPU is recognized as one of Entrepreneur’s “Best Entrepreneurial Companies in America.”
Navicure will exhibit at Michigan MGMA October 30 in Mount Pleasant.
Recondo Technology and Sutherland Healthcare Solutions will sell each other’s solutions.
Over 1,000 health and human services leaders attended Netsmart’s Connections 2015 client conference, which featured mental health advocate and former Congressman Patrick J. Kennedy.
NTT Data will exhibit at the 2015 LeadingAge Annual Meeting and Exposition November 1-4 in Boston.
Obix will exhibit at the 14th annual Perinatal Conference November 5 in Dublin, OH.
Epworth Eastern Hospital (Australia) realizes improved outcomes with Oneview interactive patient care technology solutions.
PerfectServe will exhibit at ASN Kidney Week November 3-8 in San Diego.
The SSI Group will exhibit at the Georgia HFMA Fall Institute November 4-6 in Savannah.
Streamline Health will exhibit at the Health IT Leadership Summit November 3 in Atlanta.
Surgical Information Systems will exhibit at HealthAchieve 2015 November 2 in Toronto.
Surescripts will exhibit at the NextGen 2015 user group meeting November 1-4 in Las Vegas.
The Senate passes the Cybersecurity Information Sharing Act, a bill designed to curb cyberattacks by providing US companies legal immunity for sharing protected information with the federal government. CHIME published a statement of support just after the bill cleared the Senate.
AMA publishes findings from its EHR user-centered design study, with McKesson and Allscripts finishing at the top with perfect scores, and Epic falling behind both Cerner and Meditech’s legacy system. AMA evaluated 20 EHRs in the study, choosing a mix of inpatient, ambulatory, current, and legacy systems.
HealthTap launches an all-in-one patient engagement platform designed to help health systems roll out telehealth, secure messaging, online appointment booking, appointment reminders, and a population health analytics system.
The FDA releases the findings from its unannounced inspection of the Theranos laboratory, concluding that the proprietary blood draw container used by Theranos is an “uncleared medical device” that will require a full review.
US investigators conclude that Chinese hackers targeted Anthem to learn how medical coverage is setup in the US, as the country struggles to deliver on a promise of providing universal healthcare to its aging population by 2020.
Walgreens will reportedly acquire Rite Aid for $9.4 billion, offering $9 per share, a 48 percent premium to Rite Aids closing price Monday. The acquisition will also transfer Rite Aid’s $7.4 billion in debt to Walgreens. An announcement is expected as early as Wednesday.
Roper Technologies, the parent company of Sunquest Information Systems, acquires CliniSys Group, a European laboratory information systems vendor, and Atlas Medical, which connects diagnostic testing facilities with patients.
FDA declares the proprietary nanotainer blood draw containers used by Theranos to be an “uncleared medical device” following a Wall Street Journal report that the company had voluntarily already stopped using the finger-stick containers for all but one test. A September FDA inspection of the company’s Alameda, CA facility noted a number of deficiencies, including shipping its nanotainer collection tubes across state lines without having them approved by the FDA; not performing quality audits; and documenting required software validation on a shared Excel worksheet. Meanwhile, Theranos says it will now publish data proving the effectiveness and accuracy of its methods.
Reader Comments
From Prostetnic Vogon Jeltz: “Re: ICD-10. Georgia Medicaid is denying claims that use unspecified ICD-10 codes even though CMS said that wouldn’t happen. When I first see a patient with atrial fibrillation, I might not know whether it is paroxysmal, persistent, or chronic – that’s what the unspecified codes are for. I think this is important for HIStalk readers to know about.” The agency didn’t say it wouldn’t be ready for ICD-10, so it appears to have simply made the decision that it will not conform to CMS’s policies.
From Unbridled: “Re: PatientSafe Solutions. They have parted ways with CEO Joe Condurso.” Joe is still listed as president and CEO on the company’s web page, but an internal email sent my way says he resigned last Friday in a mutual decision and that Chief of Staff Si Luo will take over as president. The company announced last Wednesday that it has acquired readmission technology vendor Vree Health.
From Publius: “Re: VA. I predict the VA will go full Epic, forcing Epic and Cerner to get serious about developing interoperability with each other since DoD will be on Cerner. This will benefit all customers. A Cerner-Epic ROI exchange will be as seamless as Care Everywhere (Epic to Epic ROI module).” Politicians seem to be fretting that since VistA uses old technology (just like Epic), it therefore should be replaced with a commercial product despite the VA’s decades-long satisfaction with its internally developed system. The VA and DoD always seem to find reasons to not work together, so perhaps choosing Epic would prolong the hostilities.
From All-Around Good Guy: “Re: Lee Marley, SVP/CIO, Presbyterian Healthcare Services in Albuquerque. She has left and will be missed. The data center was built and Epic was installed during her tenure.” Unverified.
HIStalk Announcements and Requests
A reader who wishes to remain anonymous donated $250 to my DonorsChoose project, to which I applied double matching (from my anonymous vendor executive and from charitable foundations) to purchase materials for Mrs. Sandler’s elementary school class in Aurora, CO (math games), Mrs. Jones’s K-2 class of intellectually and emotionally disabled students in Galivants Fry, SC (math manipulatives), Ms. Sobczak’s Grade 1-3 class of students with communication disorders in South Holland, IL (math games), and the elementary school class of Mrs. Bowers of Oklahoma City, OK (headphones for online math intervention programs).
I’m regularly puzzled when people email me story links that I covered days before, apparently thinking that because other sites ran the news days later that I missed it. I don’t think I’ve ever missed a significant story, so I can only implore you to read all of HIStalk each time I post news on Tuesday and Thursday nights and over the weekend. Reason: other sites keep repeating the same news over and over trying to get more clicks, while I assume readers are smart enough to only need to see it once and therefore I don’t run repeats. Obviously my logic is incorrect if folks are either skimming or skipping certain posts. My other suggestion is to avoid assuming that just because I can summarize a big story in a few sentences doesn’t mean it’s not important – I don’t pad out the content with a lot of filler.
Who should I interview? Tell me someone who: (a) doesn’t work for a for-profit organization; (b) is smarter than most people; (c) is interesting and opinionated; and (d) I haven’t already interviewed recently. I like to expose fresh viewpoints, but those who possess them don’t always volunteer to be interviewed.
I was thinking that what we need to learn in this country that advancing health for a tiny percentage of the population (via precision medicine, expensive celebrity surgeons and surgical gadgets, and dramatic and expensive interventions) is the wrong goal. Our overall health (and health expense) isn’t driven by new developments for the wealthiest and best informed, but rather how well we can move the public health needle for the most people who are involved alongside the medical experts. Research and new medical technology aren’t needed when we can’t even broadly roll out basic services such as prenatal care, end-of-life counseling, mental health treatment, and addressing the social determinants of health. I worry that we irrationally celebrate advancements that are very narrow in scope and outcomes.
Gag Clauses: I Find No Evidence They Exist
Some of the worst and most sensationalistic healthcare IT reporting I’ve seen (and I’ve seen a ton) involves so-called gag clauses, where IT vendors supposedly insert standard contractual terms that prohibit users from openly discussing patient-endangering software errors. That inflammatory topic, like the Loch Ness monster, has generated a lot of rhetoric (some of it political) despite the lack of proof that gag clauses actually exist.
Take the above hype-filled story, in which the reporter not only provides no examples of the gag clauses he claims to have seen, he completely confuses standard intellectual property (IP) terms — like not being allowed to post source code or product documentation on the Internet — with prohibiting EHR-using providers from speaking publicly about product problems via a non-disparagement clause.
The folks at HIMSS Analytics gave me access to its CapSite Database, which contains actual vendor contracts they obtained using Freedom of Information Act requests. I reviewed dozens of contracts from Epic, Cerner, Meditech, Allscripts, EClinicalWorks, Athenahealth, and several other vendors.
I didn’t see a single clause that prohibits customers from speaking out about software problems. I had previously challenged readers to give me a real-life example of a gag clause and I didn’t receive any there, either.
My experience working for providers is that any pressure to keep quiet about software problems is self-imposed. Health system executives don’t want to jeopardize an expensive implementation or annoy their vendor “partner,” so internal policies require that employees obtain approval before making any public comments or publishing articles. The CIO of one of the health systems I’ve worked for said outright that nobody in the IT department (including clinicians) was allowed to publicly comment on anything without his explicit review and approval (“I’ve been burned by that before”) or they would be subject to termination, which may give you insight as to why I remain anonymous.
Epic has raised the most ire by enforcing the intellectual property provision to include screen shots. Customers can’t publish or share Epic screen images – even those involving customizations of Epic they perform themselves – without approval from Epic. The company’s rationale is that screen design exposes IP, where just seeing what fields are captured provides a lot of insight as to what’s happening under the covers such that a competitor could steal the logic. They give permission to publish the screenshots when that isn’t the case.
That doesn’t prevent users from talking about or describing Epic software problems. It just means they can’t publish screen shots, documentation excerpts, or source code (yes, Epic customers receive source code) to make their point without the company’s permission. I saw nothing to prohibit or even discourage that kind of discussion in any of the contracts I reviewed. Perhaps it is included elsewhere, such as in the particulars of Epic’s support fee rebate program where customers get money back for voluntarily following Epic’s suggestions, but I haven’t seen it or heard of a real-life example. I’ve also not heard of a vendor taking formal action against a provider for making unflattering software comments.
I’ll throw out one more challenge and them I’m calling gag clauses a Snopes-like false rumor spread by misinformed people. If you’ve seen an example of a vendor software contract that includes anything resembling a gag clause that prohibits customers and their users from talking about product or company problems, send it my way anonymously and confidentially. I would also like to hear of examples where a provider has spoken unfavorably about a company or product and was pressured to stop, either from the vendor or from their employer, since I suspect that information pressure is far more common.
Webinars
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Sunquest owner Roper Technologies acquires CliniSys Group and Atlas Medical, which offer laboratory information systems to 2,000 labs in Europe and lab-customer connectivity in the US, respectively.
Walgreens is rumored to be preparing for a Wednesday announcement that it will buy competitor drugstore chain Rite Aid for up to $10 billion and will take on its $7.4 billion debt load. The deal would give Walgreens 17,800 stores worldwide vs. the 7,800 owned by CVS. Walgreens would also gain Rite Aid’s walk-in clinics, wellness stores, and EnvisionRX pharmacy benefits business. Italian-born businessman Stefano Pessina became the CEO and majority shareholder of Walgreens when it acquired his British pharmacy chain Alliance boots Group in 2012, giving the 74-year-old net worth of $14 billion.
Xerox reports Q3 results: revenue down 10 percent, EPS –$0.04 vs. $0.22 following a $385 million write-down after pulling out of two state Medicaid system contracts. The company says it won’t sell itself, but “a comprehensive review of structural options for the company’s portfolio is the right decision at this time.” Above is the one-year share price chart of XRX (blue, down 28 percent) vs. the Dow (red, up 4 percent). Shares dropped 8.3 percent Tuesday to a 52-week low on 13 times average volume.
Lexmark announces Q3 results: revenue down 7 percent, adjusted EPS $0.57 vs. $0.96. The company’s board has authorized “the exploration of strategic alternatives to enhance shareholder value and unlock the intrinsic value created by the company.” Shares dropped 13 percent following Tuesday’s announcement before the market’s open. Above is the one-year share price chart of LXK (blue, down 25 percent) vs. the Dow (red, up 4 percent).
San Francisco-based, 15-employee medical image analysis vendor Enlitic raises $10 million from an Australian diagnostic imaging company.
HCA announces Q3 results: revenue up 6.9 percent, adjusted EPS $1.17 vs. $1.18. The company blames lower profit on patients who were previously insured but stopped paying their Affordable Care Act premiums. The board authorized the repurchase of up to $3 billion of the company’s shares.
Dialysis Clinic (TN) chooses the EClinicalWorks EHR.
UNC Health Care (NC) and UF Health Shands Hospital (FL) choose Lexmark’s vendor-neutral archive.
Catholic Health Initiatives will expand its agreement with Allscripts to include managed services and its FollowMyHealth patient engagement platform. Mineopie reported as a rumor on October 21 that CHI had signed managed service agreements with both Allscripts (outpatient) and Cerner (inpatient). CHI signed a three-year, $200 million infrastructure outsourcing deal with India-based Wipro in March 2013 with little fanfare since except for IT employees complaining on Glassdoor that outsourcing, layoffs, and marginal management has put IT in shambles. The CEO said in 2010 that the organization would spend $1.5 billion on EHRs and other IT systems.
People
Jyotishman Pathak, PhD (Mayo Clinic) is named chief of health informatics at Weill Cornell Medicine.
Announcements and Implementations
IBM releases Datacap Insight Edition, which can classify and route scanned documents using advanced imaging, natural language processing, and machine learning. It provides an unconvincing healthcare example: “Where doctors and hospitals are transferring hand written notes and images into electronic health records for analysis or filing.”
Truman Medical Centers (MO) and Cerner will work together in piloting healthcare IT and giving Cerner employees on-site experience.
Peer60 publishes “Into the Minds of the C-Suite 2015.”
The American Dental Association’s ADA 2015 conference chooses DataMotion to provide Direct Secure Message and secure e-mail solutions as the technology backbone for secure digital exchange demonstrations.
Privacy and Security
In a remarkable statement, an FBI cyberattack expert says the agency often advises people to just pay cybercriminals the demanded money when a PC is infected with ransomware, which locks their computer information until payment is made to release it. He suggests that the malware is so sophisticated that payment is the best option, with the others being to revert to a backup or pay a security expert to try to remove the malware. Knowing that most people never make backups means they’ll pay either way. It’s a bit surprising that people still store their one single copy of valuable data on their local hard drive, which is a problem we’ve always had in hospitals where employees ignore strong suggestions (or policies) to store everything on the shared drive only. You can easily determine those who didn’t by the volume of their whining when they report a problem that requires immediately replacing or re-imaging their laptop or desktop.
Investigators conclude that China-based hackers breached insurer Anthem because the Chinese government is desperate for ideas on how to care for its aging population. Chinese citizens were promised universal access to healthcare by 2020, but they are not satisfied with the cost, quality, and gaps between the rich and the poor. Somehow the hackers missed the fact that the US has failed equally spectacularly on those same issues despite spending many times more than China and everybody else, so perhaps our cyber-retaliation involves hoping they follow our pitiful example.
Celebrity gossip site TMZ says several employees of Sunrise Hospital (NV) have been fired for trying to take photos and look up the medical records of former NBA star and comatose brothel patron Lamar Odom.
Other
A observational study by Massachusetts General Hospital finds that medication errors were made in half of its surgeries, a third of which caused patient harm. The most common errors involved mislabeled drugs, incorrect doses, failing to treat situations indicated by vital signs, and documentation mistakes.
In Australia, the Queensland government will provide an extra $4.2 million to support the Cerner rollout at the newly opened Lady Cilento Children’s Hospital, which has had many planning-related problems since its opening including an IT budget estimated at $29 million now standing at $67 million.
A state audit finds that South Australia’s Cerner Millennium pathology information system implementation skipped project steps and will fall short of money to complete the project, as additional costs for an unplanned disaster recovery center, legacy system decommissioning, and absence of an electronic ordering module are expected to exceed originally estimated costs of $22 million by several million dollars.
UMass Memorial Health Care (MA) will staff its $700 million Epic implementation by moving its 500-employee IT team to downtown Worcester to create room to house the 250 new hires needed. That’s what the local business paper says, although I would bet a lot of those new IT people are assigned there temporarily for the Epic implementation only. A common Epic implementation model is to choose existing IT team members for the Epic project via interviews and scores on Epic-mandated personality tests, hire new people as needed using the same interviews and tests, bring on temporary resources from clinical and administrative departments to provide subject matter expertise, and move everybody to a sequestered location where they won’t be bothered by unrelated IT work. A lot of those folks are borrowed until after go-live, when they return to their home departments. Hospitals usually hire experienced consultants as well to get them through implementation, after which they go away.
I mentioned previously that I had run into problems using Stride Health to look up available health insurance in various parts of the country to see how many plans involve high deductibles (answer: just about all of them). The company quickly responded with a request for details, then let me know that they had fixed the problems, one of which they hadn’t heard of until my report. It’s working great now.
In bizarre irony, the SXSW festival cancels two panel discussions covering the bullying of females in the online gaming industry after it receives threats of on-site violence. Members of Gamergate, whose members claim a lack of game journalism transparency, have threatened gaming industry women, vowing to publish their personal information or to rape or kill them.
Weird News Andy calls this story “You Don’t Know Squat.” A hospitalized woman in labor passes on the nurse’s recommendation that she perform squats to hasten her delivery, instead choosing to dance down the hall to a rap tune.
Sponsor Updates
Medecision will sponsor the HIMSS Summit of the Southeast 2015 October 29-30 in Nashville and HIMSS Big Data and Analytics Forum November 5-6 in Boston.
AirStrip will exhibit at The Health Management Academy’s CMO and CMIO Forums October 28-30 in Deer Valley, Utah.
Bernoulli becomes a sponsoring partner of the AAMI Foundation’s Coalition for Alarm Management Safety and Coalition to Promote Continuous Monitoring for Patients on Opioids.
Bottomline Technologies sponsors the nonprofit Leadership Seacoast for the fourth consecutive year.
Divurgent wins Business of the Year and Executive of the Year awards from the Business Intelligence Group.
EClinicalWorks will exhibit at the 2015 NJPCA Annual Conference October 28-29 in Las Vegas.
Extension Healthcare receives a 2015 Innovation Award in the Technology category from the Greater Fort Wayne Business Weekly.
FormFast will host a virtual user group meeting November 3 and 4.
HCS will exhibit at the LeadingAge 2015 Annual Meeting November 1-4 in Boston.
HDS will exhibit at Summit of the Southeast 2015 October 28 in Nashville.
Healthcare Growth Partners advises Lavender & Wyatt Systems on its sale to Netsmart.
Zynx Healthcare SVP of Mobile Strategy Siva Subramanian, PhD will participate as a panelist at Partners HealthCare’s Connected Health Symposium October 29-30 in Boston.
Burwood Group becomes one of the first Citrix Solution Advisors to complete three Citrix specializations in virtualization, networking, and mobility.
CitiusTech will exhibit at the NAHC Annual Meeting 2015 October 28-30 in Nashville.
Researchers at Massachusetts General Hospital analyze records from 277 operations and observed that 124 of the operations included at least one medication error, one-third of which resulted in harm to patients.
Truman Medical Center (MO) expands its partnership with Cerner, a fellow Kansas City organization. Under the new partnership, Truman’s IT staff will become Cerner employees and TMC will provide Cerner with a nearby “living lab” to research new solutions.
In preparation for its Epic implementation, UMass Memorial Health Care (MA) will relocate its 250 employee IT staff to a new 94,000 square foot office space in Worcester, MA that will provide enough room to expand the department to 500 people.
With the goal of expanding the number of meetings and conferences we report on, Mr. H is sending me to the AMIA Annual Symposium this year. I’ll be reporting on the activities each day. I’m looking forward to it as I haven’t attended previously. I’m also eager to log some hours towards Maintenance of Certification (MOC) for my Clinical Informatics board certification.
I’m not the only one looking forward to getting the continuing education credits. The AMIA listserv for the Clinical Informatics Community of Practice (CICOP) has been hopping with quite a few complaints about the whole MOC process for those of us in this new specialty. With the first cohort passing their exams in the fall of 2013, we’re decently into the first part of our 10-year recertification cycle. Those of us certified through the American Board of Preventive Medicine (the American Board of Pathology also certifies) are required to obtain a certain number of ABPM Lifelong Learning and Self-Assessment (LLSA) hours every three years in addition to regular continuing education hours.
Most of the current LLSA-approved continuing education offerings are within ABPM’s longer-standing subspecialties such as Aerospace Medicine, Occupational Medicine, General Preventive Medicine, and Undersea/Hyperbaric Medicine. The number of courses for clinical informatics are few and far between and typically involve on-site courses. AMIA has completed the process to offer LLSA hours for the fall meeting, and for those of us unable to get hours over the previous two years, it’s a huge help.
When I initially decided to try to become part of the first class of board certified clinical informaticists, I really didn’t think about what it would be like to maintain certification with two different board organizations. The American Board of Family Medicine already requires me to do 150 hours of CME each year, of which a certain percentage has to meet specified criteria. Certification by the AMA or the American Academy of Family Physicians are two of the criteria that count. Finding AMA- or AAFP-approved CME is easy. It’s everywhere, and can be earned not only through face-to-face symposia but also by reading journal articles and taking CME quizzes or doing online coursework.
We’re one of the first specialties that required Maintenance of Certification. Although the policies are a little tedious, they’re well documented and pretty straightforward. With Clinical Informatics being relatively new (coupled with the fact that many of us in the first two certification cohorts are, shall we say, fairly Type-A personalities) there’s a lot of tension around MOC. In addition to the LLSA credit, we’re also supposed to complete a “patient safety module” which is somewhat ill-defined (although ABPM did offer a link to a discounted course from the National Patient Safety Foundation that they’ll accept). A friend of mine got his university course approved as well, but the rest of us may not have that option.
I’m grateful that the Board has agreed to recognize some of the MOC (called Part IV) activities that physicians are already performing for their primary board certification. The current Clinical Informatics subspecialty certification requires physicians to maintain full certification in another American Board of Medical Specialties sanctioned discipline so it seems only fair, especially considering that the Board has yet to come out with a recognized clinical informatics module. I have to admit that the process to have my Family Medicine credits recognized was fairly straightforward, although it did require printing and completing a paper form and emailing it to the Board.
One of the respondents on the AMIA email thread mentioned that as a specialty deeply involved in computer-based projects, we should be at the forefront for virtual and online courses. Unfortunately one of the major challenges is completing the paperwork from the board to have your course recognized, which I hear is not exactly straightforward. I don’t know if there are fees involved with submitting a course offering, but that could be a de-motivator for some providers of continuing education credit.
There aren’t any well-known online providers for the kind of credit we need. Although some of our colleagues in academic settings are going to try to get their local courses certified, that doesn’t help those of us who are in parts of the country where we’re thinly populated. I’m one of two certified informaticists in my metropolitan area of over three million people, and I’m sure there are others even more sparsely arranged than we are.
One of the AMIA representatives mentioned being in contact with the Board and that we’re going to get an extension on some of the initial deadlines, but as a diplomate of the Board, I haven’t received that communication directly from them nor has it been posted on their website or in any other print media that I’m aware of. It’s understandably frustrating then for those of us who don’t want to fall behind but are somewhat stuck about what we need to do to be successful.
We’ll gather at AMIA, though, and see what kind of credits we can rack up and whether they’ll be enough to get us through the first checkpoint at the end of Year Three of our certifications. Hopefully some virtual offerings will be approved soon, or at least some recordings for those of us who aren’t willing or able to spend several thousand dollars (not to mention the time out of practice) to attend a conference in person.
It’s exhilarating to be on the cutting edge of things, but like being in the health information technology industry, it can also be frustrating and at times downright exhausting. I’m hoping that attending AMIA and networking with others in the field will help recharge some of my depleted energy and give me ideas for future projects. If nothing else it’s an excuse to visit San Francisco, which I’ve never done in the fall.
I noticed that the patient's bill in this case included a $12,000 charge for just showing up. I wonder how…