Morning Headlines 10/2/15

Alexander to Administration: 5 Reasons to Take More Time Before Making Final the Stage 3 Rule for the Electronic Health Records Program

Senator Lamar Alexander (R- TN), chairman of the Senate’s HELP Committee, continues with his efforts to delay the implementation of MU3 by publishing a list of five key reasons for the proposed delay, adding “there is broad and bipartisan interest in seeing the administration take its time to get this done right.”

Profit Heaven: UNC Hospitals quadruple operating income in 2015

UNC Hospitals (NC) reports an operating income of $115 million, quadrupling its 2014 figure. The system credits added beds and its Epic implementation for the financial turnaround.

Medical software boom: eClinicalWorks buys third Westboro building for $21.1M

Massachusetts-based practice management vendor eClinicalWorks buys a 192,000 square-foot office building as it makes plans to add 1,000 employees to its workforce.

Morning Headlines 10/1/15

Electronic Health Records: Nonfederal Efforts to Help Achieve Health Information Interoperability

A GAO report on EHR interoperability concludes that the five major barriers to improved interoperability are cost, inadequate data standards, variation in state privacy rules, poor patient record matching technology, and a lack of trust between sharing entities.

2015 Industry Drill-Down Report – Healthcare

A Raytheon-Websense security report finds that cyberattacks on healthcare entities surged 600 percent in 2014 and the industry now experiences 340 percent more security attacks than the average industry. Researchers explain, “Criminals often move to the easiest targets, and with retail and banking becoming more secure, healthcare networks became a prime target.”

MedAssets to cut 5% of workforce in cost-cutting move

MedAssets, an Alpharetta, GA-based healthcare performance improvement company, will lay off 180 full time employees, or five percent of its total workforce, by the end of 2015.

HealthTap Launches Compass, A Revolutionary New Personal Healthcare Application That Will Give Employees of Flex the Ability to ‘Tap In’ to Intelligent, Efficient World-Class Healthcare 24/7

Online consumer health startup HealthTap announces plans to move into the employer wellness market with an app that offers telehealth consults, treatment planning, and patient reminders.

Morning Headlines 9/30/15

Senate Committee Chairmen Urge Administration to Immediately Adopt Stage Two Modifications for Electronic Health Records Program, Make Rules for Stage Three Final No Sooner Than 2017

Senators John Thune (R-SD) and Lamar Alexander (R-TN), along with a 116-member bipartisan group of representatives, ask the administration to immediately adopt MU2 modifications that would introduce a 90-day reporting period for 2015 and scales back patient engagement metrics.

Thousands of ‘directly hackable’ hospital devices exposed online

White-hat hackers Scott Erven and Mark Collao find thousands of medical devices that are exposed online and vulnerable to attack. At one large, multi-facility health system, the team discovered “21 anesthesia, 488 cardiology, 67 nuclear medical, and 133 infusion systems, 31 pacemakers, 97 MRI scanners, and 323 picture archiving and communications gear.”

OCR Should Strengthen Its Followup of Breaches of Patient Health Information Reported by Covered Entities

An HHS OIG report recommends that the Office of Civil Rights collect breach reports on all data breaches, instead of just just large ones. The report also recommends improved tracking of corrective actions and prior breaches.

Study casts doubt on computer-aided mammograms

A  study of computer-assisted mammogram analysis finds that computers do not find more tumors than radiologists, despite costing $400 million annually and being used to screen 90 percent of all mammograms processed annually.

News 9/30/15

Top News

Three patients sue DC-area MedStar Georgetown University Hospital and George Washington University Hospital after being charged hundreds to thousands of dollars to obtain electronic copies of their medical records. MedStar Georgetown’s release of information contractor HealthPort charged two patients $1,168 and $1,558 respectively, itemized as per-page copying fees, a basic fee, and shipping.

The lawsuit claims that HealthPort refused to provide the records electronically except via its portal, which also requires paying per-page fees as well as a membership fee for storing the information. The second patient’s bill grew to $2,500 after paying a variety of per-page and handling fees. The patients are seeking class action status for their lawsuits, claiming that DC law requires offering records in an electronic format without fees other than for any labor involved in copying.

Reader Comments

From Tittering CIO: “Re: grammar. I saw this image and thought of you.” I call myself a Grammar Nazi. but I’m probably not since I wouldn’t correct someone directly in conversation or email – there’s no excuse for that kind of pedantic rudeness. However, I like calling out widespread misuse, perhaps subconsciously hoping someone else will do the dirty work of operationalizing my broad statements (and risk getting their own nose punched).

From Liszt Composer: “Re: blog list. You made a best blog list. You would make more of those lists if you didn’t write HIStalk anonymously – think about it.” I honestly don’t follow those lists of recommended blogs or most Twitter influence. It’s nice to know someone recognized HIStalk (most likely to publicize their own site, which is the usually the point) but winning or not winning changes nothing about what I do. I actually like being left out of most of those lists since it motivates me to be more caustic and irreverent as an underdog. Staying anonymous means that as a nobody, I can’t get too full of myself, can’t show up at every major conference to strut around as a self-anointed thought leader, and can’t be influenced by people or companies trying to gain something. My job is to sit in front of an empty screen each day and spend a lot of hours filling it up with whatever interests me for anyone who cares to read it. I don’t need or want personal attention for doing so. We have plenty of healthcare IT limelight hoggers already.

HIStalk Announcements and Requests

Thanks to the folks at Phynd for upgrading their sponsorship to Platinum. They just released a free ebook titled “The Benefits of a Unified Provider Management Platform.”

If you’re an HIStalk, HIStalk Practice, or HIStalk Connect sponsor exhibiting at MGMA, complete this form and we’ll include your company in our attendee guide. Jenn will be attending, so you can expect regular updates on HIStalk Practice.

Reader MC contributed $100 to my DonorsChoose project, which funded $405 worth of teacher project grants thanks to matching funds from my anonymous vendor CEO and other sources. That money bought 25 sets of headphones for Mr. Weightman’s elementary school class in Indianapolis, IN and 25 calculators for the elementary school math classes of Ms. McCarthy in Brockton, MA. Meanwhile, middle school student Luis from San Diego sent a thank you letter for the two Amazon Fire tablets we provided to his class. He says,

These tablets proved to be very useful in helping me learn and and also improving my grade in classes such as math. Thanks to these tablets, I was able to go from a very low F to a high F and eventually passed the class. This allowed me to attend my promotion ceremony, which makes me extremely grateful for your donation. It also helped me learn and stay up to date with new lessons in class. Thanks to that I am now ready for the next grade.

Webinars

October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.

Contact Lorre for webinar services.

Acquisitions, Funding, Business, and Stock

Israel-based drug manufacturer Teva will acquire Gecko Health Innovations, a Cambridge, MA-based smart inhaler hardware and software vendor. The company had reported $2.1 million in funding, although $2 million of that was in debt financing and none was more recent than two years ago.

Sales

Nebraska Methodist Health System (NE) chooses Lexmark Accounts Payable Automation.

Boston Children’s Hospital (MA) will use VitalHealth Software’s QuestLink for measuring the outcomes of children treated for cleft lip and palate.

WCA Hospital (NY) chooses Imprivata Confirm ID, integrated with Cerner Soarian, for electronic prescribing of controlled substances.

People

University Hospitals (OH) promotes Charlotte Wray to president of UH Elyria Medical Center. She was previously VP of clinical operations and information systems and chief clinical officer/CIO.

Bayhealth (DE) names Rick Mohnk (UMass Memorial Health Care) as VP/CIO.

Viewics hires Eleanor Herriman, MD, MBA (Bloomberg BNA) as CMIO.

Monadnock Community Hospital (NH) hires Peter Johnson (Dartmouth Hitchcock Medical Center) as interim CIO. He replaces Nancy Barisano, who retired two weeks after a failed upgrade that crippled the hospital for four days.

Announcements and Implementations

Intelligent Medical Objects offers a free trial of IMO Anywhere, an iOS or Android app that allows clinicians to document from any location with ICD-10 drill-down capability and 460,000 terms.

Nuance announces Dragon Medical Advisor, computer-assisted physician documentation for ICD-10.

An Emory University study that used Glytec’s Glucommander IV glycemic control system finds that treating type 2 diabetics undergoing CABG surgery with intensive insulin therapy reduces post-surgical complications.

Navicure offers its clients free access to ICD-10 transition tools that include online correction of rejected claims, expanded claim tracking, and ICD-10 to ICD-9 mapping for any payers that turn out to be unprepared for the change.

Government and Politics

Massachusetts General Hospital (MA) will pay $2.3 million to settle federal drug diversion charges following its 2013 disclosure to the DEA that two of its nurses had stolen 16,000 doses of oral narcotics, mostly oxycodone, by removing them from the hospital’s automated dispensing machines. MGH’s corrective action plan requires it to hire a full-time drug diversion compliance officer, to install biometric security on its automated dispensing machines, and to implement controlled substance surveillance software. Technology-specific issues were that the pharmacy system’s drug count didn’t match the contents of the dispensing machines, drugs could be withdrawn for patients up to three days after their discharge, employees could remove drugs from the dispensing machines for up to two minutes before being locked out, and pharmacy employees did not monitor dispensing machine overrides.

An HHS OIG investigation of Medicare-paid ambulance rides in 2012 finds that $30 million worth of them apparently resulted in no medical treatment, some urban ambulance services billed the government for trips averaging 100 miles vs. the average of 10 miles, and at least 20 percent of ambulance companies billed questionable trips. Medicare paid $5.8 billion for ambulance trips in 2012. The OIG suggests that Medicare require more documentation from ambulance companies and tell its billing contractors to stop paying claims quickly if they don’t meet basic requirements. Weird News Andy suggested the photo above.

Senators John Thune (R-SD) and Lamar Alexander (R-TN) of the Senate’s HELP Committee ask the administration to immediately delay implementation of Meaningful Use Stage 2 to at least January 1, 2017 and then phase in Stage 3 based on provider readiness. They join a 116-member bipartisan group asking for the same delay.

An HHS OIG report recommends that OCR record information on all data breaches – not just large ones – in its database and that it do a better job following up on and documenting corrective action.

Privacy and Security

Security researchers find thousands of Internet-exposed medical devices, 68,000 of them owned by an unnamed health system. The researchers also created fake MRI and defibrillator honeypots that attracted 55,000 successful logins, 299 malware insertion payloads, and 24 remote code execution exploits. They note that many of the devices are not configured correctly for security and that medical devices are often running Windows XP without antivirus protection. Above is a sample search I ran on Internet of Things search engine Shodan showing ports and services used by a Kentucky hospital.

A California dermatology practice notifies patients that its document scanner was inadvertently exposing their records on the Internet.

Innovation and Research

A study finds that computer-aided detection of breast cancer that costs hundreds of millions of dollars per year doesn’t perform any better than radiologists examining the images manually. Insurance companies pay an extra $20 per exam for using the technology, while Medicare pays $7. The CEO of one of the two companies that sells the technology says clinical literature supports its value and the FDA has approved its safety and benefits.

Technology

The Wall Street Journal notes the growth of telemedicine-like programs offered by healthcare chaplains, with the HealthCare Chaplaincy Network offering free online chats with individuals or paid services to hospitals who want to expand their offerings for the growing number of patients who have limited inpatient stays.

Other

A Peer60 report finds that speech recognition in radiology, cardiology, pathology, and in EHRs is being used by 20 percent of survey respondents, while another 27 percent plan to use it in the next 1-2 years and 30 percent more are considering it. Nuance has 90 percent of the market share but only 60 percent of the mind share across all departments, which the report suggests means they have done a good job but are vulnerable to losing market share to MModal and Dolbey. Cardiology has only an 8 percent adoption rate (mostly because of integration issues) and its users are least likely to recommend their current vendor, making it a high priority market for speech recognition vendors.

More than half of respondents to a Surescripts survey say their doctor doesn’t have their complete, accurate medical history during their visit. Around two-thirds say they’re OK with doctor using computers or tablets during their visit and half wish their doctor would communicate by email. Around half also say they would demonstrate more loyalty to a practice that lets them fill out forms online ahead of time, review lab tests online, store their medical records electronically, and schedule appointments online. The average doctor’s visit lasts 15 minutes, of which 11 minutes is wasted in filling out paperwork and reciting the medical history.

PBS covers Air Louisville, a project in which asthmatics use “smart” inhalers with Propeller Health’s sensor attached to contribute to a database that matches the severity of their symptoms to their GPS-reported locations at the time, helping the city understand how poor air quality affects the 13 percent of its residents with asthma.

OHSU informatics professor Bill Hersh, MD worries about the future of clinical informatics board certification, offering these points:

• Clinical informatics is a subspecialty, so those who earn board certification must also maintain their primary medical specialty certification even though they may spend all of their time working in an informatics role. Those informaticians who don’t have board certification are not eligible for the clinical informatics board certification at all.
• Once the grandfathering period ends in 2018, the only way to earn informatics certification will be by taking a two-year fellowship, which isn’t practical for physicians who enter the field mid-career.
• Based on these rules, a real-life student who will complete an MD/PhD in 2016 and then will finish residency sometime after 2018 will not be eligible to take the clinical informatics board exam despite holding a PhD in biomedical informatics.

The San Diego paper describes the city’s attempts to redirect frequent 911 callers from EDs to detox facilities, profiling its most frequent flyer, a homeless, wheelchair-bound alcoholic who has called 911 for a ride to the ED 242 times in three years, consuming $573,000 worth of medical care. The city provides paramedics with iPads that track 911 calls in real time, providing medical and social histories for frequent users. It is also creating a grant-funded Community Information Exchange that involves paramedics, case workers, a homeless support group, and the police department, but no hospitals have signed up. Hospitals are, however, supporting housing and coordinated care for the frequent 911 callers in an effort to reduce readmissions.

Sponsor Updates

• AirStrip CEO Alan Portela discusses the future of digital health on CNBC’s Squawk Alley.
• Craneware will host its Financial Performance Summit in Las Vegas October 20-22, which will emphasize the value cycle.
• Aprima Medical Software will exhibit at the Texas Pediatric Society annual meeting October 1-2 in Sugarland.
• Billian’s HealthData interviews David Sindelar, CEO, St. Anthony’s Medical Center.
• Caradigm will exhibit at the iHT2 Health IT Summit October 6-7 in Chicago.
• CompuGroup Medical will exhibit at the Symposium for Clinical Laboratories October 7-10 in Las Vegas.
• Cumberland Consulting Group will exhibit at the MDRP Annual Summit September 30-October 2 in Chicago.
• Divurgent will exhibit at the AEHiX 15 Fall Forum October 7 in Orlando.
• EClinicalWorks will exhibit at the 2015 KHIE EHealth Summit September 30 in Bowling Green, KY.
• HCS will exhibit at the AHCA/NCAL Annual Convention & Expo October 4-7 in San Antonio.
• Healthwise will exhibit at the HIMSS Public Policy Summit October 7-8 in Washington, D.C.
• Holon Solutions will exhibit at the NRHA Critical Access Conference September 30-October 2 in Kansas City, MO.

Blog Posts

• Strategies to enhance your scheduling process, steps 4-5 (AdvancedMD)
• Awarepoint Launches New Website (Awarepoint)
• State-by-State Impact of Readmissions Penalties for 2016 (Besler Consulting)
• Podcast: Deploying medical device integration within med-surg care units (CapsuleTech)
• Why Secure Texting Isn’t Enough (PatientSafe Solutions)
• How to Quit Your Job Gracefully (Direct Consulting Associates)
• Bulletproofing Your Finances against ICD-10 (Greenway Health)
• 4 Tips for Successful Project Closure, Why It’s a Crucial Step Between Go-Live and Optimization (Hayes Management Consulting)
• McKesson Horizon – Which Way Now? (The HCI Group)
• Understanding Female Physicians (Healthcare Data Solutions)
• Software piggybacks on electronic medical records, saves time (Healthfinch)

HIStalk sponsors exhibiting at the AAFP FMX Annual Meeting September 29-October 3 in Denver:

• Aprima Medical Software
• CareSync
• CoverMyMeds
• E-ClinicalWorks
• Elsevier
• E-MDs
• Greenway Health
• Ingenious Med
• NextGen
• Quest Diagnostics
• Surescripts
• Wolters Kluwer

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 9/29/15

Patients file lawsuit against two D.C. hospitals alleging excessive fees to obtain medical records

Georgetown University Hospital and George Washington University Hospital are named in a class action lawsuit for failing to provide electronic copies of medical records when requested and instead charging patients $1,000 or more in processing fees for paper copies of their records.

A better way to treat cancer

Brian Druker, MD, director of the Knight Cancer Institute at OHSU and 2009 recipient of the Lasker Award, publishes a piece on the impact that genetic sequencing and precision medicine is having on cancer treatments.

Census Estimates Show Progress Toward ACA Coverage Goals — But There Is More To Be Done

Health Affairs analyzes a recent Census Bureau report confirming an 8.5 percent drop in the USuninsured population, concluding that the gains were driven largely by subsidies and Medicaid expansions introduces within the Affordable Care Act.

Dow Industrials Sink 313 Points

The DJIA falls 1.9 percent Monday, due partly to healthcare and biotechnology stocks dropping as Congress and presidential hopefuls discuss Valeant Pharmaceuticals and controlling drug price gouging. The Nasdaq Biotechnology Index dropped six percent, erasing gains for the year.   

Curbside Consult with Dr. Jayne 9/28/15

There was a fair amount of buzz around my recent Curbside Consult on Theranos and its CEO, Elizabeth Holmes. Most of the comments and emails agreed with the need to question the company and its approach.

Thanks for putting a little reality into the mix. Like many in the healthcare field, I’ve been shocked at the money and attention being given to them. A couple of facts: the actual blood draw is a fairly involved and still painful procedure involving a “trained pricker” who prepares the finger for a few minutes with warm towels before sticking you to get the blood out. Personally I find finger sticks more painful than traditional blood draws. Sites still need trained people and it still takes 5-15 minutes per patient. Not very efficient. As for timing, the results don’t come back immediately and I believe it takes 15, 30, or more minutes. Most patients will be long gone anyway, so how is that much different from sending to a lab and getting them back the next day? I’m not sure “point of care” labs are hugely valuable for the typical primary care physician as the results are not immediate, and even if they were, they would only make sense if the patient got labs before the visit.

The reader goes on to agree that the industry is ripe for disruption, but that we need a couple of evolutions first. We need non-invasive testing that can be done almost instantly, as well as tests that are so cheap every patient will be able to come to the office to have them done immediately before seeing the physician. Maybe they’ll be able to do them at home or on a regular basis. He thinks maybe Theranos will evolve to that or maybe some quicker, cheaper company will come along. Another possibility is computerized algorithms that clarify what needs to be ordered and how to understand the results and explain them to patients.

There were also anecdotal stories about the risk of ordering labs without a clear indication.

I am a medical technologist, moving over to IT after having spent over a decade in the reference lab industry. I agree with your statements regarding interpretation of test results. My pregnancies were after age 35 and I chose to have an amniocentesis. A physician inadvertently ordered an AFP test during my second pregnancy. I didn’t know it was ordered, but found out it was elevated after a negative amnio. If I had received the results without the context of the amnio, it would have led to a great amount of stress. I fully support technology to lower costs in our healthcare system and consumer-friendly strategies to expand access and experience for patients as purchasers, but frankly don’t get the buzz around Theranos. Coordination around the right test for the patient at the right time with the right engagement of the patient makes sense. If the patient can get the order fulfilled easily and at a low cost with communication to their care team, than I am interested.

I have also been on the receiving end of tests ordered without my knowledge. Even as a physician, the results were stressful because there wasn’t a clear indication and I was confused as to what the ordering physician suspected. We’ve come a long way from the paternalistic “doctor knows best” days and I fully agree tests should be ordered with patient understanding and consent.

Additionally, physicians should explain why they’re ordering a test and what they hope to do with the results. In addition to justifying the medical necessity, this can get the patient thinking about the potential outcomes and what we might do with the information we get back. Several wise medical school professors beat the fact into my head that you should never order a test unless you’re ready to do something with the result. Unfortunately, I see a lot of tests ordered for no good reason. Some of these orders are influenced by our reimbursement system, which makes it easier and cheaper to order a bundle of tests than the individual tests that one actually needs. Medicare is guilty of supporting, this but I don’t think it’s ever going to change.

Some readers took issue with my assessment: 

Traditionally, physicians have purposely kept patients in the dark in regards to what their lab tests mean. Even today, physicians routinely send “normal cards” to their patients without any explanation as to what the real values are or how to interpret. As healthcare requires increased patient engagement and increased participation in their care, it is imperative that all providers either teach or provide educational materials to start the educational process on what lab tests mean. That would be to understand normal variants, normal abnormal for the patient, etc.

I wholeheartedly agree. Most of the major health organizations in my area did away with “normal cards” for patients more than a decade ago, along with the antiquated notion of “no news is good news.” Our patients have been getting copies of their labs since 2008 or 2009 and most of the time they have physician annotations, unless the labs result on a weekend when the office is closed, in which case they should receive a communication on Monday. At my former employer, physician bonuses helped drive this behavior.

It sounds like this reader is also advocating that we all have a role in promoting health literacy. Dr. Wu commented on this topic, saying,

Health literacy is, as you may agree, embedded in the archaic public health concept of health promotion, which is still rooted in a pre-Internet, paternalistic medical model approach… Perhaps Ms. Holmes’s analogy is ironically correct — a weapon can be used for good (crime prevention) or bad, and how it is used, intent, and training are variables. Giving patients unfettered access to their medical data without context, training in a usable format, accompanied by an actionable plan is like handing a loaded weapon to a random person on the street. Oh yeah, we allow that.

I disagree that the concept of health promotion is archaic or paternalistic. Although it may not apply to all specialties, most family physicians who have trained in the last three decades have been schooled in health promotion as a shared interest between the patient and their care team. Health literacy is an essential part of health promotion and should be all of our responsibilities, whether we’re part of the public health infrastructure or not. As I mentioned above, physicians that order tests without explaining the risks and benefits to a patient are part of the problem.

Reader Long Time, First Time also disagrees:

Is this what passes for critical thinking in the doctor’s lounge? I doubt Theranos or Ms. Holmes has any more obligation to educate patients than your profession does. After centuries of privilege, your profession seems to take little accountability for the ignorance of your “real world patients,” as you like to call us sheep. You seem to think like the clerical elites that one resisted translating the Bible from Latin into the vernacular. In fact, I bet some of these same arguments are used in Saudi Arabia to keep women from driving cars. First they must understand fuel injection before they can drive… So in order to be acceptable, Elizabeth Holmes must first succeed where your professional has failed. I will posit that your professional elite never tried to educate us. This is a false and unattainable standard you are applying to Theranos. The Pot has once again called the Kettle black. I do not know if Elizabeth Holmes is the next PT Barnum of the next Steve Jobs. I do doubt she has any obligation to educate me, either in a moral or legal sense.

I didn’t say she had an obligation to educate patients, rather my hope that she would champion health literacy so that the average person could truly be empowered to take charge of his or her own health. Theranos and Elizabeth Holmes are receiving a tremendous amount of attention these days and could use that to the further advantage of patients across the country. I also hoped she’d find greater connection with the people she’s trying to serve, as I agree with many that her isolation isn’t good for her (or the company) in the long term.

I take issue with your point about making people understand fuel injection before they can drive. Keep in mind we don’t just let anyone drive in this country either – one has to be of a certain age and has to have passed both a written and skills test to do so legally. They may not need to understand fuel injection, but they do need to know the difference between the gas and the brake so that no one gets hurt.

Although I know that many physicians don’t have the time or the skills to truly engage with their patients, there are tens of thousands of us that do so on a regular basis. We do take it personally when our patients have difficulty understanding their health issues, and if we can’t get the job done, we’re not afraid to leverage other members of the care team. I certainly don’t have “centuries of privilege” behind me and was trained in several programs that kept the patient at the center of the care team.

There’s no litmus test that requires Theranos to atone for the sins of other professions, but one would hope they could use the spotlight currently shining on them to do more to help people understand exactly what it is they’re offering and how it could be of benefit. I do, however, think there should be a litmus test for companies that sell products that could be potentially harmful. If we have to put a disclaimer on a set of lawn darts, then we should probably have some protections around patients ordering tests whose results could lead to harm. Most physicians who have had to work up something like a false positive CEA (cancer antigen) test would probably have stories to share about the harm something like that can do and the unneeded fear, pain, and costs associated.

A couple of other readers made similar points that I agree with. From Not From Monterey:

Honestly, and this isn’t a cop-out, I believe that both you and the Theranos lady are correct. It is right to have people (or put differently, consumers) be allowed to buy tests on their own and it is also correct that many, many people in our fair nation would have no idea how to interpret the results of those tests. I think Elizabeth Holmes’s target customers are not the 50+ percent of our nation that are working poor or lower middle class. She’s targeting the young and well-educated who are doing pretty well but would love to get more information about their health. I know plenty of people who are not smart enough to understand the basics of lab test results, and that number of people might at times even include myself. But I also know lots of very smart people who can use Google, compare information across authoritative sites, and ask for advice. The second group is the bunch that Holmes will be targeting. I can’t pretend that this direct model, taking physicians out of the loop, won’t create confusion or misinformation. But it might also help some people. Some people.

I think you’re spot on. As a physician, though, I am morally obligated to serve all types of patients, not just those with the resources or education to manage tests on their own (and I’ve seen plenty of really smart people, including physicians, get in trouble managing things beyond their expertise). I’m happy to support greater engagement to those patients with the desire to be engaged whether they have the financial or educational resources to do so.

I’ll close with one reader’s personal Theranos story from Engaged Patient:

Just read your article on Theranos. I use to be in awe of this upstart who went up against Quest and Labcorp. But that impression changed when I got my own test done there. I have a severe family history of diabetes and had a wake-up call with a hemoglobin A1c of 6.0. I became an avid runner and ate well for three years. August 2015 was my next turn to see what improvements I brought to my health. Theranos did a complete venous draw (traditional test tube) on me, not the much-advertised finger prick. The result came back 6.0 and my PCP advised getting it done with a local reference lab. Their result was 5.4. If three years of sincere lifestyle changes had not moved my A1c lower, I was contemplating medication in the near future.

My issue with Theranos is that they don’t make it explicit to patients that not all their tests are FDA certified. They get undue press attention for the one-drop capillary draw – lots of marketing done for that. But the truth is that they, too require venous blood in huge amounts. How the heck does FDA/CLIA let unverified tests be out there for public consumption? I find Theranos to be dishonest and deceptive. I think we (health IT enthusiasts) are sometimes so deep in our MU/HIE/EHR world that these small, dangerous twists in the mass market go unnoticed. I shudder to think what would happen if a non-health-IT person would use Theranos to make health decisions.

I’m not the expert on laboratory regulation except where it is involved in how results are ordered and rendered in EHRs, so I’ll have to rely on readers to comment on the latter points. But the example brings up another wrinkle, which is that sometimes it’s important to make sure serial tests are being done by reference labs using the same or at least comparable methodologies. Different reference ranges can also cloud results even for tests that are supposedly “standardized.” I once counseled a patient who was in tears about his lab results, which were essentially identical. However, one facility reported them in nanograms (10) and the other in picograms (10,000) making it appear to be a dramatic change.

I don’t claim to have all the answers. If the comments are any reflection, none of us really do. The only constant is change and it will be interesting to look back at Theranos in three, five, or 10 years and see what they accomplished.

What do you want to accomplish in 10 years? Email me.

Email Dr. Jayne.

Readers Write: HIEs Deliver the Promise of mHealth

HIEs Deliver the Promise of mHealth
By Stuart Hochron, MD, JD

The successful transition from fee-for-service to value-based care will require a high degree of coordination and the sharing of real-time health information among physicians and patients. This article describes how quality and cost incentives are encouraging payers and providers to leverage the information contained within health information exchanges (HIEs) to empower providers and patients.

Patient outcomes improve when timely personal health information (PHI) is shared with and among providers and their patients. Reducing preventable hospital readmissions is an example of the power of this information. As a result of recent successes in the acute care and post-discharge environment, payers and physicians responsible for the care of populations across multiple EHRs are seeking ways to (a) avoid treatment delays and improve care quality by sharing PHI among clinicians, and (b) engage and empower patients. Mobile communications that engage physicians and patients and deliver relevant clinical information can help healthcare organizations coordinate quality care, manage cost, and satisfy physicians and patients.

Until recently, providers seeking PHI from multiple EHRs were required to access and navigate secure HIE websites using personal computers or mobile devices. Web access has generally been less than a user-friendly experience. The fact that many HIE websites are not mobile enabled and rarely push data to user-friendly mobile apps has further limited physician-HIE engagement. Today, however, mobile technology has given rise to an increasing number of user-friendly mobile apps that integrate with HIEs and push the type of information that physicians and patients find most useful.

All sectors involved in value-based care can benefit from mobile delivery of HIE data. Government benefits when the transition to value-based care is facilitated. Payers benefit by more efficiently coordinating care, containing cost, and facilitating quality and member satisfaction. HIEs benefit by expanding their services. Physicians benefit from easy access to critical information and from financial incentives that derive from effective value-based care. Patients benefit from greater security that results from knowing when and why their PHI is being accessed and by whom.

The following case studies represent mobile HIE initiatives that add value in different ways.

Case 1 – Patient Status Notifications to ACO Physicians

An ACO managed by a hospital system is implementing an automated status notification system for primary care physicians. It provides ACO physicians with the opportunity to participate at an early stage in the care of patients presenting to emergency departments or who are hospitalized. In the absence of such information, treating physicians are deprived of the opportunity to discuss details of the patient’s medical history with the patient’s primary care physician. This lack of communication can to lead to otherwise preventable hospital admissions, over-prescribing of diagnostic studies, iatrogenic complications, lower patient satisfaction, poorer outcomes, and increased cost.

Automated patient status notification takes advantage of hospital-HIE data connections, whereby PHI is uploaded in real time to the HIE when a patient presents to a regional emergency department or hospital. ACO-participating physicians are identified by the ACO and HIE using unique numeric codes.

When a patient is registered by an emergency department or is admitted to a hospital, the HIE identifies the patient as part of the ACO, reconciles the physician identifiers, and feeds pre-selected PHI to the patient’s ACO physician(s). This information includes the patient’s name, DOB, diagnoses, emergency facility location and contact information, and the time of ED registration and/or admission. The message is delivered from the HIE to physicians via an HL7 or sFTP (secure fie transfer protocol) data feed that reaches the mobile vender’s server through a VPN (virtual private network).

In this case, all physicians credentialed by the ACO’s hospital are required to participate in the hospital’s mobile communication platform. The time interval between ED registration or admission and ACO physician mobile notification is measured in seconds. Armed with this information, ACO physicians are able to the share key patient information with treating physicians at remote facilities.

Case 2 – Fraud-Protecting Payers and Patients Using HIE Status Notifications

An HIE seeking to expand the scope of its services is developing a mobile patient app that will fraud-protect state Medicaid and its beneficiaries and engage patients. Fraud-protecting Medicaid beneficiaries has the potential to reduce state and federal government annual losses related to fraud. Engaging patients has the potential to improve outcomes, control cost, and improve patient satisfaction. The system will use the HIE’s mobile patient app to authenticate patients and notify patients in real time when a healthcare facility or provider adds, accesses, or requests access to PHI. Patient access to this information requires a paper-based application and considerable time and thus is rarely requested.

Medicaid patients will self-authenticate using the HIE’s secure mobile app. After downloading the app from either the Google Play store or Apple App Store, patients will register by answering a few simple questions including their name, date of birth, and state of residence. The mobile app will connect to Equifax, the HIE’s consumer credit reporting agency, which will ask patients up to five personal financial questions. Questions can be related to a patient’s cable television bill and other commonly purchased product products and services, which broadens the potential applicability of the authentication process. Once authenticated, the patient’s app is activated and protected by a PIN. Patients can present their activated mobile HIE app when accessing Medicaid services at pharmacies, hospitals, and other facilities to document their identity.

Each Medicaid beneficiary has a unique Medicaid and HIE identifier. When a request by a provider for access to a patient’s health record is received by the HIE or when PHI is added, the HIE will store this information, identify the patient as a Medicaid beneficiary, reconcile the patient’s Medicaid and HIE identifiers, and feed pre-formatted notifications specific to each type of status change to the patient’s mobile app. Examples of patient notifications include 

• Radiology results have been delivered to your physician’s office.
• Laboratory results have been delivered to your physician’s office.
• An admission-discharge-transfer summary from a hospital has been delivered through your HIE.

The patient app will also provide patients with relevant health and insurance information and connect patients to network providers and services.

HIEs, like electronic health records in hospitals and physicians’ offices, are repositories of large amounts of PHI. The goal of realizing value from collecting and storing such data is directly related to how quickly and easily relevant PHI is shared with providers and patients. Relevant PHI that is delivered in real time to engaged physicians and patients has the greatest potential to improve outcomes, control cost, and increase physician and patient satisfaction.

Using HIEs to deliver PHI-related information instantly in user-friendly ways to physicians’ and patients’ mobile devices is delivering on mHealth’s promise of adding value through innovation.

Stuart Hochron, MD, JD is co-founder and chief medical officer of Practice Unite of Newark, NJ.

Morning Headlines 9/28/15

‘Trust but verify’ – five approaches to ensure safe medical apps

Researchers at the Imperial College London find that mobile health apps consistently fail to deliver evidence-based clinical recommendations, while most also fail to meet basic data security standards, such as encrypting personal health information that is being transmitted over the Internet.

A Medical Detective Story: Why Doctors Make Diagnostic Errors

In a Wall Street Journal interview, Hardeep Singh, MD and chief of health policy, quality, and informatics at the Houston VA Medical Center, discusses diagnostic errors and the potential roles and roadblocks that electronic diagnostic tools will face in care delivery.

Iowa’s mental health bed-tracking database ‘not useful’ so far, hospitals say

In Iowa, a $15,000 bed-tracking system implemented to help rural hospitals find available inpatient mental health beds across the state is not working out as planned because the 29 facilities with psychiatric beds are not updating the system with availability information.

WEDI and National Association for Trusted Exchange (NATE) Announce Partnership

The Workgroup for Electronic Data Interchange (WEDI) will partner with the National Association for Trusted Exchange to continue work on WEDI’s Virtual Clipboard initiative, a project aimed at establishing industry standards for automating the patient check-in process.

Monday Morning Update 9/28/15

Top News

A study in England finds that NHS-endorsed medical apps often implement security and privacy poorly, give users bad advice, and have no track record of improving outcomes. Nine of 10 dose calculators don’t check the information entered by users, 70 percent don’t state their formulas, and half of the developers didn’t respond to questions about how their systems performed their calculations. The authors of a BMC Medicine article recommend educating consumers about how to evaluate apps. They also urge developers to be more transparent by providing documentation covering their design and testing methods, privacy policies, and business model. All of that, they say, is better than government regulation of apps as medical devices. It concludes,

The potential for benefit remains vast and the degree of innovation is inspiring, but it turns out we are much earlier in the maturation phase of medical apps than many of us would like to have believe. To build the future we want, in which patients can trust their medical apps, we need to verify that they function as intended.

Reader Comments

From Huskydoc: “Re: Epic. For many years, I’ve been practicing in Epic-based organizations. I’m now in a system that doesn’t. I was anticipating some minor, primarily aesthetic differences in the functionality between Epic and my new EMR… actually looking forward to the experience. But I must say that I was stunned by the inadequacies of my new EMR – a recognized brand name EMR that’s not Cerner. And I’m talking simple stuff, people. I now understand that Epic’s competitors’ boasts of interoperability are really just cries for help.”

HIStalk Announcements and Requests

Only five percent of poll respondents view a company name change as a positive event, with more than 40 percent assuming that the company replaced its old name to distance it from past failures. Unrequited Marketer offered some great thoughts: (a) companies that have grown by acquisition often want their product lines to seem cohesive via consistent naming; (b) research has shown that there’s not much brand equity in B2B product names anyway; (c) many or most people keep using the old product name even after it’s been changed; and (d) he or she doesn’t know of any cases where a company changed a company or product name because of past failures and asks readers for examples. New poll to your right or here as the first in a series of polls I’ll call “Hero or Villain” – is Blue Cross Blue Shield a hero or villain? You can click the Comments link after voting to explain why you think so.

Dennis Lee donated $100 to my DonorsChoose project, which along with matching funds from my anonymous vendor executive and the NEA foundation bought 15 flash drives and six sets of headphones for Mrs. Winger’s fourth grade class in Seattle, WA and math learning tools (plan sets, Base 10 starter sets, and GeoBoards) for Ms. Fulford’s elementary school class in Santa Ana, CA. Meanwhile, it took only five days for Ms. Thomas’s Georgia elementary school class to receive their iPad and bean bag chair to create their Math Exploration Station, leading her to email to say, “It takes one moment to make an incredible impact on a child and you are responsible for this ‘one’ moment! I am so excited to see how this project will support my students in acquiring the independence needed to be successful! Your dedication to children and providing educational opportunities like this one is unmatched!”

Also checking in was Mrs. Wilson from Wisconsin, who sent photos of her students using the listening center we provided.

I’m just full of grammar and usage peeves being a “you kids get off my lawn” kind of curmudgeon in training, but here’s another one: people who spell “desert” when they mean “dessert.” It’s probably because the words are pronounced the same when “desert” is used as a verb, but that’s not a great excuse. If you ate desert, expect an undesirable consequence like sands through the hourglass. One more: the phrase “the Internet is buzzing” in a news story means two things: (a) they should give numbers to back up that conclusion; and (b) it’s probably not a real news story if its main attribute is that a large number of Facebook and YouTube zombies have mindlessly clicked on it.

A friend is taking care of a relative in hospice care, which involves three kinds of caregivers (nurse, aide, and social worker.) Each of them called to schedule their first visits with the usual over-explaining and chattiness that is well intentioned but a bit grating in a hospice situation. All three had the same conversation with my friend:

• Caregiver: I’ll need turn-by-turn directions to get to your house. Can you give them to me now?
• Friend: It’s quite a few miles with several turns. Can’t you use the GPS that came on your phone? I’m standing in line at Walmart buying medical items.
• Caregiver: (without answering the GPS question) We need printed directions for the folder.
• Friend: OK, then I’ll get on MapQuest myself, copy and paste the instructions from wherever you’ll be starting, and email them to you when I get back home.
• Caregiver: Well, if you don’t have time to give me exact directions, I can figure it out.

It’s been years since someone asked me for directions to my house, and to be honest, I might be inclined not to hire them if they can’t figure out how to use free phone GPS apps instead of bugging every customer to spell out streets, distances, and turn directions that the free app would do much better (not to mention preventing them from crashing their car while trying to read and drive at the same time). The folks above make their living going to the homes of patients, so you would think they could fast-forward to the current decade where personal directions, AAA TripTiks, and gas station maps are all enjoying their much-deserved retirement.

Last Week’s Most Interesting News

• The GAO says CMS seems to have prepared well for the ICD-10 switch, but cautions that all software projects carry risks that can’t be identified until after go-live.
• Accenture acquires Epic-focused Sagacious Consultants.
• Blue Cross Blue Shield announces its Axis claims and quality database, to which all 36 BCBS companies will submit data.
• An IOM report on diagnosis recommends that ONC require health IT systems to support information flow across care settings.
• The medical information of millions of people is found to be publicly available on Amazon Web Services, apparently from unsecured SQL backups stored there by claims management vendor Systema Software.
• An updated report from Robert Wood Johnson Foundation finds that ONC made mistakes in managing its siloed grant programs and that EHR adoption digitized information only within “corporate islands” that were created by ever-expanding health systems as a way to improve their competitive position.

Webinars

October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.

Contact Lorre for webinar services.

Acquisitions, Funding, Business, and Stock

Medical image exchange platform vendor LifeImage receives a $5 million investment from the investment arm of BCBS Massachusetts, raising its total to $62 million.

Announcements and Implementations

WEDI (Workgroup for Electronic Data Interchange) and NATE (National Association for Trusted Exchange) will work together on the next phase of Virtual Clipboard, a mobile app that would speed up patient check-in by transferring their demographic, insurance, and clinical summary information to the provider’s system.

Government and Politics

Three Alaska healthcare providers sue a Xerox subsidiary for causing delayed payments from the state’s new Medicaid system, claiming that Xerox lied about the system’s readiness for its October 1, 2013 go-live.

Other

We should all be grateful to hedge fund manager turned pharma bro Martin Shkreli of Turing Pharmaceuticals for exhibiting an astounding amount of greed, arrogance, and patient indifference by buying an old but vital single-source drug and jacking up its price by 5,000 percent. He’s a cartoonish bad boy who helped everybody finally realize how drug companies have been given capitalistic free rein in charging whatever they want while hiding the research costs they blame for their high prices, all while the pharma lobby successfully deleted planned price controls from the Affordable Care Act and US citizens pay dozens or hundreds of times the price the rest of the world enjoys as a result of our drug development subsidy. The soothing suits from the big drug companies have been coached to feign patient concern and a willingness to participate constructively in healthcare system dialog while Shkreli just told everyone unapologetically that he fully intends to make a lot of money and too bad if they didn’t like it. He’s exactly what we needed to bring the drug pricing issue to light in a way that even dim-witted citizens can get mad about. Healthcare is full of companies and people who try to make everybody forget that they’re in it for the cash and it’s refreshing for someone to finally say so, leaving the rest of us to decide what if anything we do about the system we built that allows it.

Eastern Iowa hospitals say a state-run database for locating available mental health beds isn’t useful because the psychiatric hospitals aren’t updating it with their available bed count.

Informatics and health policy expert Hardeep Singh, MD, MPH says common medical conditions such as UTI and CHF that are most often misdiagnosed, with the most common cause being the provider’s lack of time to conduct a thorough patient interview and then perform critical thinking. Doctors with a poor diagnostic track record are overconfident in failing to consult external resources. He shows modest hope for electronic diagnosis tools, saying they require complete patient data and doctors don’t use them for situations they think are routine. He says that nobody follows up on eight percent of abnormal lab tests, suggesting that electronic escalation could help and patients could take more responsibility in checking their own results on patient portals.

Sponsor Updates

• Divurgent will host a cybersecurity dinner discussion during the AEHiX conference in Orlando on October 8, with guest speaker Sensato CEO John Gomez.
• The SSI Group will exhibit at the 2015 SurgCenter Development Annual Conference September 27-28 in Clearwater Beach, FL.
• Sunquest Information Systems is featured in a JAMA article on connecting healthcare data.
• Nordic posts video highlights from its open house during Epic’s user group meeting. It was brilliant – they worked with a local brewery to create a custom beer, distributed it to 14 bars and restaurants, and donated $1 for every pint poured to The Road Home Program for veterans. I was trying to figure out ways to shamelessly steal their idea for the HIMSS conference. 
• Surescripts will exhibit at the AAFP Family Medicine Experience October 1-3 in Denver.
• TeleTracking’s annual users conference will feature a record number of health system presenters and innovative new products.
• Valence Health will exhibit at the NASHCO Annual Conference 2015 September 27-29 in Denver.
• Verisk Health will host the VHC2015 client conference September 30-October 2 in Orlando.
• VitalHealth Software will exhibit at Transform, hosted by the Mayo Clinic Center for Innovation, September 30-October 2 in Rochester, MN.
• Huron Consulting will exhibit at the Rural Health Clinic and Critical Access Hospital Conferences September 29-30 in Kansas City, MO.
• Wellsoft Corp. will exhibit at Emergency Nursing 2015 September 28-October 3 in Orlando.
• Zynx Health will exhibit at the Meditech on the Road Event September 30 in Toronto.
• XG Health Solutions Chairman Glenn D. Steele Jr. takes part in the opening of Geisinger’s new laboratory medicine building.

Blog Posts

• Look Who’s Coming to VUE15! (Voalte)
• 5 Ways to Lessen the Impact of ICD-10 (Streamline Health)
• AHIMA 2015 Convention: T-System’s Jeannie Ruch leads two sessions you won’t want to miss! (T-System)
• Your Peers Think You Should Go the VUE – Here’s Why (Versus Technology)
• Think the New Medical Codes Don’t Impact You? Think Again (Xerox)
• Top 5 Tips as Providers Transition to ICD-10 (ZirMed)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 9/25/15

CMS Has Updated Systems and Supported Stakeholders’ Efforts to Use New Codes

The CMS GAO publishes a report on its investigation of the preparations made by CMS ahead of the ICD-10 transition, concluding that the agency will not truly know how prepared it is until it starts processing claims.

The breakdown of costs of Addenbrooke’s Hospital’s £200m Epic IT system

The Cambridge University Hospitals NHS Foundation Trust has been put on special measures “after over-spending an average of £1.2m a week, in part due to its new online patient-record system, which has been fraught with problems.”

OPM says 5.6 million fingerprints stolen in cyberattack, five times as many as previously thought

The Office of Personnel Management reports that 5.6 million fingerprints were stolen in its recent data breach, updating its original estimate of 1.1 million by more than five times.

News 9/25/15

Top News

A GAO report says CMS has done everything right in preparing for the ICD-10 switchover next week, but al software changes are likely to have unplanned problems and nobody will really know how well CMS did until it starts processing ICD-10 codes. CMS spent $116 million to update its claims processing systems, with last year’s one-year delay adding to the cost as CMS had to put the ICD-9 logic back in place after the unexpected decision. Problems or not, to get GAO’s blessing for following complex government procedures is impressive.

Reader Comments

From Meditech Customer: “Re: Meaningful Use. I’m seeking input from health systems that have undergone a system conversion during attestation. How have you handled the need to have data from the old and the new system available if you changed vendors?” Comments are welcome.

From Tuna Piano: “Re: Epic. I left the company four years ago. The only safe place to comment is from the sidelines. Epic will go after folks who speak ill of them. I know of at least one instance where Epic said they would withdraw from an RFP unless providers who were speaking ill of them stopped. Epic offers a great EMR and is a leader in so many ways, but there is no need to fear fair discourse or interoperability.” Unverified. If true, the most amazing aspect is that Epic’s threat to pull out of an RFP scares prospects so much they’ll squelch their own people. What kind of prospective vendor has that amount of clout?

From CD: “Re: McKesson. I heard they’re doing work with CRM/case management vendor Pegasystems. Could be a future acquisition?”

From Proud Yankee: “Re: Cerner. Interoperability may have gotten them the DoD bid.” The HIMSS-owned publication’s justification of its conclusion (published on July 30, the day the DoD bid was announced) is pathetic, citing a bunch of unrelated facts such as Cerner’s membership in CommonWell, its participation in DirectTrust, and an unsubstantiated claim that the market “perceives” that Cerner is more open than Epic. No evidence was provided that the DoD even considered interoperability as a reason to choose Leidos (and thus its partner Cerner). That may or may not have been the case, but it’s still just time-wasting speculative filler from the cheap sets as to why DoD chose the Leidos bid package and which EHR characteristics they valued since none of us really know. The reporter’s need to fill space is not necessarily congruent with the reader’s desire to get only concise, useful information.

HIStalk Announcements and Requests

My latest grammar and use peeve: saying “build out” instead of just “build,” which is admirable in trying to make something conceptual seem more concrete by using a construction term, but is still superfluous and therefore annoying. I’m also increasingly peeved when “spend” is replaced with “invest” to editorialize an expense into the financing of a wise decision. It also really bugs me that people (loosers?) who confuse “loose” with “lose” and say something like “I loose my cool.”

Mrs. Henson says her Arkansas second graders are using the wireless microphone photo booth setup we provider via DonorsChoose to create YouTube videos about what they’ve learned, using a green screen setup to add photos to the produced video. She says, “When a six-year-old has the courage to stand up in front of a small crowd of people and talk using a microphone, then I have created a future leader, or at least a very confident adult.” Another teacher borrows it to create news and events broadcasts that are played throughout the building.

I was thinking about the glut of worthless information contained in the typical patient’s medical record. It would be interesting if the patient and each person who cares for them could electronically flag individual data elements or snips of text as important, taking away the noise caused by capture of pointless click boxes and data points. It would also give the patient a voice in letting caregivers know which items they think are most relevant. Our old problem was that we collected too little data electronically. Our new problem is that we collect too much that isn’t relevant and fail to highlight the important parts.

This week on HIStalk Practice: ONC goes into overdrive, releasing the Federal Health IT Strategic Plan 2015-2020, the latest round of EHR adoption statistics (primary care leads the way), and a consumer-centric paper on telemedicine. Medical students see the need for interoperability, but aren’t big believers in telemedicine for initial encounters. The Wounded Warrior Project teams with Brain Injury Services of Southwest Virginia to offer telemedicine to vets. Janet Munro offers telemedicine implementation best practices. Whoop launches an "elite" wearable wristband with round-the-clock analytics. Harrington Family Health Center finds success with tablets. Frank Fortner discusses portals, mobile devices, and patient engagement.

Webinars

October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.

Contact Lorre for webinar services.

Acquisitions, Funding, Business, and Stock

Accenture acquires Sagacious Consultants, adding its 250 mostly Epic-focused employees into its EHR practice.

Revenue cycle services vendor MedData acquires Alegis Revenue Group of The Woodlands, TX, which offers eligibility and enrollment solutions.

Sales

Allegheny Health Network (PA) chooses Visage Imaging’s Visage 7 Enterprise Imaging Platform for primary diagnosis and clinical image distribution among its eight hospitals and 2,800 physicians.

The Central Virginia Health Services FQHC chooses the eClinicalWorks EHR for its 70 providers.

People

Stephanie Fraser (CHIME) joins Amendola Communications as senior media relations and social media director.

Voalte names Sean Friel (Siemens Healthcare) as VP of sales and marketing.

Stanford Health Care President and CEO Amir Dan Rubin resigns to take an EVP job with UnitedHealth Group’s Optum. 

Announcements and Implementations

The FHIR team publishes its second DSTU (draft standards for trial use) that includes a simplified RESTful API, extended search and versioning, definition of a terminology service, and broader functionality. This is the final specification before FHIR is published as a standard in 2017. 

Leidos donates another $40,000 to Georgia Tech’s Interoperability and Integration Innovation Lab, this time to fund a pilot data analytics platform.

Smilow Cancer Hospital at Yale-New Haven (CT) will implement telepharmacy at Lawrence + Memorial Hospital (CT), where centrally located oncology pharmacists oversee chemotherapy dose preparation, advise physicians, and counsel patients using digital imaging, audio, and video connectivity. The hospital announce a few weeks ago that it will join YNHHS  and implement Epic.

Riverside Medical Center (IL) will implement Epic, planning to go live December 31 for its 325 inpatient beds at a cost of $35 million.

Blue Cross Blue Shield Association announces that all of its 36 BCBS companies will contribute their quality and cost information to BCBS Axis, which will include information on one-third of Americans. Employers will be able to compare cost and outcomes and consumers will have access to provider and procedure information. 

Government and Politics

Congress may allow the VA to transfer $625 million from its budget to complete a scaled-back version of its half-built Denver hospital, which is $1 billion over budget.

Privacy and Security

The federal government’s Office of Personnel Management says that 5.6 million fingerprint profiles were stolen in its June 2015 breach, five times the number it originally reported. That’s an interesting shortcoming of biometrics – unlike a credit card number or password, users can’t simply swap them out once they’ve been compromised. Here’s a question for experts – what could a hacker do with the fingerprint profiles without having the fingerprints themselves? My understanding is that’s what stored is a mathematical model of the fingerprint pattern, which doesn’t seem like it could be used directly to mimic biometric ID. Meanwhile, the government has awarded a contract worth at least $133 million to provide identity theft services to the 21.5 million people whose information was exposed and expects to pay another $500 million for post-breach services.

HP will add Department of Defense-developed malware-blocking firmware to its LaserJet Enterprise printers.

Innovation and Research

Two Australia-based physicians will sell their CliniCloud kit — a smartphone-powered digital stethoscope and no-contact thermometer – in US Best Buy stores starting in November. The planned retail price is $149.

Technology

In England, the Leeds City Council hosts an NHS-funded open source healthcare project called Ripple, directed by a physician who was a chief clinical information officer at the Leeds Teaching Hospital. The Integrated Digital Care Record assembles information from NHS systems into a dashboard (via an integration engine) and offers online appointment scheduling.

A Forbes article says that deflationary economics (reduced spending) will create startup opportunities in healthcare as it did for efficient online startups such as Amazon, where incumbent healthcare providers locked into a high-cost, poor-service, high-practitioner burnout model are vulnerable to lower-cost startups. It cites a study concluding that only 20 percent of health outcomes are driven by clinical care (“with a few exceptions, hospitalizations represent a failure to extinguish a medical ‘fire’ when it’s small.”) I don’t necessarily disagree, but I would observe that it’s naive to assume that big health systems, insurance companies, pharma, and medical equipment vendors will simply bow to better, cheaper competitors without first unleashing their extensive financial and legislative influence to protect their fiefdoms. The real determinant is the consumer, who despite being characterized as being fed up with the healthcare systems, seems grateful to have access to it even with its obvious faults.

Processed food vendor Nestle moves into higher-margin healthcare products in announcing that it will co-develop an Alzheimer’s disease diagnostic test with a Swiss biotech company.

Other

Need a good example of hammy, click-baiting headlines and irrelevant photos? This one takes a dry study and turns it into a comic book just like most of the reader-desperate health IT sites do in sounding like the old Batman show (Pow! Bam! Thwack!)

@JennHIStalk noticed this article describing the 18 bizarre domain names bought by Kaiser Permanente, all variations of HowKaiserKilledMyKid.com. They are registered to MarkMonitor, a Thomson Reuters company that protects brands from being hijacked.

This could be interesting for healthcare. A startup creates a payment collections app that sends payment reminders, rewards customers for paying their bills on time, and the ability to request payment plan changes electronically after losing a job or bearing unexpected expenses.

In the UK, Computing magazine digs into the Epic project costs for Cambridge University Hospitals NHS Foundation Trust, which was just put into “special measures” for incurring host of financial, clinical and Epic-related problems. The project will cost $300 million over 10 years, of which Epic will be paid $91 million and the rest is IT infrastructure. Beyond that, the systems Epic replaced will remain in place at an annual cost of $15 million until their information can be migrated to Epic.

A note to vendors: your “how to prepare for ICD-10” articles are too late. It’s here and there’s no time left to start training, analyze the most commonly used codes, or arrange loans in case receivables get hung up.

Sponsor Updates

• Hayes Management Consulting and Liaison Healthcare will exhibit at the 2015 Fall CHUG Conference October 1 in New York City.
• Holon Solutions will exhibit at the NRHA Critical Access Conference September 30-October 2 in Kansas City, MO.
• Ingenious Med CMO Steven Liu, MD is featured in The Atlanta Journal-Constitution.
• InterSystems will exhibit at the iHT2 Health IT Summit September 29-30 in New York City.
• Crossings Healthcare Solutions will exhibit at the Cerner Health Conference October 10-14 and the NJ/Delaware Valley Regional HIMSS meeting October 28-30.
• LiveProcess will exhibit at the California Hospital Association’s Disaster Planning for California Hospitals Conference September 28-30 in Sacramento.
• First Databank posts a video in which VP Dewey Howell, MD, PhD talks about the design and usability of its MedsTracker electronic medication reconciliation solution.
• Talksoft Outreach 3.0 earns ONC-HIT 2014 Edition Modular Certification.
• NVoq will exhibit at the RBMA Fall Education Conference September 27 in Austin.
• PerfectServe will exhibit at the Maryland MGMA State Conference September 25 in Baltimore.
• PeriGen offers a new white paper, “The Physiology of the Fetal Heart Rate Control.”

Blog Posts

• ECW Podcast: Exploring Community Health Centers, Part 1 (EClinicalWorks)
• First, Do No Harm – Balancing Health Tech with Patient Safety Obligations (Extension Healthcare)\
• You converted to a new EHR mid-year … now what? (Galen Healthcare Solutions)
• Interoperability: Benefits Brought to Life in Portland (Greenway Health)
• The Business Case for Patient Engagement: Efficiency for the Medicare Patient (Healthwise)
• Checking Your Practice’s Pulse: Using Accessible Analytics to Gauge and Improve Financial Health (Navicure)
• BYOD – What Devices Do Users Prefer? (Oneview Healthcare)
• The Importance of Integrating Clinical Data into Payer Organizations (Orion Health)
• Going Beyond Interoperability (PatientSafe Solutions)
• VMworld 2015 in Review – Demystifying Trends to Solve Customer Problems (PDS)
• Sustainability Metrics to Improve Your Bottom Line (Lexmark)
• Secure communication of clinical information is the name of the game (Phynd Technologies)
• PMD Makes More than Just Doctors Happy (PMD)
• Deaconess Hospital Trains Thousands on Unique Workflows and Scales Back (Sagacious Consultants)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

EPtalk by Dr. Jayne 9/24/15

We’re just under a week until ICD-10 hits and I’m starting to hear about some potential issues. One of my colleagues received an email from his vendor informing him that although he had taken all required patches and performed all necessary steps, he needs to take another small patch. Needless to say he’s not amused and I don’t blame him. As one of the few independent small practices left in the community, it’s not like he has a full IT staff that he can just hand it off.

I’ll be glad to stop receiving daily emails about ICD-10, especially the ones from CMS including these questionable graphics. Although the cardiology and orthopedics ones make sense, I’m puzzled why family practice is represented by the Star of Life, which traditionally represents ambulance and emergency medical services. If you look carefully, there are two snakes on the staff, making it the staff of the god Hermes rather than the Rod of Asclepius. Wikipedia has a great summary of the “one snake or two” controversy, including some ironic points, if you’re looking for a diversion. At least we’re not represented by an unfortunately stylized uterus or a sad-appearing bear, so I shouldn’t complain.

It will be interesting to see if we have a government shutdown competing with ICD-10 for attention. Regardless, the work of ONC rolls on. Public comments are being accepted on a draft of the 2016 Interoperability Standards Advisory. The comment period is open through November 6. The Advisory includes not only recommendations from the HIT Standards Committee, but also feedback from public comments on the 2015 Advisory.

Primary care physicians are nowhere near the top of the physician salary list, so they’re often concerned about the cost of delivering new models of care. Although they will receive higher payments if they can demonstrate greater quality, it often requires hiring more staff to implement programs to move the quality needle well before the first payment increase arrives. One of my former partners forwarded a Medscape article that lists the cost of maintaining a Patient Centered Medical Home practice at over $100K per physician per year. This represents the extra staffing needed for increased quality reporting, patient outreach, and care management.

The data comes from a University of Utah study that looked at 20 primary care practices across Utah and Colorado. The data assumed a patient panel of 2,000 patients with an incremental cost per member per month of about $4. Physician leaders are using the information to help spur payment reform, including requests for upfront payments to transform practices and train staff. The study looked at practices that were already high functioning with EHRs in place. For less-advanced practices, the cost of PCMH will be even higher.

I’m extremely happy to report that I have delivered my last scheduled ICD-10 training session. I left a few days open for last-minute stragglers, but it doesn’t look like I’m going to have any takers. I’m glad for a couple of days without client engagements so that I can recover from the last six weeks. I can only describe them as a slog. I plan to catch up on Netflix (“Call the Midwife,” Season 4 is beckoning) and rest as much as possible. I’m sure next week will bring some emergency consultations and I want to be ahead on my beauty rest.

It won’t be all fun and games, though. I’ll be attending Monday’s FDA/CDC/NLM Workshop on “Promoting Semantic Interoperability of Laboratory Data.” I’m looking forward to the scheduled panel discussion on LOINC adoption. Although all the EHR vendors I work with support LOINC result codes, I’ve struggled with several reference lab vendors who fail to deliver the codes with results. Even the large national reference labs seem to struggle with this and I’ve had to push some regional lab representatives to deliver what my clients need. It shouldn’t be this hard. There’s also an open public comment section, but comments had to be submitted in advance, so I don’t expect much drama.

I wanted to be a physician since I was small. Thinking back on a career in medicine that morphed into one in informatics, sometimes I’m still surprised by some of the things I end up discussing in casual conversations. LOINC codes are one of those things. I stumbled into a lab normalization project at my health system that led to a clinical repository project that morphed into a standardized order project. After beating my head against the wall with disparate lab systems as they gradually came together, I really became a fan of LOINC and it’s something I enjoy working with.

I have a client who insists on pronouncing it “Low-Ink.” The first couple of times they said it, I had trouble connecting the dots to figure out what they were talking about. While I was cruising the LOINC website the other day, I came across this page confirming it really does rhyme with “oink” and also that the pig is the “unofficial official mascot” of LOINC.

Have you worked with a vendor or a technology that has a mascot? Email me.

Email Dr. Jayne.

Morning Headlines 9/24/15

Accenture Adds Distinctive Electronic Health Record Consulting Capabilities with Acquisition of Sagacious Consultants

As reported by HIStalk readers yesterday, Accenture acquires Sagacious Consultants for an undisclosed sum.

GE Healthcare Announces $300 Million Commitment to Support Emerging Market Health

GE Healthcare, the $18 billion healthcare technology division of GE, announces the creation of a new business unit that will focus on bringing low cost, high impact health technology solutions to Africa and parts of Asia.

Interoperability Tops ‘To-Do’ List According to Medical Students

Athenahealth publishes findings from its annual Epocrates Future Physicians of America survey, which finds that 96 percent of medical students believe that improving EHR interoperability is important to patient care, while 87 percent support the creation of a universal patient record.

Why Cleveland Clinic Shares Its Outcomes Data with the World

Michael Kattan, PhD and the chair of the quantitative health sciences department at the Cleveland Clinic’s Lerner Research Institute, writes a Harvard Business Review article explaining how the Cleveland Clinic captures and analyzes its outcomes data and why it publically reports all of its findings.

Morning Headlines 9/23/15

Addenbrooke’s and Rosie hospitals’ patients ‘put at risk’

In England, the Care Quality Commission inspects Cambridge University Hospitals Trust, Epic’s sole UK customer, and finds that the implementation negatively affected the hospitals “ability to report, highlight, and take action on data” and caused medications to be incorrectly prescribed.

The Future of Emergency Department Information Systems

Peer60 publishes a report on the EDIS market, finding that 32 percent of respondents plan to switch ED vendors, with Meditech leading in market share and Epic leading in replacement vendor mind share.

FDA Announces First-ever Patient Engagement Advisory Committee

The FDA launches a new patient engagement advisory committee made up of nine voting members who are experts in clinical research, primary care patient experience, and the health care needs of patient groups.

Adventist Health System to pay $118 mln to settle fraud claims

Adventist Health System (FL) will pay $118 million to settle a whistleblower lawsuit alleging that it paid kickbacks to providers in exchange for referrals.

News 9/23/15

Top News

ONC’s just-released five-year “Federal Health IT Strategic Plan” says the federal government learned from HITECH that federal entities need to integrate their health IT planning and the need to move to a person-centric health IT infrastructure. ONC revised its plan based on stakeholder comments that it was too focused on data and systems rather than how participants in the healthcare system can work together. Nothing in it stood out as interesting, other than that I didn’t see any direct reference to ONC’s proposed Health IT Safety Collaboratory.

Reader Comments

From Long Time, First Time: “Re: Dr. Jayne’s post on Theranos. Is this what passes for critical thinking in the doctor’s lounge? I doubt Theranos or Ms. Holmes has any more obligation to educate patients than your profession does, which after centuries of privilege, takes little accountability for their ignorance.” I think Dr. Jayne will respond.

From K-Dog: “Re: Volkswagen emissions scandal. Did anyone else immediately think of EHR certifications?” Volkswagen sets aside $7.3 billion for recalls and penalties and the CEO of its US division admits that “we have totally screwed up” after the company was caught programming the software in its diesel cars to under-report their emission levels that were up to 40 times the allowed amount. I don’t know if there’s an EHR equivalent unless a vendor either earned certification fraudulently (which would be the certifier’s problem) or the once-certified certified product no longer meets the requirements. The one and only de-certification was because the company went out of business (as did the original certification body, CCHIT).

From Former Epic: “Re: Epic. Anyone grossed out by the passive-aggressive media blitz it’s running via its clients? Refusing to exchange more than minimum data and forcing providers to install EHR systems again is irresponsible and motivated by hubris. Legacy Health, no one is ‘snake oiling’ us into believing that Epic isn’t doing the right thing. They are showing us with their hypocritical rhetoric. Stop being a mouthpiece for a big vendor that can fight its own battles.” CIOs at Epic-using health systems can’t win. If they say anything good about the company, people who don’t like Epic for whatever reason accuse them of being mindless lemmings or cunning company shills. Not only that, people who wax pedantic on what they think is wrong with Epic marginalize those provider CIOs who actually chose and use the system, as though hands-on expertise is by definition tainted by self-interest. I don’t know of any other industry where sideline observers are assumed to have more credibility than paying customers. If healthcare IT were Yelp, we would allow each restaurant to be reviewed only by self-appointed experts who haven’t actually eaten there.

From Rumor: “Re: Cohealo founder Mark Slaughter. Removed from the website – out as CEO?” Apparently – his LinkedIn profile says he’s gone as of this month and is now a “healthcare entrepreneur.” According to the supply chain technology company’s executive page, he’s been replaced as CEO by co-founder and COO Brett Reed, whose pre-Healo career was at Burlington Coat Factory.

From Feeling Bamboozled: “Re: Sagacious Consultants. Announced to employees Tuesday night that they’re being bought by Accenture. Transition over the next 10 days, according to leadership.” Unverified since it’s late in the day Tuesday, but I’ll probably get confirmation or denial on Wednesday.

HIStalk Announcements and Requests

Bird Blitch was incorrect in tagging his $100 donation to my DonorsChoose project as “not being much, but it adds up.” It actually provided a lot for the elementary school class of Ms. Thomas from Jonesboro, GA, which will get an iPad Mini, a kid-proof case, and a bean bag chair to create a Math Exploration Station, with matching funds my anonymous vendor executive and that total amount doubled again by the Smarties candy folks. I even had enough money left over to give Mrs. Lantinga’s eighth-grade science class in Battle Creek, MI two science magazine subscriptions to replace the five-year-old copies they were using for their weekly class discussions about science “current” events, with matching money from my vendor person as well as the Bill & Melinda Gates Foundation. One of Mrs. Lantinga’s advisory council students explained why they hoped their grant requests would be funded on behalf of their 125 classmates: “I think that the rest of the kids will look at us as leaders because we saw a problem and came up with an idea for a solution and that’s what a leader would do."

Here’s one of the most valuable lessons I learned in my MBA program. Sunk costs (money already spent) shouldn’t affect go-forward decisions. In a  a real-life example from my own recent experience, I bought inexpensive tickets for a football game that I didn’t really care about other than to enjoy the game-related activities outside the stadium. Torrential rains caused those pre-game activities to be cancelled. Should I go anyway since I’d already bought the ticket? Correct answer: no. I wasn’t going to get the money back either way, so the only consideration was whether I’d rather spend the time doing something that didn’t involve huddling miserably under a poncho. When making a decision about anything in business or otherwise, forget historical financial or emotional investments and evaluate your options starting only with right this minute. In other words, don’t throw good money after bad.

Webinars

October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.

Here’s the video of Tuesday’s webinar from The Breakaway Group titled “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements using Simple but Predictive Adoption Metrics.”

Acquisitions, Funding, Business, and Stock

Phynd Technologies secures $1.1 million in Series A equity funding to accelerate growth of its provider management platform, raising its total to $3.1 million.

Specialty EHR vendor Modernizing Medicine raises $38 million in Series E financing, increasing its total to $87 million.

Ascension invests $18 million in data analytics vendor Atigeo and will use its technology as a customer. It’s not a healthcare-specific product.

Wolters Kluwer says it will acquired India-based digital health solutions startups.

Sales

John Muir Health (CA) chooses Health Catalyst’s enterprise data warehouse and analytics platform.

Sharp HealthCare (CA) chooses Qpid Health for PQRS compliance.

Duke Clinical Research Institute (NC) will implement VitalHealth Software’s QuestLink to allow clinical trials patients to report their outcomes electronically.

Memorial Medical Group (IL) chooses the eClinicalWorks EHR.

People

Healthgrades makes three executive hires: Keith Nyhouse (TeleTech) as chief marketing officer, Mayur Gupta (Kimberly-Clark) as SVP/head of digital, and Kate Hyatt (ProBuild Holdings) as SVP/chief people officer.

AxisPoint Health, the former McKesson Care Management division that was sold earlier this year, names Ron Geraty, MD (DermOne) as CEO.

Announcements and Implementations

AirWatch announces that its mobility management solution is iOS9 ready.

Government and Politics

Adventist Health System (FL) will pay $119 million to settle a whistleblower lawsuit that accused it of paying doctors kickbacks for their referrals, the largest settlement ever for referral improprieties. Three former employees of Park Ridge Hospital (NC) will divide up to $30 million of the settlement.

The FDA announces formation of a Patient Engagement Advisory Committee made up of experts and a single consumer representative that will advise it on complex issues.

England’s Chief Inspector of Hospitals recommends that Cambridge University Hospitals Trust be placed under remedial oversight after finding significant problems with its finances, staffing, and its Epic rollout that caused clinical issues. The inspector says employees are caring and skilled, but hospital executives have “lost their grip on some of the basics.”

I didn’t catch this story two weeks ago: CMS gives California Medicaid a waiver allowing it to keep submitting ICD-9 claims after the October 1 switch to ICD-10. California started a six-year, $1.6 billion upgrade of its Medicaid systems in 2010, but it’s still testing the Xerox-developed changes for ICD-10. CMS will allow California and three other states to submit ICD-9 codes that it will try to convert to ICD-10 equivalent using a crosswalk table.

A new IOM report called “Improving Diagnosis in Health Care” makes these health IT recommendations:

• Software vendors and ONC should ensure that health IT systems used for  diagnosis demonstrate usability, incorporate human factors knowledge, integrate measurement capability, integrate with clinical workflow, provide clinical decision support, and facilitate timely information flow among patients and providers.
• ONC should require that IT systems allow effective flow of information across care settings to support diagnosis by 2018, including meeting interoperability standards.
• HHS should require health IT vendors to have their software independently evaluated to determine if it could cause adverse effects on diagnosis.
• HHS should help users exchange information about their experience with health IT design and implementation that could effect diagnosis.

Privacy and Security

NYU professor Arthur Caplan frets about the medical privacy of sensor-containing pills for NBC News, saying the just-approved tablets (he calls them “snitch pills”) from Otsuke Pharma and Proteus Digital Health “will let third parties snoop on you and nag you if they see you are not doing what the doctor ordered.” I think his concerns are unfounded and I would instead consider the broader problem of the societal cost of patients who intentionally don’t do what’s good for them. It’s like “intrusive” laws that require motorcyclists to wear helmets so the rest of us aren’t stuck footing the bill when their inevitable helmet-free crash sends them to years of expensive ventilator care. I think smart pills are an overly intrusive and expensive way to address patients who don’t take their meds as prescribed, but I seriously doubt that anyone is going to poach the entirely uninteresting data they create for evil purposes.

Other

The 32-year-old former hedge fund manager turned CEO of a drug company that acquired a 60-year-old AIDS drug for $55 million and then increased its price from $14 per tablet to $750 says the drug costs only $1 per tablet to manufacture, but it was underpriced compared to other expensive drugs on the market. He responded to a tweet questioning the price hike with, “You are such a moron.” The Wall Street Journal noted in April the trend of aggressive drug companies buying patents of drugs sold by competitors and then jacking up their prices by multiples, with one company raising the price of two old heart drugs that still had no generic competitors by 525 percent and 212 percent the day they bought them. In related news, a drug company that bought rights to an old tuberculosis drug and then increased its price 20-fold gives the drug back to the non-profit that previously owned it just three weeks before, with both organizations stung by public outcries of price gouging. The most interesting aspect of all of these examples is that the drugs are off patent, yet nobody makes a generic, leading to one of two conclusions: (a) the market for the drugs is so limited that the few patients who need them have to pay the entire cost of manufacturing and marketing them; or (b) generic manufacturers have been bribed not to jump in. Either is a big problem for overall healthcare costs.

Peer60’s new EDIS report finds that hospital EDs are getting significantly more visits and one-third of them plan to switch ED information system vendors in the near future. Most interesting to me is that the integrated vendors (Allscripts, Cerner, Epic, and Meditech) are the most likely to lose clients. Meditech has big-hospital market share, but almost zero mind share, which sounds like an opportunity for someone. Usability was the #1 user-reported problem by far at 49 percent, but one-third of respondents say there’s nothing their vendor can do to keep them because they’re switching to their EHR vendor’s EDIS anyway. Nearly half of respondents say their increased ED volume is due to the lack of available primary care.

Howard Zwerling, MD, president of ComChart Medical Software, announces that he’s taking his company’s EMR off the market because its underlying technology (Filemaker, various browser plug-ins, and fax programs) makes upgrades too slow and unreliable. He takes shots at the EHR market on the way out the door, saying that evidence that healthcare IT is effective is lacking and “the large EMR/EHR vendors now have undue influence over the Federal Government’s HIT initiative.” I might offer a counterpoint – the predictable problems the physician had as a spare bedroom programmer trying to write, sell, and support an EMR as a side job is precisely why those big vendors are succeeding and he failed. He didn’t have a problem with the government and its EHR industry bailout when he was selling his system, saving his parting shot for when he shut down and left his customers in a lurch (after reassuring them otherwise – above). This necessary thinning of the EHR herd is exactly what the industry needs in getting to fewer but better vendors as we finally graduate from opportunists who incorrect believe that the software business is easy and then cut and run when they find it isn’t.

Medical school professor Aaron Carroll, MD, MS writes about health IT from his perspective as a chronic disease patient in the New York Times, observing that his health plan keeps changing lab providers that don’t share his information, faxes are flying around because labs don’t connect electronically with practices, mail-order pharmacies require starting over when the health plan changes to a new one, and a communications nightmare happens when he tries to coordinate getting his same old prescriptions and lab orders repeated as required by the insurance company.

The local paper explains the newly implemented visitor policy of Halifax Health (FL), which will print photo-bearing visitor badges after first checking the visitor against a sexual predator list.

Weird News Andy calls this story “Shark Snark,” which he found on “the highly respected site E-Online.” More people are killed taking selfies than are killed by sharks. WNA helpfully looked up the ICD-10 codes, W56.41 (bitten by a shark) and W56.42 (struck by a shark). Only one deals with selfies, Y93.C2 (activity, hand held interactive electronic device). WNA laments, “When, oh when are we finally going to have a coding system that accurately reflects the modern world in which we live?”

Sponsor Updates

• AirStrip will exhibit at the Southeast Pediatric Cardiology Society Conference September 25-26 in Birmingham, AL.
• Aprima Medical Software will exhibit at the Colorado MGMA Fall Conference September 24-25 in Breckinridge.
• Capsule Tech will exhibit at the Academy of Medical-Surgical Nurses Annual Convention September 24-27 in Las Vegas.
• Clockwise.MD CEO Mike Burke will speak at the Urgent Care Fall Conference September 24-26 in New Orleans.
• Cumberland Consulting Group CEO Brian Cahill shares the company’s motto for growth with the Nashville Business Journal.
• Nordic adds its 500th Epic consultant.
• Forward Health Group CEO Michael Barbouche will speak at the American Heart Association’s Check, Change, Control summit in San Francisco on October 22.

Blog Posts

• Going Beyond Interoperability (PatientSafe Solutions)
• Strategies to enhance your scheduling process, steps 1 & 2 of 5 (AdvancedMD)
• Readmissions Penalties: Are commercial payors following Medicare’s lead? (Besler Consulting)
• Healthcare Social Media: Hospitals Jump on Digital Bandwagon (Billian’s HealthDATA)
• Prescribers: With Specialty Meds on the Rise, You Need a Better PA Solution (CoverMyMeds)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 9/22/15

Federal Health IT Strategic Plan: 2015 – 2020

ONC publishes its five-year strategic plan which proposes shifting the national focus from EHR implementations to improving patient engagement, supporting the transition to value-based reimbursement models, expanding the use of EHR data mining in research, and improving the nation’s health IT infrastructure.

Google’s NIH steal Tom Insel on the ‘major paradigm shift’ of digitizing mental health care

Tom Insel, MD and former director of the National Institute of Mental Health, discusses his decision to move to Google and the work he plans to do there.

In Unit Stalked by Suicide, Veterans Try to Save One Another

The New York Times profiles the 2/7th Marine Regiment, whose veterans have a suicide rate 14 times higher than the average American, and the homegrown tracking systems that former members of the unit have created to help coordinate emergency response efforts at a national level.

Maintaining PCMHs Will Cost $105,000 per Physician per Year

Researchers calculate the number of hours it would take a primary care physician to complete the tasks outlined in the National Committee for Quality Assurance’s standards for maintaining patient-centered medical homes, and conclude that it would cost $105,000 per year in additional time spent.  

Curbside Consult with Dr. Jayne 9/21/15

A quote in this week’s Monday Morning Update caught my eye. Billionaire CEO Elizabeth Holmes of Theranos addressed concerns that average patients aren’t capable of understanding their test results:

The idea that I as a human should not be free to access my own health information, especially using my own money – even though I can buy weapons and anything else I want – and rather should be legally prohibited from doing so, summarizes the root of the fundamental flaw we’re working to change in our healthcare system.

While Holmes may be a prodigy and a billionaire, I wonder how much real-world experience she has interacting with real world patients. It’s likely to be minimal, since she readily admits to barely having a life outside of Theranos. She’s quoted as saying she “doesn’t really hang out with anyone any more” and also doesn’t date, saying she “literally designed my whole life for this.” She even chooses her wardrobe based on efficiency and elimination of the need to make decisions.

Certainly she has advisors — some of them might want to clue her in on what the average patient’s situation looks like. Most of my patients don’t have the means to buy anything they want. Many haven’t had the opportunity to attend college and would find it hard to understand why someone would drop out. Some of them barely graduated from high school. General literacy is an issue, pushing health literacy farther down the list. Most of our patient education materials are written at the fifth grade level and even then it’s still not understandable.

I’m puzzled by her reference to buying weapons as well as her premise that we aren’t already free to access our own health information. Although it might be sometimes challenging (as Mr. H has illustrated in his quest to get a copy of his hospital chart), records are generally more open than they’ve ever been. I’m confronted on a regular basis by patients who have received laboratory results directly through a patient portal and are worried about what they see since it’s often delivered without context. I have had several patients bring in printouts from an EHR patient portal and ask for me to explain high or low lab values when they see them on the weekend and can’t get in touch with the ordering physician.

Unfortunately, they’re often out of context even for me. If I don’t have access to the ordering physician’s thought process or other benchmark values, I can’t really advise the patient one way or the other. Maybe it’s a low value and it’s trending up or maybe it’s getting worse, but it’s often impossible to tell. Knowing that many patients don’t understand the idea of reference ranges (defined by statistics – so that you can be “out of range” but still healthy) it’s likely they won’t understand more complex concepts such as the positive predictive value of a test or its ability to rule in or rule out a disease.

In the interview Mr. H referenced, the examples of breast and prostate cancer are mentioned. Screening tests can lead to false positives and unnecessary procedures. Over the last several years, we’ve seen PSA testing fall out of favor, but patients still request it. Once I discuss the evidence, a good percentage of patients decide to opt out. Given the availability and accessibility of cheap testing, patients might opt in to testing that could be dangerous to their health. Theranos has been instrumental in creation of Arizona laws that allow patients to order their own tests. Based on the fact that tests aren’t without risk, I’m not sure I agree with that approach.

I also disagree with their premise that 40 percent of people don’t get blood tests ordered by their physicians because of the fear of a traditional blood draw. Holmes is admittedly “terrified” of traditional needles. I agree with her assertion that cost is an issue that prevents patients from receiving recommended tests, but I’ve only seen one patient in my career with an actual fear of needles.

I do agree our healthcare system is broken. If Theranos can compete with the large reference labs, everyone will benefit from reduced costs, improved access, and less-invasive testing. If they inspire patients to take charge of their health, even better. But I’d challenge them make sure they’re putting their proverbial money where their mouth is by also providing education, not only to patients, but to the greater community.

Holmes is experimenting with life in the outside world and has been speaking to young women to promote academic achievement. I’d love to see her champion health literacy so that the average person can truly become empowered to take charge of his or her own health. Theranos has multiple job postings for creative, sales, and marketing positions – what better way to leverage them? Even though she’s dedicated her life to solving a narrow problem, she may find other ways to think about it as well as experiencing a greater connection with the people she’s trying to serve.

What do you think about Theranos? Email me.

Email Dr. Jayne.