Survey results from The Commonwealth Fund and The Kaiser Family Foundation measuring primary care provider attitudes toward payment and care delivery reform finds that while views on health IT are generally positive, patient-centered medical homes and ACOs are met with mixed feelings, and the use of quality metrics to assess performance and rationalize financial penalties generates negative feelings.
Yelp partners with ProPublica to begin embedding a subset of health care statistics into its listings pages for hospitals, nursing homes, and dialysis clinics.
Five years after its initial passage, the SEC has approved a highly-contested regulatory requirement included in the Dodd-Frank Act that requires publically traded companies to report the ratio of CEO compensation to median employee compensation, effective January 1, 2017.
Cloud-based EHR vendor Medical Informatics Engineering updates an earlier disclosure to clarify that as many as 3.9 million patient records were potentially exposed during a May 2015 cybersecurity breach.
Cerner reports Q2 results: revenue increased 32 percent to $1.13 billion, adjusted EPS $0.52 vs. $0.40, missing analyst estimates for revenue and reporting a 53 percent increase in operating expenses.
Allscripts reports Q2 results: revenue was flat at $352 million vs $351 million for Q2 2014, adjusted EPS $0.12 vs. $0.09. Bookings for the quarter increased 11 percent to $260 million, but the company still posted a net loss of $3.2 million.
Meditech reports Q2 results: revenue falls 16 percent to $117 million, EPS of $0.46 vs. $0.63. Service revenue increased five percent to $80 million, while sales revenue dropped 42 percent to $37 million for the quarter.
In England, Papworth Hospital NHS Foundation Trust rescinds its Epic selection following recently reported problems with the Epic install at Cambridge University Hospitals. Papworth had entered into a joint procurement process with Cambridge in 2012 and was slated to install Epic in 2016.
Cerner announces Q2 results: revenue up 32 percent, adjusted EPS $0.52 vs. $0.40, meeting earnings estimates but falling short on revenue expectations as service revenue declined and operating expenses jumped 53 percent. The company raised full-year earnings guidance but lowered full-year revenue guidance, sending CERN shares down 3.5 percent in after-market trading following the market’s close Tuesday. CERN shares are up 26 percent in the past year vs. the Nasdaq’s 17 percent.
CFO Marc Naughton says the company is disappointed that it missed its guided revenue estimates, but is happy with its all-time high strong sales and positive outlook.
Recurring revenue from the Siemens acquisition is tracking as expected, but fewer than expected customers committing to moving to Millennium or buying additional of the former Siemens solutions as they are “holding pat with their hand.”
President Zane Burke says Cerner differentiates itself (presumably from Epic) on predictable costs of ownership, fixed-fee implementations, and partial or full IT department outsourcing.
Cerner says (without naming names) that it is gaining ambulatory business at the expense of Athenahealth because it offers better service and value.
Burke says Cerner is happy to have been chosen by the DoD as part of the Leidos bid, but doesn’t expect a material impact on sales, revenue, or profits in the near term. He adds that the DoD’s project estimate is $9 billion over 18 years, but the value of the contract awarded is less.
Cerner says its customers “are actually very excited” about its DoD win.
Cerner’s new campus construction will require a capital expenditure of $150 million in the fiscal year.
CEO Neal Patterson was supposed to join the call for Q&A, but did not participate.
Reader Comments
From Captain Cupric: “Re: CHIME’s for-profit vendor-CIO matchmaking service. Isn’t that what the AHA’s AHA Solutions group does? Vendors pay hundreds of thousands of dollars (sometimes more than a million dollars) for an agreement, then pay a percentage of sales for ‘introductions’ to decision makers.” I believe that’s the case, although AHA Solutions does have some sort of vetting procedure (other than having the vendor’s check clear) before anointing their solutions as “endorsed.” It annoys me when supposedly non-profit member organizations can’t resist the lure of transforming themselves into richly rewarded pimps who arrange vendor-member liaisons in exploiting the “Ladies Drink Free” business model. The healthcare history is rich with examples (AHA, AMA, HIMSS, etc.) and CHIME seems anxious to pile onto the financial bandwagon in selling access to its provider members.
From CIO Doc: “Re: DoD EHR coverage. HIStalk had all I needed to know, from the early rumors to Dim-Sum’s webinar to critical analysis of the selection and then contract and vendor insight.” The other sites didn’t get anything wrong, they just didn’t add much value to the single-paragraph DoD contract notice (which is all they had to work with) in cranking out mindless articles and tweet-seeking missiles like (a) plucking a few random tweets or reader comments about the selection and passing them off as an insightful article representing the industry’s collective reaction; (b) running a long piece about how Epic feels about getting passed over in repurposing content from a rather sloppy Madison newspaper article; (c) asking but not answering questions in headlines; and (d) assembling random, pointless factoids together in proclaiming “X things to know” that were in fact not at all worth knowing. I don’t see much value in having writers with zero healthcare or IT experience rewording public information to seem like fresh news, hoping to attract reader eyeballs and advertiser support with stories that provide those readers with little value, but that’s just me.
From Horse Hockey: “Re: Healthcare IT News. Tooting its own horn in an odd press release. It’s odd that they brag on their unstated DoD reader numbers and even more that they issued a press release about themselves – what editor other than their own would think something like that is newsworthy?” I hesitate to comment since this reader’s email came after I had already written my media diatribe in response to the comment above, but the HIMSS-owned HITN issues a self-congratulatory news flash stating that its (unstated) readership numbers temporarily rose by an (unstated) percentage after they stopped the online presses for lightweight articles as, “CIOs ‘surprised’ at Cerner DoD win,” “Is DoD’s EHR modernization bound to fail?” and “The good, the bad, and the ugly: social media’s response to DoD Cerner EHR contract win.” I don’t read any health IT sites since I’ve yet to find anything there that wasn’t amply described elsewhere, but more power to everybody who can earn and keep readers, especially if they’re trying to do it as cheap seats observers.
From Informatics Please: “Re: Tampa General Hospital. Has extended their instance of Epic to the University of South Florida in a large ambulatory Epic Connect project involving 850 physicians and 2,800 users.” Unverified, but the source is sound.
From RingRing-Tom Brady: “Re: question for clinical readers. What about a vendor prompts them to want more in going to the vendor’s website or picking up the phone? I’m interviewing and am amazed at how much faith sales and marketing people place in their CRM and automated marketing platforms to drive sales. Is email outreach and social media really making an impact or is it just lazy selling? Does it matter how many touches you hit a prospect with, or do they just hit delete? Does an old-school ‘let me tell you how I can help solve your problem’ work?” I’ll let readers weigh in, but I’ll say this: I often find that clueless sales and marketing people who measure vanity but irrelevant metrics such as ad clicks to be employed by equally clueless and unsuccessful vendors. I’ll also opine that any company that relies on Twitter and Facebook to drive sales might as well lock up and go home since most heavy users of social media (both vendors and providers) are junior employees rather than decision-making executives. I would wager that most healthcare IT sales come from word of mouth or existing personal relationships, not a flashier HIMSS booth or insultingly boilerplated emails.
HIStalk Announcements and Requests
Welcome new HIStalk Platinum Sponsor VitalHealth Software. The company, co-founded by Mayo Clinic and Noaber Foundation in 2006, offers cloud-based solutions that include chronic disease care management, patient questionnaires, an integrated digital interventions portal, a next-generation heath IT application development environment for deploying cloud-based EHR solutions, and a Mayo-designed EHR for specialty practices. The company is a certified supplier of ICHOM, which defines global outcomes standards for issues that matter most to patients. The company’s global eHealth solutions are used by 100 healthcare networks in the US, Argentina, China, Spain, and several other countries, with a project in China, for example, providing cost-effective telemedicine services with shared medical records, risk profiles, and patient access to their medical records by smartphone. Thanks to VitalHealth Software for supporting HIStalk.
I found this YouTube video describing the use of VitalHealth Software’s QuestLink questionnaire platform for patient-reported outcomes.
I was about to eat an apple this morning and polished it on my shirt, leading me to ponder, why do I do that? The apple has passed through a lot of unwashed hands on its way from orchard to me, so anything short of washing it or peeling it isn’t going to accomplish much (not to mention that polishing it will deposit cloth particles and whatever’s on my shirt on the peel I’m about to eat). It’s almost as mystifying as why many men (not me) pointlessly spit in a public restroom urinal before using it.
Listening: Vaults, a London-based synth pop trio that nobody seems to know anything about — their website says nothing about them and they aren’t even on Wikipedia or Amazon. Their melodic, slow, bass-heavy music is fronted by a siren-like singer. Trying to find them turned up “In Vaults,” a new album of Chicago-based, female-led prog rock from District 97. The band played an amazing live version of “Starless” that features King Crimson’s vocalist/bass player John Wetton, who sang the original version of that King Crimson musical epitaph to itself on the group’s 1974 final album “Red” and who delivered an engaged performance here, unlike most of his 1970s-era music peers who just prop themselves up on stage like sagging, lip-syncing Disney audio-animatrons.
I’m happy to report that most of the HIStalapalooza sponsorship spots have been claimed, meaning the odds have improved that I won’t go broke in throwing the industry a free party next February. Still available are the all-access CEO Rock Star package and one I’m calling HIStalkacabana, although we’ll still consider the needs of smaller companies who want to be involved (we’ve customized some packages already). Contact Lorre. Thanks for the companies that have stepped up – it’s going to be a great evening as always.
Webinars
None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.
Acquisitions, Funding, Business, and Stock
Activist investor Starboard Value, which holds an 8.7 percent stake in MedAssets, calls for the company to replace some of its board members, questioning its acquisition track record and undervalued share price. MedAssets also files SEC disclosure that Tenet will not renew its group purchasing contract with the company, costing MedAssets $44 million in annual revenue or about six percent of its total, but Tenet will continue using its revenue cycle technology products under a separate agreement. MedAssets reiterated that it is continuing to pursue a “value creation plan” and the loss of the Tenet contract may cause “expense reductions, restructuring charges, and/or investments in products or services to help drive long-term growth.” Above is the one-year share price chart of MDAS (blue, up 1 percent) vs. the Nasdaq (red, up 17.3 percent). The company’s market cap is $1.3 billion, helped along by the prospect of Starboard Value taking control from present management.
Preventative care and disease management platform startup Zest Health, co-founded by former Allscripts executives Glen Tullman and Lee Shapiro, raises $6 million in Series A funding, with an unstated amount of the money coming from the Tullman-Shapiro-led 7wireVentures.
Aetna announces Q2 results: revenue up 4 percent, EPS $2.05 vs. $1.69, falling short of revenue expectations but beating on earnings. AET shares rose 46 percent in the past year, with CEO Mark Bertolini holding $83 million worth.
CVS Health announces Q2 results: revenue up 7.4 percent, EPS $1.12 vs. $1.06, beating earnings expectations but reporting a front-of-store sales drop of 7.8 percent following the company’s decision to stop selling tobacco products last fall.
The Advisory Board Company reports Q2 results: revenue up 30 percent, adjusted EPS $0.40 vs. $0.30. The company also announces a new healthcare marketing product, Audience RX.
Allscripts reports Q2 results: revenue flat, adjusted EPS $0.12 vs. $0.09. GAAP numbers showed the company losing $3.2 million in the quarter. From the Allscripts earnings call:
CEO Paul Black is happy with the company’s sales, revenue, profitability, gross margin, and recurring revenue.
The company added 180 new customers in the quarter.
The company signed one net-new Sunrise client, a 50-bed hospital.
Allscripts will work with NantHealth on API integration between their respective systems and in integrating genomic data.
I reported a reader’s rumor on July 29 that said a company (whose name I omitted) would divest several hospitals and its consulting company. I omitted some of the details since they involved the publicly traded Community Health Systems, which announces exactly what the reader reported – it will spin off 38 of its rural hospitals and Quorum Health Resources. CYH share price has risen 60 percent in the past year, valuing the company at $7 billion and the holdings of CEO Wayne Smith at $61 million.
Premier acquires supply chain and performance services vendor CeCity for $400 million. The company offers PQRS reporting, an educational platform, clinical data registries, and a performance and population health management system. CEO Lloyd Myers, a pharmacist, founded the Pittsburgh-based company in 1996.
Meditech’s Q2 report shows total revenue down 16 percent and product revenue down a startling 42 percent as the company moves from $23.4 million net income to just over $17 million quarter over quarter, reporting EPS of $0.46 vs. $0.63. Six-month net income dropped from $85.4 million to $37 million. Sales dropped nearly $26 million as maintenance fees made up more of the company’s total revenue, with that big sales drop seeming to prove the market perception that Meditech is no longer a significant challenger as Cerner and Epic make it a two-horse health system EHR race as they move down the food chain into smaller and acquired hospitals.
Sales
Delaware Valley ACO chooses Wellcentive’s value-based care solution.
Presbyterian Healthcare Services (NM) will deploy Zynx Health’s Knowledge Analyzer to standardize its clinical decision support using evidence-based intelligence.
University Health System (TX) chooses Spok for enterprise clinical communications.
Baptist Health South Florida chooses Cerner Millennium and HealtheIntent for all of its locations, apparently replacing Soarian clinicals but keeping Soarian financials in favor of Cerner’s own offering.
Spartanburg Regional Healthcare System chooses HCTec Partners for Epic 2015 implementation consulting.
People
Hebrew SeniorLife (MA) names Peter Ingram (MetroChicago HIE) as CIO.
Diana Nole (Carestream Health) will join Wolters Kluwer Health as CEO.
Ingenious Med names Todd Charest (Cogent Healthcare) as chief innovation and product officer.
SRG Technology, which offers population health management technology it developed with Massachusetts General Hospital, hires Adrian Zai, MD, PhD, MPH (MGH) as CMIO.
Greenway Health names David Wirta (Vista Consulting Group) to the newly created position of chief revenue officer.
Announcements and Implementations
NTT Data acquires global exclusive rights to products from it business partner InteHealth, which include a cloud-based HIE and portals for patients and physicians. The LinkedIn profile of former InteHealth VP Frank Nash (now senior director at NTT Data) says NTT Data acquired the assets of InteHealth on June 1, 2015 and the company is now part of NTT’s Healthcare Convergence Group.
London-based EY (the former Ernst & Young) consolidates its health consulting offerings in a barrage of obfuscatory buzzwords, promising to “collaborate with clients on improving efficiencies, catalyzing new digital health technologies, and helping to ensure wellness and prevention.” The company promotes Jacques Mulder to Global Health Sector Leader, a title that begs to be uttered in a Darth Vader voice.
Government and Politics
The Senate’s HELP committee is scheduled to discuss Karen DeSalvo’s nomination for HHS assistant secretary of health on Thursday, August 6. This is probably the Senate’s first step in confirming President Obama’s May 2015 nomination of DeSalvo for the HHS promotion, which would leave ONC searching for its next National Coordinator. She won’t get much if any opposition.
Privacy and Security
Sensato and Divurgent will offer a three-day workshop titled “Designing Secure Healthcare Systems” October 27-29, 2015 in Long Branch, NJ. It would be fun to attend a hacker’s conference – I bet they are constantly trying to pry into each other’s Wi-Fi connections to earn happy hour bragging rights before the World of Warcraft all-nighter.
Indiana-based NoMoreClipboard vendor Medical Informatics Engineering says the medical information of 3.9 million people was exposed its May 2015 breach by unknown hackers. The long list of affected health organizations include Concentra, Franciscan St. Francis Health Indianapolis, and Rochester Medical Group. The company’s former president says it took in $18 million in 2014 revenue from 2,500 commercial clients, all of which could go right down the tubes after this massive breach. MIE’s other claim to fame is that it invented the phony Extormity and SEEDIE sites that made fun of EHRs a few years back, an attempt to gain the company publicity that unfortunately fell far short of the exposure it’s getting from spilling the data of millions of people into the hackersphere.
Innovation and Research
The FDA approves Spritam, the first drug to be manufactured by 3D printing. Manufacturer Aprecia holds an exclusive worldwide license for MIT-developed 3DP (powder-liquid three- dimensional printing) technology, which can deliver a high-dose drug in a quickly dissolved tablet. Spritam is a new formulation of the existing epilepsy drug levetiracetam (Keppra).
Other
In England, Papworth Hospital NHS Foundation Trust backs out of its commitment to implement Epic following an investigation into the Epic implementation of Cambridge University Hospitals NHS Foundation Trust, with which Papworth jointly chose Epic in the spring of 2013. Papworth’s board concluded last week that Epic won’t deliver optimal value and says it will consider other vendors to provide “a cost-effective ICT system which meets our patients’ needs.” I like that they’re thinking value, as they obviously do in working from building that looks like a slightly decrepit hotel rather than the obscenely glitzy edifice complex palaces commonly found in even financially teetering US hospitals.
Athenahealth posts a video of CEO Jonathan Bush interviewing oncologist, author, and Affordable Care Act contributor Ezekiel Emanuel, MD, PhD. Emanuel says excess hospital bed capacity, low margins, and the fact that nobody really wants to be hospitalized will cause 1,000 hospitals to close as their bond market drives up, while the survivors will shift into other care venues. He’s against health system consolidation, which focuses on controlling the market, vs. more care-focused integration. He says most hospital executives have no idea what it costs to perform a given procedure or service, so any claims that they lose money on Medicare or Medicaid patients aren’t fact-based. Emanuel says EHR information can drive quality and price transparency. He thinks video visits are the wave of the future.
Researchers find that hospitals that score well on clinical quality metrics often have quality-focused boards of directors.
Computer systems at the fantastically named Credit Valley Hospital in Ontario, Canada go down for a day and a half following flooding that took out its telecommunications systems. As is always the case, the hospital claims patient care was not impacted in moving back to paper, which if you take at face value raises the question of why they bothered installing those systems in the first place.
Sponsor Updates
Peer60 names Nuance as the leading provider of medical image-sharing offerings with its PowerShare Network.
ADP AdvancedMD offers “5 ways to enhance your current ICD-10 transition plan.”
Aprima will hold its user conference August 7-9 in Dallas.
Aventura, Capsule Tech, CareSync, and Culbert Healthcare Solutions will exhibit at the Allscripts Client Experience August 5-7 in Boston.
Billian’s HealthData offers “Traversing the Path to Patient Data Access.”
Caradigm posts “Moving Healthcare Analytics from Measurement into Management.”
Jaffer Traish, director of Epic consulting with Culbert Healthcare Solutions, publishes a letter to the editor of the Boston Globe titled “Celebrating strides being made in electronic health records.”
CitiusTech wins the “2015 Best Companies to Work For” award from the Great Place to Work Institute for the fourth consecutive year.
Community Health Systems will shed 38 of its 196 hospitals as it restructures to focus on larger markets. The health system, which currently owns 196 hospitals, will lose its status as the largest health system in the process.
The FDA has cleared a new 3D-printed oral epilepsy drug designed to dissolve with just a sip of water, even at doses as large as 1000 mg. The drug marks the first 3D printed medication to earn FDA approval.
A study published in JAMIA looks back on EHR adoption rates during the five years since the passage of the HITECH Act, Surprisingly, researchers claim that the MU program only spurred EHR adoption by seven percent above the anticipated adoption rate given pre-MU adoption trajectories.
August 3, 2015Dr. JayneComments Off on Curbside Consult with Dr. Jayne 8/3/15
I spent most of this weekend doing something that I really enjoy. Most physicians dread it, IT people tolerate it, and vendors may or may not love it (depending on whether they’re getting paid for it.) I won’t keep you guessing on the riddle of what I was doing – I was running a client’s upgrade project. As a CMIO, I picked up a lot of skills I never dreamed I’d have. It’s fulfilling to use them to help clients who are struggling or who want to take on something that’s bigger than they’re used to handling.
This wasn’t just any upgrade – the client wanted to install new hardware, upgrade the operating system, and upgrade the EHR/billing system all in the same weekend. There are varying opinions on whether that combination of tasks should be done at the same time. Does it make it too hard to troubleshoot? Does it create too much stress for the team? Is it just a bad idea?
Ideally most of us would prefer not to have to do all of these things at once, but unfortunately this client’s parent organization backed them into a corner from a timeline perspective, so we had to make it work. They realized the need to have some project management support so they could focus on other things they needed to complete prior to the upgrade. I was happy to agree, although somewhat nervous about the whole idea.
The client is one that I’ve been working with for some time. Even before I left my full-time CMIO gig, I had done some side consulting work and was therefore familiar with the team’s abilities and work ethic. I knew they had a strong leader – one of those “the buck stops here” types – who wasn’t afraid to roll up her sleeves and get dirty if needed. They also had a proven track record for solid communication and problem-solving. Upgrades of this magnitude aren’t without issues and I strongly suspected that with those factors in place that we would be successful.
The other asset of this team is its culture. They’ve embraced the idea that it’s OK to ask questions even if it seems to be challenging the status quo or questioning someone’s expertise. All the members seem genuinely motivated to deliver a quality product whether that product is software, connectivity, training, or support. They also have relatively thick skins and don’t take things personally, which is my favorite part of working with them. Sometimes the role of the consultant is to turn over every rock and make sure there isn’t anything hiding under it, even if it makes people uncomfortable. I appreciate being able to do my job without any hurt feelings or drama.
This team also has a strong record of aggressive project management, detailed planning, and constant refinement. They’ve done many individual upgrades over the last half-decade and have continually modified their plans to make sure that every detail has been attended to and that they have planned for a variety of contingencies. When they decided they wanted to try this plan, they already had proven methodologies for doing each of the component parts and it was fairly easy to figure out how we could fit them together.
When they first presented their plan, I was impressed. They had data on each of the last several upgrades they had done, including the elapsed time for various steps and a log of what didn’t go as planned as well as the modifications they identified for the future. They also had worked with the various vendors involved to identify potential timelines and to determine whether the combined project was even possible. A review of their documentation showed that the planning was sound, so the next step was to perform a tabletop exercise and walk through all the moving parts to identify any other potential gotchas.
This was several months ago, but I still remember how they walked through it all, talking through each step and verbalizing the handoffs. Several team members also added specific comments on their steps, such as, “… and now I’m going to stop process A, because we know that if we just pause it we’ll have a problem. Process A is now stopped. Clear for the handoff to the DBA.” It was overkill from anything I’d ever seen, but it let me know that they knew their stuff and were ready to tackle something larger. It did feel a little bit though like being in mission control for a spaceship launch, however.
Over the last several months, they’ve performed each upgrade separately in a test environment except for the hardware piece. Although they experienced some performance issues, they were within the expected realm considering that their test servers were several years older than their production servers. They started training end users several weeks ago and ensured that not only did the users demonstrate mastery of the content, but of the support process and troubleshooting steps and downtimes procedures that would be needed if something didn’t go as expected.
Our final test came about a month ago when they received their new hardware and did a complete dry run. There were a couple of glitches, but nothing that couldn’t be addressed. All training was complete the week before last and they’ve been in a code freeze, so all that was left was to review the downtime plan and train a couple of stragglers.
Most of my work with this client has been remote (I do so love working in my fuzzy slippers), but I wanted to be on site for the go-live. They’re in a city that has a lot to offer and I headed to town on Thursday to spend time with friends as well as to make sure I was in position if anything unexpected happened. When we took the system down on Friday evening and the clock started ticking, I admit it was a little bit of an adrenaline rush. I wasn’t prepared for what was next though – this is the most anxious I’ve ever been on an upgrade project. It wasn’t necessarily because I was worried, but because it was so quiet. I’m used to getting phone calls here and there with questions about sticky situations and I wasn’t hearing anything from this client.
When we reached our first pre-scheduled checkpoint call, everything was under control and they were even a little bit ahead on the timeline. I’m not used to working with a team that is this capable and organized and found myself having to come up with strategies to just mentally let it roll. The friends I was staying with have a pool, so I spent the better part of the weekend contemplating the mysteries of various kinds of rafts and floats while waiting for my next checkpoint call.
Everything finished early Sunday morning and we were able to get some end users on the system for quick testing before we released it to the urgent care locations that were just getting ready to open. I have to admit, with all the pool time this is the most relaxed I’ve ever been going into post-live support. The urgent cares represent only 10 percent of the typical user load, however, so Monday morning might be a different story.
We’re as ready as we can be – issue tracking processes are in place, people know where they need to be, the communication plan has been reviewed, and I’ve ordered enough food into the command center to feed an army. Every practice site will get a personal visit from someone on the team at some point during the day, whether there are issues or not. And every visit will be accompanied by a snack basket. Maybe it’s because of my roots (don’t ever go visiting without a covered dish, seriously) but I believe in letting the users know that we care how they are doing and wanted to bring a little something to brighten up the day.
It’s now Sunday evening and the daily close process is running. The nightly backup will kick off soon and I hope everyone is settling in for a good night’s sleep. I’ll let you know later in the week how it goes. Despite its magnitude, this has been a lot of fun.
Grahame Grieve is a principal with Health Intersections of Melbourne, Australia and was the architect-developer of HL7’s Fast Healthcare Interoperability Resources (FHIR, pronounced “fire”) specification that allows EHRs to exchange information.
Tell me about yourself and what you do.
I qualified as a bench scientist in a hospital, but got dragged into working for a lab systems vendor. I got more and more involved in interoperability. Eventually I cut loose and consulted in interoperability and system integration in healthcare. Then I got gradually more and more involved in leading the standards in the area. Mainly I consult with the national programs.
Programmers call FHIR public API for EHRs. How would you define FHIR to a clinician and explain to them why it’s important?
It’s a framework for finding and exchanging data between two different systems so that they can exchange data in the background to provide services in the foreground that make people’s ability to do medicine better. You have to sort out flows, data contents, and agreements about responsibilities. FHIR focuses on doing those through modern technology, the same kind of agreements that support the massive systems around Facebook, Google, Apple, and the current social web system.
What lessons have we learned from the adoption of HL7?
It’s really hard to get people to agree. The content agreements and business agreements are valuable things that accrete very slowly. People line up with very long life cycles to them. You can’t expect quick change. You can legislate for it, you can pay for it, but you won’t get it. It takes time to get people to perform surgery on their systems while they’re going.
The criticism of HL7 is that vendors took advantage of its flexibility in making it less of a standard and more of a general framework. Is there a fine balance between being prescriptive enough versus making a standard too open?
Yes, it’s really difficult to find the right balance there. This variation in implementation was because vendors didn’t know any better and we didn’t have any way to encourage consistency of interpretation. We’ve tried to do what we can about that more recently.
There’s also variation because we have no authority to tell people to behave better, to act consistently, to make consistent decisions. Because we can’t dictate behavior, we have to tolerate a lot of inconsistency in the base specification. That fosters inconsistency in interpretation. It’s an ongoing process getting people to agree about those decisions.
What they don’t like is telling them how their business should work. But they do like to tell us that we should solve their business problems.
Are there concerns that the FHIR standard may fall short in meeting the lofty expectations that have been set for it?
There’s people out there who think that with FHIR we’ve solved all the problems. We haven’t, because we’re not authorized to solve lots of the problems.
What we’re trying to do is to get the interoperability format and framework out of the way of the problems that exist. They’re still real problems that will require real hard work to solve. I’m proud of what we’ve done with FHIR, but we only solve one of the set of problems that exist.
What else has to be done beyond developing and using FHIR?
There’s a set of things around security and understanding the balance between usefulness and risk in healthcare. Until we get a degree of agreement across a broad set of stakeholders about what risk is acceptable and what the trade-offs between risks and benefits are, that will continue to be a roadblock.
Then there’s a bunch of things needed around legal liability for exchange of data. There’s always ongoing tension about how much data people want to exchange. Exchanging data and commoditization are related. People will always resist commoditizing their core business. They’ll always be in favor of commoditizing their plumbing. Not a lot of awareness about the relationship between people’s interoperability and commoditization and plumbing in core business. Until core businesses align, then that will continue to be a challenge as well.
Finally, at the clinical level, there’s strong disagreements about clinical content and what kind of clinical statements you should be able to make and be able to exchange. Until the clinicians agree about what clinical interoperability is — not IT interoperability, but clinical interoperability, and that we actually need that — then the amount of clinical interoperability we have will be highly limited.
Was the past focus on document-based exchange a good learning experience and a good alternative or did it take us away from where we should have been going all along?
One of the things that I keep saying within the standards community is that you’ve got to accept your limitations. You can have what’s possible. We weren’t in a position to offer a data-centric standard. The industry went with a document-centric approach. It has great limitations around the ability to do workflow and data integration, but it has a great advantage around the ability to have some kind of immediate, computer-assisted data exchange for humans, where you have low agreement about workflow and clinical content.
Lots of the systems that have come to exist have come to exist because we did what you might call the low-coherency, document-based exchange approach. That’s continued to be a valid thing to do. We’ve gone out of her way to make that possible with FHIR while at the same time allowing people to cherry pick things and do data-based integration and exchange where the clinical processes support and need that. It’s going to continue to be a mixed picture.
When you look at the lack of interoperability, what do you think are the most important or the most difficult issues to address?
Moving data around costs money. Nobody really knows how much that should cost. There seems to be a strong view that the market value is not a fair value because the market is rigged. But none of the proposals that I’ve seen to fix that involve less rigging of the market. They’re just rigging it differently.
It’s extremely difficult to have any sense of what fair value for the cost of exchanging data is. It’s too easy to extract rent one way or another. That will continue to be a major obstacle because for most data exchanges I get involved with, there’s a real asymmetry between the cost of moving the data and the benefits of moving the data. The benefits typically accrue further downstream to someone who’s not paying for the data exchange and really thinks they shouldn’t need to. That will continue to be a big barrier to progress.
Other than that, getting clinical agreement about what the clinical interoperability needs to be and driving clinicians to change their practice to be consistent and to practice medicine consistently rather than inconsistently. That’s a huge cultural gulf that they’re going to have to confront soon.
How long will it be before patients can reasonably expect a new provider to have instant access to their existing data?
It’s a process. In the past, we didn’t have any way of exchanging data. We figured out how to exchange billing and identification data and some diagnostics. Then we added the ability to do some pretty crude document-based transfer of the data. That was a big achievement. I worked on that.
Now we’re extending that to cover through the JSON API task report to cover availability of limited data that can be looked at and maybe processed a little bit. A bunch of consortiums are working on getting better quality and more consistent data. That will take a lot longer.
You build a mountain, you stand on top of it and see a bigger mountain that you can go and stand on top of. The urgent need to build bigger mountains never goes away. We’ll just keep climbing up the stack towards a useful system. Each mountain is about a 10 to 15 year building process. That’s how it has gone historically.
Are we trying to do something in healthcare that other industries haven’t done in asking competitors to share their customer data with each other?
There’s a number of industries where they have data sharing arrangements of one kind or another. Those things are possible and they work to some degree. They need some kind of governmental interference or mandate to make them happen. Very often, most of those industries wouldn’t go back to the chaos they had before.
I live in a country where there’s not a lot of competition for business, but the interoperability picture is not very different. It’s really hard to move data. The US focus on competition and anti-competition is a bit overstated. Countries that don’t have a lot of competition still have trouble exchanging data unless they have a single provider providing all of the clinical systems. It’s just a matter of time to drive consistency.
One big problem people don’t talk about very much is legacy data. Almost all of us could easily get to an interoperable state if we simply one day turned off our legacy data and threw it away. Most practicing clinicians and clinical institutions are kind of reluctant to part with their legacy data. They call it ongoing care of a patient. As long as take that attitude — which we should — to healthcare interoperability, it’s got to be a slow process to move everything forward.
You mentioned that there’s a disconnect between who gets benefits from sharing data versus who pays for the cost of sharing data. What would be the ideal model? Should those who contribute data be rewarded in some way by those who receive it?
I don’t really know. Standards arise in a broken market. That’s a question that I’ve heard a lot of speculation about, but no convincing story. If the incentives were aligned, we wouldn’t need standards and people would just do it. We’re trying to move the market to a better, stable place.
Perhaps countries where they have a more holistic approach to funding … there’s a professor at my local university who says that we have an "ill-thcare" system rather than a “healthcare system.” If we focused on health and paid for health, then maybe the incentives would align differently. I don’t think that’s a very easy transformation to make.
What do you think of the work of the SMART group that uses FHIR as their data query method?
We love SMART. The SMART team are members of the FHIR team and vice versa. We have a very strong working relationship indeed. I think that 80 to 90 percent of the deployment of FHIR systems will also be a deployment of SMART on FHIR systems. It’s possible, although not certain, that SMART on FHIR will eventually become part of the FHIR specification. That’s water to go under the bridge yet. They’re doing great work. I really personally endorse their goals and they endorse our goals to the point where at some stage we might just be one team.
If you could wave your interoperability magic wand and have one wish granted, what would it be?
I wish the clinicians would believe in clinical interoperability the way that the IT people believe in IT interoperability. We’ve had doubters in the past, but pretty much everybody believes in it now if only we can get there. I wish the clinical people thought that that was a clinical problem.
In England, the Cambridge University Hospitals NHS Foundation Trust will be investigated by Monitor, the primary regulator within the NHS, over financial problems, including the introduction and management of its $300 million Epic install.
The FDA has issued a safety alert warning that Hospira’s Symbiq infusion pumps contain software vulnerabilities that allow attackers to take remote control of them over hospital networks. The alert recommends discontinuing use of the pumps and moving to a new infusion system as soon as possible.
The Institute of Medicine publishes a report on issues related to access, scheduling, and wait times in healthcare. The report outlines ten strategic initiatives it hopes will improve access and care delivery options for patients.
England’s Monitor regulatory program is investigating the $300 million Epic rollout and overall financial management of Cambridge University Hospitals NHS Foundation Trust. Cambridge was Epic’s first UK client, with the 10-year, $250 million contract announced in early 2013.
Reader Comments
From Military Medicine: “Re: DoD EHR bid. Your estimate of 10-20 percent of the total contract value going to Cerner is a bit high from what I’ve heard – it might have been as low as 9-15 percent, which is why Cerner cautioned investors not to get overly excited about their potential revenue and profit. I also suspect Leidos won’t be all that excited about rolling out a new solution since they have the lucrative contract to maintain the old system – they will let the government delay at every step they can bill for working on both systems at the same time.” Leidos its later spinoff SAIC have been paid billions to create and support the DoD’s AHLTA, the renamed Composite Health Care System that wags say stands for “oh, hell, let’s try again.” Leidos has incentive to milk AHLTA for as long as possible while simultaneously collecting checks for its new project work. Using the low end of that range, Cerner’s cut of the rumored $1.7 billion in guaranteed money over 10 years would be only $15 million per year, which given Cerner’s annual revenue would indeed not be an investor-cheered windfall.
From Grunt in Green: “Re: DoD EHR bid. For those who say this is the world’s largest HIT procurement, 60 percent of DoD care is handled by civilian delivery systems under TriCare, so quite a few systems are already larger than DoD, including Kaiser for sure and probably Sutter and Providence.”
From Bang a Gong: “Re: DoD EHR bid. I hope everyone watches closely as Leidos goes over their $1.7 billion bid, then blows through the $2.6 billion in contingencies, and then keeps right on running up the project’s tab while simultaneously renewing their sustainment contracts for AHLTA. By the time they realize how far over this will go, they’ll be beyond the point of no return and will have to finish it, even with huge overages, to avoid an even bigger NPfIT debacle.” Of that I have little doubt since government IT projects never come in on schedule and at the original cost estimate.
From UberUser: “Re: Uber’s user rating added in the latest update. Lots of HIS consultants and vendors use Uber. I wonder if anyone has attained the elusive 5.0 rating? I have a 4.7 with 50 rides, so I probably got a 1 from a guy I complained about.” I checked mine and it’s 4.9. I’m a bit less enamored than I once was with Uber due to (a) frequent surge pricing that makes me suspect that it’s more reflective of company need for profits rather than the demand for rides; (b) drivers who cancel the arranged ride because they don’t want to travel that far to pick me up; (c) lack of drivers in some areas so that you can’t get a ride at all; and (d) imposition of minimum pricing in some cities and when traveling from some airports such that it’s cheaper to just get a cab or an airport limo. I miss Uber when it’s not available, though, such as in Las Vegas, where cab driver protests and the city’s powerful taxi lobby (which includes two former Nevada governors as lobbyists) got Uber shut down awhile back, although I hear it may return. I tried to use Uber in Seattle and only Uber Black (not Uber X) is available at the airport, with the $50 flat rate charge to downtown being $5 more expensive than booking a car on the spot, which in my case turned out to be a stretch limo for the flat $45.
HIStalk Announcements and Requests
Eighty percent of poll respondents check their work email or voicemail at least once per day while on vacation, most just a handful of times, but 12 percent admit that they do so nearly constantly. New poll to your right or here: what factor was most responsible for the Leidos-Cerner-Accenture DoD EHR win?
Readers continued to seek information on the DoD’s EHR project Thursday, when HIStalk pages were displayed 17,000 times in 12,000 unique visits, beating the all-time record set the day before. Since then, though, newsworthy “news” has been close to non-existent. Today’s post is short, but includes everything important — there just isn’t much of it post-DoD announcement and I won’t waste your time with faux news.
Here’s a tip to folks running tiny (or even one-person) companies: it’s pompous to call yourself CEO when you don’t really have many executive duties. I hereby create an industry rule: you can use the title “president” once you’ve hit five employees, but you can’t brag on being “CEO” until you have 25 employees. Fewer than five employees makes you a “principal” or “owner” or whatever else you like the suggests roll-up-your-sleeves work rather than jetting off to board meetings or delivering weighty speeches.
Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, or HIStalk Connect. Click a logo for more information.
My Medical Records Saga Continues
I faxed my request for a copy of my medical records to the hospital on June 26. This past Friday, five weeks later, an letter-sized hospital envelope came in the mail with my name and address handwritten on it with no indication of what was inside. I opened it up and there was my visit summary, contained on two pages front and back as printed off from the hospital’s Epic system. The hospital didn’t include a greeting or explanation or anything to indicate why they had sent the copies – it was just the two pages in an envelope with the hand-scrawled address, which was a long way from being professional. I was surprise they didn’t include a marketing or personal message knowing that most people request their records because they’re going to seek care elsewhere or file a lawsuit, either situation being an excellent time to engage positively with the patient.
Last Week’s Most Interesting News
The Department of Defense chooses the team of Leidos, Cerner, Accenture, and Henry Schein for its EHR implementation project.
McKesson CEO John Hammergren says in the company’s earnings call that “we have been struggling in the hospital IT business.”
Rep. Renee Ellmers (R-NC) introduces the Flex-IT 2 act that would delay Meaningful Use Stage 3 until at least 2017.
An investment fund co-founded by Harvard professor and disruption author Clayton Christensen invests $8.4 million in care coordination vendor ACT.md, whose platform was developed by Zak Kohane, MD, PhD and Ken Mandl, MD, MPH from the informatics department of Harvard’s Boston Children’s Hospital.
NantHealth Founder Patrick Soon-Shiong, MD takes his cancer drug firm NantKwest public, valuing his holdings at $1.6 billion, 33 times the amount he paid for the company a year earlier.
UMass Memorial Health Care (MA) says its implementation of Epic will cost $700 million over 10 years, the health system’s largest capital expense ever.
Webinars
None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.
Sales
Department of Vermont Health Access chooses eQHealth Solutions for population health management technology.
People
Gretchen Tegethoff (TechExec Advisors) is named to a newly created CHIME VP position overseeing its for-profit CHIME Technologies. The business apparently charges vendors an enrollment fee and then takes a percentage of each sale made to CHIME members. Even HIMSS isn’t so brazen as to pimp out its dues-paying members for a percentage piece of the sales action.
Announcements and Implementations
Allscripts Sunrise user National Institutes of Health Clinical Center attains HIMSS EMRAM Stage 7.
Privacy and Security
FDA advises hospitals not to use Hospira’s Symbiq infusion pump following a Homeland Security warning that it is susceptible to attacks from hackers who could gain access to a hospital’s network. It’s the first time FDA has issued a cybersecurity-related medical device product warning. Hospira had been phasing out the Symbiq pumps since 2013, when FDA raised product quality concerns.
Innovation and Research
An Institute of Medicine report titled “Transforming Health Care Scheduling and Access: Getting to Now” lists patient scheduling best practices that include having the scheduler delve deeper into the patient’s need, give the patient options for appointment times, and providing alternatives to a clinician visit.
Other
I was talking to an ENT surgeon last week and asked him about his EHR. He says his office uses the NextGen practice management system, but gave up on its EHR because it was too cumbersome and slow. He said he enjoys e-prescribing, but uses a standalone product instead because NextGen’s module isn’t workflow friendly. It sounds as though he might be better served with a specialty EHR.
Ten leukemia patients in Australia receive half the intended dose of cytarabine due to what sounds like an incorrectly created order set.
Former Kaiser Permanente semantic interoperability expert and former HL7 board member Robert Dolin, MD surrenders his medical license following his September 2014 sentencing for possession of child pornography.
Rocky Mountain Health Plans rolls out its MyDigitalMD video visit service with a funny parody video called “Save the Hipsters.”
Weird News Andy calls this a “s-s-s-selfie.” A man poses for a photo with a rattlesnake in Yellowstone National Park, with his resulting snakebite requiring a five-day, $150,000 hospital stay for treatment and antivenin (which only one company makes at $5,000 per vial.) That reminds me of an old snakebite joke you probably know whose punch line is, “He says you’re going to die.”
Congresswoman Renee Ellmers (R-NC) introduces the Flex-IT 2 Act, which proposes delaying MU Stage 3 rulemaking until at least 2017, citing as a reason the fact that only 19 percent of providers have met Stage 2 attestation requirements thus far.
Healthcare Growth Partners publishes its 2015 midyear review, focusing on health IT investments and IPOs. The report finds that private investments have increased 509 percent since 2007, while the number of IPOs has climbed 367 percent.
13-hospital BJC HealthCare (MO) experiences 20 hours of network downtime that impacted both its EHR system and its corporate email across all of its facilities.
McKesson reports Q1 results: revenue grew nine percent to $47.5 billion, adjusted EPS $3.14 vs $2.47. Revenue from the company’s technology solutions business unit fell four percent.
July 30, 2015Dr. JayneComments Off on EPtalk by Dr. Jayne 7/30/15
I received a fat envelope in the mail today. Unfortunately it was from my former employer’s credential verification service, reminding me of the need to renew my medical staff privileges. I thought it was odd since I resigned my appointment when I quit, but a call to the medical staff office confirmed they never received my letter. In keeping with the digital age (even if it doesn’t comply with the medical staff bylaws) they let me resign via email and confirmed receipt. This is the first time I’ve been without hospital privileges since finishing residency and it feels a little odd.
Speaking of receipts, my new pet peeve: Outlook users who have their accounts set up to request a “read receipt” for every email they send, regardless of its importance. One of my consulting clients gave me a corporate email account and my inbox is plagued by two analysts with this behavior who also engage in extreme carbon copying. You can bet our next discussion of their communication policy will include these elements.
Another pet peeve: sales teams who use physician directories to try to drum up business from people they think might have money. “I called your office earlier and spoke with Katherine, but wanted to follow up with you via email about our event.” Interestingly, I’ve never worked with anyone named Katherine and haven’t had an office for months. I’m not sure I’d trust someone to manage complex affairs like asset protection and financial advice if they can’t manage the truth.
From Cardinal Fan: “Re: BJC HealthCare experienced a system-wide computer outage lasting over 20 hours across more than a dozen facilities. It wasn’t just the clinical systems – everything was down including email. Corporate mouthpieces celebrated our contingency planning, but things were far from smooth. Emergency departments went on diversion and transfers from other hospitals were impacted. Although there is no official root cause, lots of employees are speculating hackers might be involved.” Local media agree with the lack of smoothness, noting problems with moving patients from the emergency department to patient care floors without a functional bed tracking system. An internal email forwarded to me described “system-wide information systems non-functionality.” I admire their fine use of synonyms to avoid saying “outage” or “downtime.” Definitely a bad week to practice medicine in St. Louis – about four hours into the incident, a 20-inch water main broke outside flagship Barnes-Jewish Hospital, sending water into lower levels of the facility and shorting out electrical equipment. At least one backup generator failed and over 130 patients were evacuated.
Some physicians I was having lunch with earlier in the week were discussing the recent Forbes article about curing “Doctor Dropout.” Young physicians see the stress levels of their teachers and mentors and are selecting careers outside of traditional practice. The piece cites Stanford as having just 65 percent of their students going on to residency training in 2011. That doesn’t surprise me – although it was a few years before 2011, nearly 10 percent of my medical school graduating class elected not to pursue residency training or even physician licensure. Of those who did complete their training, quite a few of us have left the careers we trained for.
The author comments that “trying to combine revenue maximization into a clinical process results in a system best described as a Gordian Knot designed by Rube Goldberg. Common sense would suggest that adding yet more complexity (e.g. new payer reporting requirements) on top of an already-flawed model is a recipe for disaster.” That about sums it up.
In case you were getting bored waiting for the Meaningful Use final rule, CMS released proposed rules addressing long term care facilities. The nation’s 15,000 nursing facilities would be required to send care summaries when patients are transferred. I’m disappointed that they’re not requiring electronic transactions in the same formats required of the rest of us. Instead, they’re just proposing a set of information to be communicated. Problems with transcription errors and inaccuracies were cited as why the rest of us need to exchange data electronically with prescribed formats, but I guess CMS thinks nursing homes don’t need to be held to the same standard. The actual language states:
Transfers or Discharge: We propose to require not only that a transfer or discharge be documented in the clinical record, but also that specific information, such as history of present illness, reason for transfer and past medical/surgical history, be exchanged with the receiving provider or facility when a resident is transferred. We are not proposing to require a specific form, format, or methodology for this communication.
I can’t believe that not even a problem list, a medication list, or an allergy list made the cut. At least when they’re done torturing eligible providers and hospitals, CMS will have plenty to work on with other facilities.
What do you think about the proposed rule for nursing facilities? Email me.
The Department of Defense awards a $4.3 billion renewable EHR contract to the team of Leidos, Accenture, Cerner, Henry Schein, and 31 partner companies, with the DoD estimating its total project cost at $9 billion over 18 years. The roster of companies in the Leidos Partnership for Defense Health includes:
Most interesting of these subcontractors is the apparently defunct Ocean Bay Information & Systems Management LLC, launched in April 2012 in Alaska and shut down in December 2014 without an online trace. Its founder, Ernest Anastos, lists his current occupation as “versatile executive seeking new challenges.” The meaty part of his bio is further down the page: he was a former CEO of the Navy Medical Information Management Center and handled Navy acquisitions (DHMSM is a Navy project).
Reader Comments
From HIPAA Love: “Re: requiring a signature on patient information requests. It’s not a HIPAA requirement, but HIPAA allows covered entities to require individuals to make their requests in writing as long as it tells them so.” Thanks. That means hospitals and practices that require patients to fax or mail a signed request form are just making their own rule, not enforcing a HIPAA requirement.
From Denominator: “Re: former Epic employees. Profiled on a Madison site.” The article describes a few former Epic project managers and implementation consultants who struck out on their own after growing tired of endless travel, long hours, and lack of personal satisfaction. They twenty-somethings report changing jobs to fulfill their true passions despite walking away from an average Epic salary of $83,000.
From Red Man Walking: “Re: companies and CEOs. Which ones have you advised or worked with?” None. My life’s work seems to be sitting in an empty room filling an empty screen every single day, but perhaps I’m missing an opportunity to become a “Consigliere to the CEO Stars,” where I would serve as the invisible, ambition-free, bias-free source of truth for CEOs who don’t trust their ambitious, biased VPs to challenge their decisions, provide brutally honest advice, or provide a spin-free assessment of what customers and the market are saying. I like to think that my complete lack of qualifications (having never run a business or climbed the executive ladder) is offset by my naive objectivity and lack of a socially acceptable verbal filter.
From Festus: “Re: BJC HealthCare. Experienced a system-wide computer outage this week.” The St. Louis-based system goes down for 20 hours through Wednesday morning, leaving its 13 hospitals with no access to its EHR, administrative systems, and email. The hospitals went back to paper and turned away transfer patients. BJC hasn’t announced the cause, although with all systems down you would have to assume network problems or maybe even a malware attack since otherwise I would expect the hospital to have diagnosed and announced what went wrong.
HIStalk Announcements and Requests
You may have noticed that you couldn’t bring up the HIStalk page for part of Wednesday afternoon. So many readers were looking for DoD news that my web hosting provider initially thought it was a denial of service attack. Even though the site couldn’t handle all the readers with the server’s CPU usage needle pegged, it still received 16,000 page views in 12,000 unique visits Wednesday, which I’m pretty sure is a record. I’m writing this Thursday evening and today’s numbers are tracking just about as high. A couple of people emailed me to say that I should start a DoD EHR site, although I think interest will wane as the hard work goes underground and there’s not much to talk about for a year or two.
Here’s a shout-out to Carla from Health Data Specialists, who asked for a “we sponsor HIStalk” website badge since they are fans. I didn’t give much direction to the offshore guy to whom I paid $15 to design the graphic figuring it wasn’t all that important, but Carla was right – dozens of sponsors have asked for it for their own sites after I mentioned it in my email to them. It’s gratifying to be supported so enthusiastically.
This week on HIStalk Connect: Nike and Apple settle a class-action lawsuit alleging that the companies knowingly marketed FuelBand activity trackers as more accurate than they actually are. German engineers develop a prosthetic hand capable of mimicking details muscle memory functions. AstraZeneca partners with Adherium, a New Zealand based digital health company that makes smartphone-connected inhalers to help COPD and Asthma patients track medication adherence. Illinois amends its blue sky laws to allow startups to run equity-backed crowdfunding campaigns worth up to $4 million.
My Medical Records Saga Continues
Add to my list of ways providers can make patient electronic records requests easier by sending me your ideas. Here’s one I received:
Provide several ways for patients to request them. Over the phone, online, patient portal, etc. Ensure that in order to receive the records, patient needs to provide several key identifiers that ensure the information is secure and is only provided to said patient (or patient POA). Have a dedicated person and/or department handle these requests so that there is an efficient process and patients don’t have to wait to receive information that is rightfully theirs.
Thoughts on the DoD’s selection of Leidos, Cerner, Accenture, and Henry Schein
The DoD notified the bidders of its decision early Wednesday morning but asked them not to comment until after its contract announcement, which was posted online at just after 5:00 p.m. Eastern time. Analysts for the publicly traded participants apparently started leaking the news at between 3:00 and 3:30, giving shares of Cerner and Leidos a sharp rise on high volume by around 3:30.
This was not a typical EHR procurement given that the package includes a lot more than just a single product. It wasn’t just Allscripts, Cerner, and Epic that were being evaluated, but rather an extensive package of services, infrastructure, maintenance, and willingness to meet the DoD’s ongoing needs. It would be interesting to know how much of the final scoring involved the actual EHR product and vendor.
Self-proclaimed experts lauded the decision in suggesting that “openness” played a part even though: (a) they didn’t define “open”; (b) they didn’t say how they determined that Cerner is more open than Epic or Allscripts; and (c) DoD didn’t say how (or if) it measured and scored “openness.”
Most of the industry – me included – underestimated the importance of the military’s comfort level with the prime contractor based on what knowledgeable readers have told me since the bid was announced. I’ve heard that IBM isn’t strong in defense contracting compared to the winning consortium’s defense powerhouse of Leidos, Accenture, and SAIC.
Allscripts had one good partner (HP) and one not-so-good one (CSC) and a product with tiny market share and limited breadth, making that team the obvious long shot no matter how you look at it. Clearly nobody expected the Allscripts group to win given that MDRX shares didn’t drop on the news that it lost.
Accenture’s participation may have tipped the scales slightly for Leidos since it helped save Healthcare.gov.
The DoD says it has spent more time on the EHR project so far than it did on the trillion-dollar F-35 Joint Strike Fighter.
Leidos operated as SAIC until it spun that unit off as a separate business and renamed itself Leidos in September 2013. SAIC has outperformed Leidos on the stock market in the past year, with its shares up 28 percent compared to those of Leidos at 6.5 percent.
Cerner will replace the military’s present system, the many-billion dollar, contractor-enriching, VA-ignoring, custom-written taxpayer boondoggle known as AHLTA.
Cerner did not win the bid, Leidos did. It’s an important distinction since Cerner is not accustomed to taking a second banana position. Cerner as a company is worth nearly nine times the stock market value of Leidos. Even Henry Schein is four times larger than Leidos.
I’ve heard rumors that Leidos won the bid mostly on price and DoD comments seem to reflect that. The company needed good news after recent major business problems (huge losses, CEO replacement, and a big drop in its healthcare business) and may have bid aggressively for that reason.
I’ve also heard that a lot of the $4.3 billion initial contract value (more than half, in fact) isn’t guaranteed, but rather is set up as contingency money. Leidos and its partners excel at extracting money from the often clueless Washington bureaucracy, a capability that will be essential if the contract really does put so much of the contract value at risk. The #1 rule of government software project bidders: put in a lowball bid knowing that once you get your foot in the door, you can figure out ways to enrich the deal.
If indeed so much of the contract is at risk, that leaves Leidos and its 34 partners with maybe $2 billion guaranteed over 10 years before extensions, which includes all costs related to implementation, support, and software maintenance. Leidos as the prime contractor will certainly be squeezing its subs (including Cerner) to keep as much of the money for itself as it can.
I don’t know how much Cerner gets from the total project award, but a SWAG might place it at 10-20 percent. If only $2 billion or so is guaranteed, maybe Cerner gets $200-$400 million guaranteed over 10 years (obviously I don’t have insider information so this is just speculation for entertainment’s sake). If that’s anywhere close, $40 million per year isn’t going to change Cerner’s life all that much given that it’s already tracking close to $4 billion in annual revenue.
One-third of the non-software cost has to be subbed out to small, minority, or veteran-owned businesses. That means Leidos will have to contract out quite a bit of even the software maintenance fees. Check the list I posted at the top of the page – many of the companies partnering with Leidos trumpet their set-aside status more than anything else.
Cerner tagged Intermountain as a “strategic partner” that will provide “clinical governance of solutions and workflow,” although I don’t understand what battlefield and military hospital expertise Intermountain brings to the table.
Cerner and Leidos are going to need a bunch of experienced project people, and in the absence of restrictive policies like Epic’s that prevent experienced people from moving on to better jobs with other hospitals or consulting firms, the poaching is probably already underway.
The contract has a first-year budget of $149 million and an expected total lifetime cost of $9 billion over the next 18 years (keep an eye on that estimate because you won’t see it that low again).
Let’s not forget that Henry Schein was a big winner, too, as one of the four winning core partners in contributing its dental system expertise.
I can’t imagine that the Epic and Allscripts teams will fight the DoD’s decision barring some major contracting gaffe, but it does bring back memories of the then-tanking, Tullman-led Allscripts throwing a lawsuit tantrum when New York City Health and Hospitals chose Epic over Allscripts in 2012, when Allscripts cried that it wasn’t fair that their prospect was willing to pay more to get Epic.
It’s hard to predict how each company will fare now that the die has been cast. Will Cerner gain knowledge and experience that it can roll into products for the general market or will DoD consume so much of its energy that it will get distracted? Will Epic lose prestige and sales now that it has lost the biggest procurement in health IT history or will it bear down harder in competing with Cerner? Does Allscripts keep trying with Sunrise or just concede the hospital EHR market and focus on ambulatory systems and population health? Do existing customers of each vendor win or lose?
It’s good for the market that Cerner won since Epic needs more competition, although it’s a shame that we don’t have a strong third competitor.
I remember the excitement when companies won those big NPfIT contracts years ago and it turned out to be a bloodbath for them when they were held accountable for delivering what they promised. Let’s hope (against hope) this project delivers more than a spectacular NPfIT bonfire of British pounds. Big government IT projects hardly ever hit their planned budget, timeline, and benefits, but contractors and taxpayers keep lining up at the trough to take another swing.
None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.
McKesson reports Q1 results: revenue up 9 percent, adjusted EPS $3.14 vs. $2.47, beating analyst expectations for both. Technology Solutions revenue was down 7 percent due to the company’s anticipated drop-off in hospital IT business and the sale of its nurse triage operation, but tempered by good performance from RelayHealth and the physician revenue cycle business. CEO John Hammergren said in the earnings call that, “We have been struggling in the hospital IT business, where we have been reinvesting in the go-forward products and de-investing in the products that we’ve already announced that we plan to sunset” as the company tries to “put the momentum back in the business.”
CVS Health will co-develop a chronic disease care management solution with IBM’s Watson group, planning to sell it to insurers and use it in its own pharmacies and MinuteClinics.
MedAssets reports Q2 results: revenue up 13 percent, adjusted EPS $0.31 vs. $0.30, beating expectations for both.
Lockeed Martin exhibits atrocious timing in announcing its Healthcare Technology Alliance the day Leidos and Accenture hogged the government contractor limelight with the DoD’s announcement, but if anyone cares, the Alliance’s founding members are Cisco, Cloudera, Illumina, Intel, and Montgomery College.
People
Stephanie Wallace (Greythorn Healthcare IT) joins Huntzinger Management Group as national sales director.
Cumberland Consulting Group promotes Praneet Nirmul and Adam Seyb to partner.
Margaret Laws (California HealthCare Foundation) is named president and CEO of HopeLab, which develops children’s health-related technology.
Valence Health names former TriZetto and Eclipsys CEO Andy Eckert as CEO. Founding CEO Phil Kamp will move into a chief strategy officer role. Eckert is chairman of Varian Medical Systems.
Announcements and Implementations
John Gomez (Sensato) and Colin Konschak (Divurgent) publish “Cyber-Security in Healthcare 2015,” available as a free e-book download from iTunes.
Government and Politics
Rep. Renee Ellmers (R-NC) introduces the Flex-IT 2 act that would delay Meaningful Use Stage 3 until at least 2017. CHIME chimes in with its support for the bill, saying it will ensure Meaningful Use’s “long-term vitality,” meaning it likes the EHR welfare program as long as the provider bar is set low enough that everybody collects taxpayer cash, not really buying into the idea that the MU program was supposed to be a short-term, cash-for-clunkers stimulus project.
Privacy and Security
Partners HealthCare-owned McLean Hospital loses four unencrypted backup tapes containing information on 12,600 people who have designated their brains to be donated upon their death.
Other
Healthcare Growth Partners publishes its mid-year health IT review with a focus on IPOs. I can’t say enough about HGP’s reports – they are stellar at summarizing the challenges and opportunities of healthcare and healthcare IT in a macroeconomic way. HGP gives their reports away when other firms produce reports with a tiny fraction of their insight and charge handsomely for them. The graphic above nicely compares the 2007 publicly traded health IT market to that of 2015. I also enjoyed this brilliant summary of US healthcare:
Healthcare spending in the US is about 90 percent higher than in most other industrialized countries. The US ranks #46 out of 48 in terms of efficiency – one place below Iran, and that’s without economic sanctions. Inefficient markets typically result in a mispricing of goods and services. The cause is often due to monopolies, poor regulation, and a lack of market transparency. Each is a contributor to inefficiency in the US healthcare economy, but the primary shortcoming is the lack of market transparency, or information, needed to define the cost and quality of goods and services, otherwise known as value. Restated, we must define the cost of care and we must define the quality of care in order to determine the value of care. That information then must be made available to consumers who can act on it to create a market-based economy, which in turn theoretically leads to outcomes and efficiencies. The concept of “value” is behind nearly all health IT investment activity, and in a market as personalized and complex as healthcare, the amount of investment required to achieve it is staggering.
Four hospital ED nurses in Saudi Arabia face prosecution for causing injuries that require a six-year-old’s hand to be amputated after their failed attempt to start an IV.
HIMSS is attempting to insert itself into the DoD’s EHR project by announcing how happy it will be if someone will just invite it to participate, so I will issue an equally self-serving statement of my own:
As the Department of Defense moves forward with its modernization project, Mr. HIStalk is committed to working closely with the DoD on the planning and implementation stages in providing biting commentary for those involved.
Weird News Andy applies his own product name of “iDon’t Touch” to iSperm, which turns an iPad into a sperm counter. WNA also likes this story about nice Canadians (he says the term is redundant) in which a woman stuck in the ED with her sick child posts her status to a Facebook new moms group worrying about her car being towed, after which several strangers feed the parking meter until she is able to leave. WNA pipes up one more time to comment on the CVS-IBM Watson story, titling it, “Come here, Watson, I need you” in picturing a CVS customer answering Watson’s questions about intestinal distress with, “Alimentary, my dear Watson.”
Sponsor Updates
An independent analyst firm places VisionWare among the leaders in master data management technology and customer satisfaction.
A Validic survey finds that 59 percent of healthcare respondents are either behind on their digital strategy or don’t have one.
DoD announces it will implement Cerner as its next EHR in a $4.3 billion initial contract through Leidos that is anticipated to be worth up to $9 billion over the next 18 years. Frank Kendall, undersecretary of defense for acquisition, technology, and logistics noted that at the conclusion of the procurement process, there was “a clear best-value solution for us.”
The Minnesota Department of Health analyzes emergency department visits, as well as hospital admissions and readmissions from 2012 claims data, finding that 1.3 million visits, generating $2 billion in spending, were potentially preventable. Pneumonia, heart failure, and COPD were the leading conditions driving up preventable ER visits.
In a follow up report from its 2015 Long-Term Budget Outlook report, the CBO discusses telehealth services and the potential financial costs or savings increased access would have on overall Medicare spending.
The Department of Defense announces that its EHR project, with an overall estimated cost of $9 billion, will be executed by the team of Leidos, Cerner, and Accenture. Leidos has been awarded a two-year, $4.3 billion renewable contract.
The Bon Secours Health System Convenes to Review the SAFER Guides By Patricia P. Sengstack, DNP
Patient safety – have we fixed that yet? Apparently not. Fifteen years after “To Err is Human” was published, we still see errors leading to adverse events in our healthcare settings.
So let’s rely on health IT to take care of the problem. Hmmmm…. It seems that health IT can actually lead to new types of errors when not configured or implemented well. I liken it to a game of Whack-A-Mole. As a new error arises attributed to health IT, we change the system or a process to make it go away. Then a new one that we hadn’t considered pops up that we have to address: orders are written on the wrong patient, a default value is provided for a medication that is inappropriate for a patient in renal failure, a result from an outside lab is manually transcribed incorrectly into a patient’s electronic record.
As we deal with each issue, we hope to become a learning health system, continuously improving to ensure our patients get the best and safest care possible. In looking for resources to support continued safety improvement efforts, we see tools emerging from our industry experts and researchers.
One such tool can be found on ONC’s website and is a collection of nine self-assessment checklists covering safety related areas such as patient identification, system-to-system interfaces, CPOE with CDS, and high-priority practices. These SAFER Guides are available on the ONC website. If you’ve read the recent Sentinel Event Alert (#54) published by The Joint Commission, you know they recommend that organizations develop a proactive, methodical approach to health IT process improvement that includes assessing patient safety risks using tools such as the SAFER Guides.
To do just this, a multi-disciplinary team from across the entire Bon Secours Health System convened to perform a self-assessment and determine areas for health IT safety improvement using the High-Priority Practices SAFER Guide. We wanted to see what this guide was all about and decide if we wanted to move forward with reviewing the other eight guides.
The High-Priority Practices guide consists of 18 evidence-based recommended practices and includes examples of how successful organizations have improved patient safety in each area. A rating scale for each practice is provided that allows organizations to identify areas of vulnerability and to help prioritize follow up activities. These ratings include Fully Implemented In all Areas, Partially Implemented in Some Areas, and Not Implemented.
Since this was the first exposure to the SAFER Guides for almost everyone gathered in the room, our intent was not to create a to-do list with assigned resources for follow up, but simply to review the guide as a group of stakeholders to understand their intent, how to use them, and determine next steps. We had about 25 people in the room that represented clinical, IT, informatics, and patient safety from our entire 14-hospital system.
We started with a discussion on recommended practice #1, “Data and application configurations are backed up and hardware systems are redundant,” then moved on to the next one, and so on. Every single recommended practice generated at least 20 minutes worth of discussion – all good. We only got through recommended practice #11 when time ran out.
Not one of the recommended practices was scored as Fully Implemented in All Areas, but some were almost there. Those were the shorter discussions. We found ourselves wishing that there was another ranking in the scale. If just about everything is “partial” without any differentiation of “partiality,” then it’s hard for an organization to prioritize which partial recommendation to tackle first, second, third. In other words, if we checked off everything as Partially Implemented, where do we focus?
I believe the group felt that the guides were validating. Never before in one place have they seen the importance of their work in black and white with references in a concise checklist. They may have heard that a particular practice was the right thing to do, but having it in this tool provides the necessary focus on things that sometimes get pushed to the back burner for system enhancements that are a bit more sexy and innovative. The list below represents highlights from our self-assessment discussions as well as some questions generated. These will help us to provide focus over the next several months:
Backup systems are currently adequate. In process of moving some backup systems to a more remote location.
Every downtime is different. If you’ve survived one downtime, you’ve survived one downtime.
We need more practice at downtime – decision making, communication, and improvements to downtime forms. If only interfaces are down, should we take the system completely down for all users?
Where appropriate, we need to ensure we are using SNOMED/LOINC terminologies, need to assess. Are there free text areas that could be coded?
Some of our naming conventions in radiology are unclear, making order entry problematic and error prone. We need to review and make improvements.
How much do we police physician use of evidence-based order sets? Do we force their use without exception?
Pharmacy build team embraces ISMP guidelines.
How do we get our vendor to help us make improvements using this guideline? They should be at the table with us during the next discussion.
End user acceptance testing as well as production validation testing are happening, but think we can improve. Problems occur when using test patients in production. (Do not assume there are no real patients in the system with the last name “Test”).
We strongly recommend using the patient’s picture for identification. If the system allows it, we should implement (and we have started in our inpatient settings).
Usability of the system can be improved. Some of the language is not clear to the end-user, making it misleading while charting. Need more inclusion of end users at both the vendor and organization level during design sessions.
We need to develop a “Top 10 Optimization List” based on our safety review.
Need better method to assess end user proficiency in order to develop effective, ongoing training programs.
At the end of the session, the group wanted to set up times to complete the remainder of the recommended practices in the High Priorities guide and then move on to the Organizational Responsibilities guide. We have the next date scheduled and will continue our review.
At no other time in our organization’s history have we convened to solely discuss health IT safety. This exercise using the SAFER guide has provided the impetus leading to valuable discussions that are only the beginning of this journey to improved patient safety.
My EHR Vendor is Losing Market Share – What Should I Do? By Jason Fortin
These are turbulent times for many EHR vendors. In fact, according to a 2014 report from KLAS, only three vendors – Epic, Cerner, and Meditech – gained hospital market share in 2013; everyone else lost more hospital customers than they won.
What should you do if your EHR vendor is one of the many that is losing market share?
Understand the market dynamics. The reality is the EHR market is shifting quickly right now, with rapid consolidation and distinct winners and losers. A number of vendors are losing customers, but there are many reasons hospitals and health systems decide to change their core EHR. Some of the shift in EHR market share is due to justified concerns about the long-term viability of certain vendors, but increasingly, it is also a result of other factors, such as recently-merged hospitals and health systems looking to align on a single EHR.
Ask the tough questions. Go beyond the headlines and try to determine why your EHR vendor is losing market share. Are these things that can change? For example, is the loss of customers a result of the vendor’s lack of executive leadership and vision? Or is it more due to the current features and functionality of the product?
It is also important to look at what types of customers the vendor is losing and how fast the attrition is happening. Are clients being lost only in a specific segment outside the vendor’s target market (such as smaller community hospitals or large AMCs)? Or are all types of customers looking to switch?
Lastly, evaluate the level and immediacy of risk. Is the loss of market share so severe that the vendor could go out of business in the next one or two years?
Don’t panic, but evaluate if your needs are being met. Look at all the factors involved. Even if your vendor is losing market share, consider how their product specifically supports your business and clinical needs right now. Do they have a clearly defined plan to support your business and clinical needs in the future?
Also consider what your vendor offers in the context of what it will take to stay competitive in your market. For example, “interoperability” is an important characteristic, but it is far more important to have a system that can exchange discrete data with the specific EHRs that are predominant in your region.
Take an objective look at the alternatives and make a decision. Evaluate the market, looking at other core EHRs as well as applicable niche solutions to get a sense of different approaches to functionality that is most important to you (i.e. data exchange, population health, etc.) Compare those to your current EHR and be honest in terms of which capabilities represent a significant improvement over what you have, which are essentially a trade-off, and which might be nice to have but aren’t critical to achieve your specific business and clinical goals.
If you decide to leave your vendor, carefully consider your options for selecting a new one. One course of action is a full system selection, which involves a thorough and comprehensive look at multiple solutions (including detailed demos and interviews), but may not be practical from a timing perspective or in cases when a replacement is urgently needed. An alternative option is a “null hypothesis” selection. This approach is focused on starting with the best potential fit based on your scan of market leaders, and then undergoing an expedited selection process with that one “null hypothesis” vendor to try and disprove why it would not be a good EHR for your organization.
The bottom line is loss of market share is a valid reason for customers to be concerned about their core EHR vendor. In some cases, it is sufficient cause to begin looking at a potential replacement. But it is also important to look at why a vendor is losing customers and to objectively look at your current system and the alternatives in the context of what your organization will specifically need to remain competitive in your market. Committing to an EHR vendor is a big decision, and unfortunately in the current landscape, it is not a decision hospitals and health systems can afford to get wrong.
Jason Fortin is senior advisor with Impact Advisors of Naperville, IL.
July 29, 2015Readers WriteComments Off on Readers Write: Meet Generation Z
Meet Generation Z By Frank Myeroff
The next generation to enter the workforce has been coined “Generation Z” or “Gen Z.” Gen Z refers to the group of people born after the Millennial Generation.
There is no agreement on the exact range of birth dates. However, according to Wikipedia, some sources start this generation at the mid or late 1990s or from the mid-2000s to the present day. Right now they comprise about 7 percent of the workforce, but by 2019 it is estimated that 30 million will be employed.
As the father of two Gen Zers, I can tell you that not only is this generation the most digitally connected, but they have no concept about life before the Internet, mobile devices, digital games, or iTunes. This screen-based generation utilizes technology as a tool to communicate, share information, be entertained, receive and complete school assignments, obtain breaking news, and so much more in every aspect of their lives.
What do we as HIT executives and hiring managers need to know about Gen Z’s arrival in the HIT workplace?
Expect leadership to be transparent. Because Gen Z knows the power of sharing and openness, they want leaders to be honest and forthcoming. There will be no place to hide for inept leaders.
Expect leaders to provide immediate results. Gen Z is used to real-time information and moving at a fast pace. They want leaders to offer exposure to new HIT projects as well as show them how to attain a high level position in a short period of time.
Plan on entrepreneurial spirit. Seventy-two percent of Gen Z expects to create and run their own startups at some point in their career. This means heavy competition. Organizations will not only have to compete against each other for talent, but against entrepreneurial startups.
Derive possible cost savings. Expect a savings by hiring Gen Z. Since they’re transient and want to work remotely from any location in the world, you’ll probably save on office space, infrastructure, and relocation costs.
Anticipate faster and easier access to healthcare. From my perspective and their use of technology, Gen Z knows that faster and easier access to healthcare is all about the adoption of emerging technology. They will expect better technical assistance and training and the adoption of HIT best practices in order to transform access to American health care. In addition, Gen Z will be demanding a higher quality of infrastructure and efficiency of operational systems in order to adopt systems that provide better quality of patient care.
Expect higher education. For the most part, when talking to Gen Z, they plan on traditional college careers, but it’s as much for the social benefits and networking connections as it is for honing IT skills. After graduation, most plan to gain higher education and many plan to accomplish this through online learning.
Plan for idealistic generation. They want to change the world, feel that their work in the HIT profession is of value to society, and love the idea of volunteer work, which many are already doing.
As more information about Gen Z emerges, it’s most interesting how they differ from other generations, including the Millennials. What will it take to attract and retain Gen Z HIT Professionals?
Create a young professionals employee group. Starting an employee group for Gen Z will engage and empower these individuals to become future leaders by providing personal and professional development opportunities. Within this group, encourage networking and civic involvement.
Provide the latest and best technology. Gen Z is accustomed to having the latest and greatest technology. They’ve been raised on smartphones, laptops, desktops, iPods, etc. and using multiple screens are the norm. Therefore, to get their attention and keep them happy, continuously invest in new technologies and provide Gen Z with the tech tools that will engage them and make them more successful.
Provide a career path that is tailored to them. As we know, the HIT industry is exploding, which is creating all kinds of employment opportunities. In order to attract and retain Gen Z, offer them a broad range of areas within your organization where they can specialize and succeed. Think about tailoring positions that leverage Gen Z’s quick adoption of technology and their desire to move up quickly.
Expand flexible work hours and remote connectivity. As the tools and technology evolve, make it part of your culture to allow remote participation in meetings. Think about embracing Web-based video conferencing and online meetings if you haven’t already.
Offer coaching and mentoring. Gen Z expects your organization to offer formal coaching and mentoring programs. They will especially need training in interpersonal skills and communication. They are so accustomed to communicating through the use of technology that most could use pointers on how to have an effective face-to-face dialogue.
refresh your rewards and/or recognition programs. Gen Z professionals need more rewards and recognition programs than any other generation. They look for accolades on even minor accomplishments. You will need to reward often and keep changing the rewards program to keep up with their expectations.
Generation Z is quickly approaching and they’re ready to live and compete in the digital world like no other. This technologically savvy and extremely innovative generation feels that they can achieve anything and they will expect your HIT organization to support them and provide growth opportunities or risk losing them.
Do you want more influence at work and life? The key to increased power is the opposite of what most of us do. Most of us hoard power. But here is the truth: the more power you give away, the more influential you are.
There are two primary reasons most people hoard power: pride and insecurity. With power we can easily become arrogant. It feels good and makes us feel important. (Maybe more important than others around us?) It begins to shape our identity and invades our ego. We become addicts reliant on a power fix to make us feel good and ignore pain.
Yesterday’s fix does not satiate today’s appetite, so we need more and when we don’t get it, we lose our security. We are no longer thankful for the opportunity to have influence. It becomes an addiction. We all know people who once were rational and lovely but became unrepentant tyrants. It’s all pride and insecurity.
I recall the difficulty of moving the “IT Agenda” forward in a specific organization. Originally technology stragglers, leadership was quick to allocate resources to any other area but IT. Clearly there are multiple approaches to overcoming this common situation and we employed many. Embracing the paradox of power was the single biggest strategy we adopted that enabled our organization to move from laggard to national leader in a very short time.
I served with a gifted CMIO who reported directly to me. Our relationship was amazing and extended far beyond the workplace. We didn’t want our friendship to change, but knew we needed broader influence, so we expanded his reporting relationships. At first it was a dual reporting relationship to the CMO and then ultimately grew to a triad reporting structure to the COO as well. This approach was so successful, we severed his reporting relationship to me entirely. We eventually took a similar path with the CNIO. The results? Laggards to leaders.
Think about it. When it was time to prioritize budget items, I had the power of a singular vote. Now, I wasn’t the only believer in the power of technology to transform how we delivered care, there were two others of the same opinion. The IT vote was essentially tripled. This is one example but you can see the principle in action. The more you give away, the more you receive. This method is effective in play, at home, and at work.
In contrast, the insecure leader tries to tighten their grip on influence. No sharing. Hoarding takes hold. Command and control. No longer viewed as a team player, the leader’s power slowly and painfully erodes and is no longer respected. Key people resign, leaving behind equally insecure “yes” men and women. In an effort to replenish and build power, energy is diverted and the insecure leader begins to self-destruct.
Not only does the leader lose, but the organization loses as well. It is an avoidable tragedy. Imagine an organization where leaders seek to share power with one another. That is where I want to serve!
The biggest blocker of giving away power is insecurity. You must be secure to give it away! Insecure leaders are easy to spot—they do the opposite. They grab for power and hold on for dear life. They protect power. They actually believe they are becoming more powerful by controlling people. Controlling reporting relationships. Controlling information. Controlling culture. Another paradox? The more they try to control, the more they become controlled, imprisoned behind bars of fear. The cellblock does not have a lock. None is required.
What is the message? Give it away. Yep. Give up your power. Give up the control. Give up the grip.
An interesting dynamic happens when you walk in the opposite mindset or what I tag “freedom.” The chains are loosened and eventually broken. As this transformation occurs, you see results that serve as motivation to give away even more. Not only did this approach help us transform healthcare delivery, but it also felt good and was fun. Insecure leaders hoarding power—not fun.
This paradox is active in every aspect of life. I had this experience with money way back when. We did not have much and everything we did have, we hoarded. We did not share. And things stayed about the same financially. One day, we started to give it away. We noticed that the door to our cell had no lock and eventually we walked out free. More money started coming in. The more we gave, the more we received.
A few years ago I posted about softball. I was the best on the team, but we were mediocre. I swallowed my pride, gave away my position and batting spot, and boom, we won every game. We went from mediocre to champions.
I could give you similar examples in love as well. Don’t argue with me until you try it. If it does not work, then let’s talk! You want more power, more love, more success, more of anything? Give away more and let the cell door slam shut behind you!
Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.
Regarding the 99% drop in AmWell stock -- True fact--I mad a profit buying AmWell on a dip once, and…