Morning Headlines 10/27/15

Medication errors found in 1 out of 2 surgeries

Researchers at Massachusetts General Hospital analyze records from 277 operations and observed that 124 of the operations included at least one medication error, one-third of which resulted in harm to patients.

Two KC health care giants team up for ‘living lab’

Truman Medical Center (MO) expands its partnership with Cerner, a fellow Kansas City organization. Under the new partnership, Truman’s IT staff will become Cerner employees and TMC will provide Cerner with a nearby “living lab” to research new solutions.

UMass Memorial to relocate 500-person IT team to downtown Worcester

In preparation for its Epic implementation, UMass Memorial Health Care (MA) will relocate its 250 employee IT staff to a new 94,000 square foot office space in Worcester, MA that will provide enough room to expand the department to 500 people.

Curbside Consult with Dr. Jayne 10/26/15

With the goal of expanding the number of meetings and conferences we report on, Mr. H is sending me to the AMIA Annual Symposium this year. I’ll be reporting on the activities each day. I’m looking forward to it as I haven’t attended previously. I’m also eager to log some hours towards Maintenance of Certification (MOC) for my Clinical Informatics board certification.

I’m not the only one looking forward to getting the continuing education credits. The AMIA listserv for the Clinical Informatics Community of Practice (CICOP) has been hopping with quite a few complaints about the whole MOC process for those of us in this new specialty. With the first cohort passing their exams in the fall of 2013, we’re decently into the first part of our 10-year recertification cycle. Those of us certified through the American Board of Preventive Medicine (the American Board of Pathology also certifies) are required to obtain a certain number of ABPM Lifelong Learning and Self-Assessment (LLSA) hours every three years in addition to regular continuing education hours.

Most of the current LLSA-approved continuing education offerings are within ABPM’s longer-standing subspecialties such as Aerospace Medicine, Occupational Medicine, General Preventive Medicine, and Undersea/Hyperbaric Medicine. The number of courses for clinical informatics are few and far between and typically involve on-site courses. AMIA has completed the process to offer LLSA hours for the fall meeting, and for those of us unable to get hours over the previous two years, it’s a huge help.

When I initially decided to try to become part of the first class of board certified clinical informaticists, I really didn’t think about what it would be like to maintain certification with two different board organizations. The American Board of Family Medicine already requires me to do 150 hours of CME each year, of which a certain percentage has to meet specified criteria. Certification by the AMA or the American Academy of Family Physicians are two of the criteria that count. Finding AMA- or AAFP-approved CME is easy. It’s everywhere, and can be earned not only through face-to-face symposia but also by reading journal articles and taking CME quizzes or doing online coursework.

We’re one of the first specialties that required Maintenance of Certification. Although the policies are a little tedious, they’re well documented and pretty straightforward. With Clinical Informatics being relatively new (coupled with the fact that many of us in the first two certification cohorts are, shall we say, fairly Type-A personalities) there’s a lot of tension around MOC. In addition to the LLSA credit, we’re also supposed to complete a “patient safety module” which is somewhat ill-defined (although ABPM did offer a link to a discounted course from the National Patient Safety Foundation that they’ll accept). A friend of mine got his university course approved as well, but the rest of us may not have that option.

I’m grateful that the Board has agreed to recognize some of the MOC (called Part IV) activities that physicians are already performing for their primary board certification. The current Clinical Informatics subspecialty certification requires physicians to maintain full certification in another American Board of Medical Specialties sanctioned discipline so it seems only fair, especially considering that the Board has yet to come out with a recognized clinical informatics module. I have to admit that the process to have my Family Medicine credits recognized was fairly straightforward, although it did require printing and completing a paper form and emailing it to the Board.

One of the respondents on the AMIA email thread mentioned that as a specialty deeply involved in computer-based projects, we should be at the forefront for virtual and online courses. Unfortunately one of the major challenges is completing the paperwork from the board to have your course recognized, which I hear is not exactly straightforward. I don’t know if there are fees involved with submitting a course offering, but that could be a de-motivator for some providers of continuing education credit.

There aren’t any well-known online providers for the kind of credit we need. Although some of our colleagues in academic settings are going to try to get their local courses certified, that doesn’t help those of us who are in parts of the country where we’re thinly populated. I’m one of two certified informaticists in my metropolitan area of over three million people, and I’m sure there are others even more sparsely arranged than we are.

One of the AMIA representatives mentioned being in contact with the Board and that we’re going to get an extension on some of the initial deadlines, but as a diplomate of the Board, I haven’t received that communication directly from them nor has it been posted on their website or in any other print media that I’m aware of. It’s understandably frustrating then for those of us who don’t want to fall behind but are somewhat stuck about what we need to do to be successful.

We’ll gather at AMIA, though, and see what kind of credits we can rack up and whether they’ll be enough to get us through the first checkpoint at the end of Year Three of our certifications. Hopefully some virtual offerings will be approved soon, or at least some recordings for those of us who aren’t willing or able to spend several thousand dollars (not to mention the time out of practice) to attend a conference in person.

It’s exhilarating to be on the cutting edge of things, but like being in the health information technology industry, it can also be frustrating and at times downright exhausting. I’m hoping that attending AMIA and networking with others in the field will help recharge some of my depleted energy and give me ideas for future projects. If nothing else it’s an excuse to visit San Francisco, which I’ve never done in the fall.

Will I see you at AMIA? Email me.

Email Dr. Jayne.

HIStalk Interviews Joseph Pocreva, MD, Colonel, US Air Force

Joseph Pocreva, MD is an emergency physician at Keesler Medical Center at Keesler Air Force Base, Biloxi, MS. He is a colonel in the United States Air Force. His views and opinions are his alone and do not necessarily reflect the official policies or positions of the Air Force.

Tell me about yourself and your job.

I’m an emergency medicine physician. I’ve been practicing for about 15 years. I am in the Air Force. I have been working in various emergency departments, Special Operations, and different areas of the Air Force.

I have been here at Keesler for approximately five years and have had various roles while I’ve been here, including flight commander, medical director, and a practicing doctor on the floor.

How much of your career is more military than medical?

Sometimes it’s not very easy to answer that question. There are some physicians who feel like they’re more doctors than they are officers. Some feel they’re more officers than doctors. I have felt both ways.

Obviously when I’m on the floor and I’m engaged with patients, I’m a doctor. Yet when I walk away from the floor, I have to interact with other places, not only in the hospital but throughout the Air Force or with engagements with the Army or the Navy. Then my role oftentimes becomes more of an officer in the Air Force. That’s in my current position.

I’ve had other positions where I had no medical role at all. It was all about being in the military and functioning as an officer. It is a switch that gets toggled quite frequently. I’m not sure if I answered the question very well. I wouldn’t be able to give you a 60 percent, 40 percent answer — it all depends on the day and the demand.

You served on a humanitarian mission to Haiti, correct?

I was in Haiti. That was in 2010, just months before I was assigned here. I was the lead medical officer in Haiti when we went into the country to open up the airfield.

Have you had other assignments or deployments to other locations?

Oh, yes. If you’ve spent any time in the military in the last 20 years, you will have deployed.

My initial assignment was at Eglin Air Force Base in Florida. I deployed to Iraq in that timeframe. I was also stationed at Hurlburt Field, which is the Air Force Special Operations base. I did a lot of shorter missions, primarily to the Philippines. That’s where I went to Haiti as well.

I’ve traveled quite a bit doing a lot of diverse things. A lot of forward medicine, dealing out in the field without a lot of hospital support, just “what I can carry on my back” type of medicine.

How have you used that front line experience from Iraq in your ED job?

I was in a forward hospital there. We had a pretty decent sized staff, but we didn’t have a lot of resources. Practicing emergency medicine in today’s world is very lab- and radiology-intense. In those settings, we just don’t have those kinds of resources. You have to rely on your clinical abilities and your ability to make a decision, which is oftentimes paralyzing to the younger clinician who depends a lot on labs and radiology and their consultant staff.

If you don’t have it, you have to make decisions. Your decisions have serious implications, because if you want to transfer somebody in that setting, you have to get an aircraft to come in and take your patient away. If you can take care of them there versus putting them on a very expensive aircraft … You have to make those kinds of decisions. There’s a lot of differences between forward medicine and medicine back home.

What it’s like practicing in an Air Force hospital ED versus a civilian one?

Some very important key differences. We practice socialized medicine. We have a very captive patient population. They all have primary care doctors. They all have access to medications. There’s a social structure which is well defined. All of our active duty people have supervisors who we can call.

It’s a very different world from the outside. I’ve worked on the outside as well. I’ve moonlit for years at many different institutions and things.

There are advantages and disadvantages to both settings, but working inside the military is what socialized medicine is, in a nut shell. Actually, I would go on to say that, as far as I can tell, it is the best example of socialized medicine that we would be able to maintain.

People forget that military medicine isn’t just taking care of active service members, but their entire families as well, so you have pediatrics, oncology, and other services.

Right. The active duty population is only a small portion of who we take care of. The majority are their dependents and then our retirees as well. It’s everything from cradle to grave.

Is military medicine care at least comparable to what is offered in civilian settings?

It is somewhere in the middle. I’ve worked in plenty of hospitals that had nowhere near the capability that we have. Then you go to some of the major medical centers which have comprehensive care … When we have patients that are beyond our capability, then we will refer them to, in our case, the University of South Alabama or the Jackson Medical Center up in Jackson, Mississippi or over to Ochsner in New Orleans. We rely pretty heavily on them.

As far as the bread and butter basics of medicine, into surgery, into your medical specialties, and what have you, what we have is quite comprehensive.

What technologies and IT systems do you use in your practice?

We have CHCS, which is our basic underlying database., It’s been in place since the late 1980s and we’re still using it to today. That is where we record all of our labs and radiology and that’s where we do our prescribing from. As old as it is, it’s solid as a rock. It never goes down, ever. Everything else can go down, but CHCS still manages to keep plugging along.

On top of that, we have a graphical interface software solution called AHLTA. When it works, it works all right. [laughs] It is a program which is designed to interface with CHCS and pull data from it, as far as all of CHCS capability. But it’s also for record-keeping and and electronic medical records. We use it primarily just as an interface to get to the CHCS data.

In our emergency department, for our recordkeeping, we use T-System, which is hands down much better when it comes to data entry than AHLTA is. Much, much, better.

Those systems may be replaced in the DHMSM project. Are you looking forward to that or concerned by it?

I don’t really know a great deal about it. I understand that Cerner won the contract to provide the next generation. There’s generally the understanding that it’s going to be coming sometime in the future. After that, I think I know enough in my career that I don’t get too excited about dates of when it’s going to come, so I don’t know when we’re going to actually see that.

I would be very surprised if it has an interface which is more user friendly than T-System. Hopefully we can find a way to integrate T-System into it. But beyond that, that’s just all conjecture, and I don’t know — I’m not a part of that whole process.

I’ve read that 60 percent or more of care delivered to military members happens outside of military facilities. How do you communicate with external providers?

That 60 percent probably reflects most of the places not around the larger institution. Around here, we probably deliver considerably more than that in our facility. But so many of the smaller bases have been reduced to clinics. A lot of that referral work and surgical procedures and things are going to be done on the civilian side, so I think we do a great deal more of it here.

However, when we do refer people out to the community, they are not on our informatics databases. We have to rely on them doing a consultation and sending the reports back to us. Then our information people enter that data back into our system. It’s a rather slow and cumbersome process.

Do you have a lot of overlap in the information that you either need from or provide to the VA?

No. We see a lot of VA patients. We have a pretty robust interventional cardiology practice here, so virtually all of their cardiac caths come here. We have a lot of vascular surgery. A lot of the VA patients come here, but we don’t use their systems, nor do they use ours. If we want that data, we’ve got to go and request it old-school style.

How long do you plan to stay in the military?

I have been in the military for 23 years right now. I will be getting out next year. I’ve already put in my paperwork to retire. I should be retiring somewhere around the first of August in 2016. I will likely be joining a local practice here in the area.

What will you miss in not being part of the military?

The people, without a doubt. My grandfather was career Navy. My father was career Air Force. I’ve been on the Air Force welfare system since I was born. I don’t know anything different.

Not only taking care of this population, which is something that is very important to me, but working alongside a lot of people who really care about being here and doing the mission and being part of something much bigger than themselves is one of those intangibles that is very difficult, if not impossible, to find anywhere else.

It will be a sad transition for me, I’m sure. Although the local hospitals around here are wonderful by any marker, it’s going to be difficult to walk away from an institution like this.

People with no military connections admire the patriotism, discipline, and sacrifice involved. Is it equally impressive from the inside?

Oh, yes. Yes. You see people with talent and abilities and what have you. You look at them and you think, "Man, you could be making a million dollars on the outside, and yet you’re in here doing this job.” I really appreciate it.

That really comes through and shines when we’re deployed. When you’re out there and you’ve been away from your family for a couple of months and people are still putting their shoulders to the grindstone and just working hard.

Sometimes the situation and the environment we’re in is less than ideal. We’ve yet to go and occupy a really great place. [laughs] We tend to deploy to less-than-ideal locations. It’s very impressive when you see people step up and do the amazing work that they do. It’s an honor to be a part of that.

Morning Headlines 10/26/15

Athenahealth (ATHN) Jonathan S. Bush on Q3 2015 Results – Earnings Call Transcript

Athenahealth stocks jumped 28 percent on Friday after reporting better than excepted quarterly results. The company added 4,800 new physicians to its platform this quarter, a 40 percent increase. It also now has three critical access hospitals billing inpatient claims through AthenaNet.

AMA’s Christine Sinsky, MD, Explains EHR’s Contribution to Physician Burnout

AMA vice president of professional satisfaction Christine Sinsky, MD reports that EHRs are cited as the biggest driver of physician job dissatisfaction. She suggests utilizing scribes and medical students to reduce the amount of data entry required of physicians.

Walgreens Scrutinizes Theranos Testing

Walgreens announces that it will halt the roll out of Theranos blood testing centers within its stores until the startup resolves questions about its technology. Walgreens, which has an equity stake in Theranos, clarifies “We’re trying to figure out where we are and what we do going forward. We need to understand the truth.”

Health Law’s Revamped Site, HealthCare.gov, to Debut on Sunday

A revamped Healthcare.gov goes live Sunday, with updates expected to increase speeds by 40 percent and add features to help consumers compare the cost vs. benefit of each insurance plan.

Monday Morning Update 10/26/15

Top News

Athenahealth shares jump 28 percent Friday after the company announces better-than-expected quarterly results. It’s now valued at $6.3 billion, with Jonathan Bush holding $51 million worth.

From the Athenahealth earnings call:

• Jonathan Bush says three small hospitals are submitting inpatient claims via AthenaNet using what is basically an interface to the acquired RazorInsights hospital information system.
• When asked about the company’s direction as HITECH winds down, Bush said, “The satisfaction and the feeling of being on-mission as opposed to on the tip of an Obama spear is phenomenal for us. No offense, Barack, I know that you’re Mr. President, but that’s just how it feels.”
• Bush described telemedicine and the addition of Chiron to its “More Disruption Please” program as, “Imagine a store whose entire inventory rots instantly at the end of each day. That’s a doctor’s office … We’ve tried hammering them too much and that hasn’t been great, e-mailing and texting and auto-calling. We’re working on a partnership with a bunch of different makers of apps. We’ve got a small team that’s toying with a universal Athena app … I imagine someday the store brand of telemedicine for Athena will expand, of course. But right now, I think the right focus is getting those new players with their new energy into the tent.”
• When asked to compare the company’s position vs. that of its competitors, Bush said, “We are the only company that’s selling a cloud-based service … No one has even a plan to think about starting to try in the sector that you guys think of as our competitors. I think of them as just a business model from a different era … That you run faster than a three-legged horse is not good enough. We really got to think about what’s emerging in the venture world and what’s possible in our business model and compare ourselves to that. We still feel like we have a long way to go on those results.”
• Bush said of the impact of Medicare’s merit-based incentive program, “The thing about the MIPS program is it creeps up on you. This year’s performance is then submitted and the government takes a year to look at the performance. Then in two years, your rates are adjusted according to this year’s performance … It’s trickier to jolt the market with it, but it’s a really big deal. It’s an 11 percent, 12 percent swing in a doctor’s Medicare take-home pay based on how he performs, or she, on this program. So we should be able to sell against it. It’s just harder to explain and to create urgency around.”

Reader Comments

From Dixie Whistlen: “Re: top 25 blogs to read. Why did the magazine list Ed Marx on HIStalk but not the rest of HIStalk? Some of those they mentioned are not even popular.” You would have to ask the magazine. I don’t read those sites or pay attention because, like all such “awards,” it’s just a scheme to get people to click through the endless slide show to fool advertisers with a higher but meaningless metrics. One of the blogs that made the Top 25 hasn’t posted anything new since March 2011 and another winner’s newest post is from December 2013, which suggests a superficial editorial vetting process.

Speaking of junk health IT reporting and meaningless reporting intended to sell ads, I just noticed that US News and World Report is announcing its “Most Connected Hospitals” list, which it has apparently been running for years. That must offer competition to the equally pointless “Most Wired” list from H&HN that achieves little except allow CIOs to pad their resumes and hospital marketing people to place yet another logo on their ads that attempt to convince the locals of their organizational competence.

From Bob Wyer: “Re: cancelled sponsors. You said you would list them each month with the new and renewing ones, but I haven’t seen any.” I did promise to do that but I promptly forgot. Companies decide to stop sponsoring for a variety of reasons: they decide to spend their marketing money elsewhere, they are unreasonably obsessed with ad clicks, I wrote something unflattering but true that made them mad, they don’t have money in the budget, or the decision was made by a marketing person who knows nothing about HIStalk or the industry in general. Anyway, here’s the list of dearly departed sponsors going back several months. I appreciate their previous support, especially those that had sponsored for several years.

From Exotic Delicacy: “Re: Caremark. They won’t allow my prescription to be filled locally, so they ship by next-day air a 12×10 inch carton containing a 9×11 inch Styrofoam cooler packed with five ice packs. The actual meds are about 1×3 inches. Besides the cost, all of that (including the chemicals) goes into the landfill.” I was musing this week of what I call the Amazon Prime effect, where my near-daily Amazon orders create a never-ending mountain of boxes and packing material that I have to scrunch and tear to squeeze them into the large recycling bin that goes to the curb weekly. It reminds me of the department store stock boy job I had while working my way through college, in which the fun chore was feeding heaps of big, flattened boxes into the mall’s paper crusher deep in the bowels of the building. I also learned to hate Christmas gift wrap since it was stored in huge quantities in a truck trailer parked out back, causing me to freeze several times a day in November and December in bringing in more big boxes of it. It wasn’t nearly as fun as my summer job working at a public radio and TV station, which didn’t require me to do a whole lot except download satellite programs like “All Things Considered” to tape for later broadcast and to read the news for our infrequent live programming.

HIStalk Announcements and Requests

It’s apparently not just me that doesn’t see Dell as a significant healthcare IT player from my extra poll last week. Machete’s comment is an admirably concise interrogatory: “Dell’s in healthcare?”

The results of my regular poll are sobering, in which 6 percent of males and 52 percent of females say they’ve been sexually harassed at work in mostly unreported incidents. Woodstock Generation hopes a lot of the harassment happened in the 1990s when reporting was uncommon, while It’s Everywhere (Unfortunately) adds, “I was harassed by multiple attending physicians in medical school and witnessed them harassing other students and even patients. It was disgusting. As a practicing physician, I have been harassed by peers. Working with software vendor employees and consultants, I have seen entirely too much harassment, mostly fueled by alcohol and testosterone.”

New poll to your right or here: would you be willing to have your lab tests performed by Theranos?

I was interested after running a TV station’s photo of a hospital documentation sheet for a chemo overdose that a couple of readers complained that I had violated HIPAA, which is surprising since we’re supposed to be the HIPAA experts. First, the family took the photos and sent them to the TV station, presumably to bolster public opinion for their lawsuit against the hospital that was involved. Second, only covered entities (health plans, clearinghouses, and providers) are covered by HIPAA. Any other perceived breach of patient privacy can be addressed only through a lawsuit, which has nothing to do with HIPAA.

Reader Derek sent $50 for DonorsChoose, which thanks to the magic of matching funds from my anonymous vendor executive and The NEA Foundation, will provide four tablets that will be shared by three pre-K classrooms in Buffalo, NY, which they will use for math practice. Meanwhile, the photos above are of Mrs. Cole’s Minnesota first graders using the math games we provided and Mr. Burnitt’s Florida elementary school class working with the model rocketry equipment we bought.

Last Week’s Most Interesting News

• Quality Systems sells its NextGen Hospital Solutions division to QuadraMed.
• Lab upstart Theranos melts down after reports question the validity and limited use of its proprietary methods.
• Vendors and providers agree on objective measures of interoperability, although not stating what those measures are or how they will be used.
• IBM turns in another unimpressive quarter despite high-profile investments in Watson.
• EClinicalWorks announces a cloud services platform, free client interoperability, and an Internet of Things cloud.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Lab innovator Theranos continues to unravel as its highest-profile partner, Walgreens, says it won’t open any new Theranos testing centers until the company answers questions about its technology and why nearly all the samples it draws are full-volume ones that are analyzed by traditional lab equipment rather than its proprietary microfluidics machines. In more bad news for CEO Elizabeth Holmes, CMS says its surveyor found nothing innovative in the company’s facilities but did observe quality control problems; some of its claimed partners (Pfizer, GSK, Cleveland Clinic) say they’ve never actually done anything with Theranos; and records show that the company has hired poorly qualified lab directors, including a part-time dermatologist who is not certified by the American Board of Pathology. Questions are also swirling about why the Theranos board is made up of old, politically connected white men without scientific or medical expertise.

Huron Consulting Group shares dropped 24 percent Friday after the company turned in decent Q3 results but also lowered revenue guidance due to expected delays in two big academic medical center projects. The company also says it has “seen a softening in demand for our performance improvement solutions,” which it attributes to stabilized hospital margins due to ACA-insured patients such that “cost reduction work at some hospitals is no longer seen as an urgent concern.”

Fort Lauderdale, FL-based healthcare business services vendor Intermedix will open an operations center, innovation lab, and executive offices in Nashville, TN, creating 116 jobs. The company says the state and city “have welcomed Intermedix with open arms,” not mentioning the open taxpayer wallet that must have influenced its decision.

Announcements and Implementations

Westchester Medical Center Health Network (NY) opens its $7 million, 5,500 square foot eHealth operations center, which contains 20 telehealth monitoring stations that will be staffed around the clock by physicians and nurses.

Government and Politics

CMS goes live with an upgraded Healthcare.gov, saying the site will be 40 percent faster and will include the ability for users to see their estimated yearly costs for each plan. Features not yet ready will eventually allow consumers to filter the list of plans to those that cover a specific doctor, hospital, or drug.

Privacy and Security

A Springfield, MA gynecologist is indicted for accepting drug company bribes for prescribing its drugs and allowing its sales rep to dig through the medical records of her patients. The smoking gun is that as soon as the drug company stopped paying her, she stopped prescribing its products.

Local police in North Carolina speculate that scammers are using data from one of the recent high-profile healthcare data breaches to send unordered diabetic supplies by mail to people who who don’t need them. A recipient whose name, Social Security number, and doctor information was included on the unordered package tried to call the pharmacy number on the invoice, but it was phony.

The Miami-Dade division of Florida’s children’s medical services program mistakenly faxes a clinic roster to four vendors, exposing the information of 150 clients.

Technology

Israel-based MobileODT offers an $1,800 cervical cancer screening tool that connects a mobile colposcope to a cell phone, allowing clinicians to quickly take a cervical image that can also be sent out for a second opinion. The technology, which was trialed at Penn and Scripps, is being used in developing countries that can’t afford a traditional $15,000 colposcope. It will be sold in the US once the company obtains FDA approval.

Other

AMA’s VP of professional satisfaction says EHRs are the biggest driver of physician dissatisfaction. She cites studies that show doctors waste 80 percent of their time performing activities that don’t benefit patients, suggesting that they hire scribes.

A study of nephrology patients finds that patient portals are being used more widely but also more selectively, with less involvement by patients who are poor, black, and elderly.

Like that old Chicago song, nobody really knows what time it is in Turkey, whose government  decides to push back the end of daylight saving time until after upcoming elections. The government doesn’t control computers and smartphones, which change time automatically based on rules rather than last-minute political pronouncements, so everybody is confused.

Centura Health SVP/CIO Dana Moore, whose ideas launched my DonorsChoose project during the last HIMSS conference, sent photos of the fundraising basketball game between the tie-dyed Centura team (which eventually won the game) and Epic. He said everybody had a great time and he’s sending me the $620 raised to fund more classroom projects, which will actually fulfill more grants when I apply the matching funds I have available. Good work by Centura, Epic, and Dana.

Weird News Andy deems Sunday’s Dilbert as “HIStalk worthy.” It’s a big panel – click the image to see it full size.

Sponsor Updates

• T-System and Wellsoft will exhibit at the ACEP Scientific Assembly October 26-29 in Boston.
• TeleTracking will host its client conference October 25-28 in Las Vegas.
• Health Catalyst releases a documentary titled “Measured Outcomes: A Future View of Value-Based Healthcare.”
• Valence Health will exhibit at the Arkansas HFMA Chapter Fall Conference October 29 in Little Rock.
• Versus Technology helps cancer clinics nationwide enhance the patient experience with real-time workflow technology.
• Huron Consulting Group will exhibit at the Connected Health Symposium October 29-30 in Boston.

Blog Posts

• Are you ready for bundled payments? Increased quality and safety reporting measures? (Nordic)
• EMV: Maybe Not Such a Big Deal for Healthcare Providers (ZirMed)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 10/23/15

Quality Systems, Inc. Board of Directors Approves Sale of NextGen Healthcare Hospital Solutions Division

NextGen’s hospital business is sold by its parent company Quality Systems to QuadraMed. Financial terms were not disclosed.

athenahealth, Inc. Reports Third Quarter Fiscal Year 2015 Results

Athenahealth reports Q3 results: revenue for the quarter was $236 million, up 24 percent, adjusted EPS $0.36 vs. $0.27, beating analyst projections on both.

New Research Finds Significant Number of Americans Not Getting Care at Right Hospitals

Healthgrades publishes a report concluding that patients treated in a 5-star rated hospital have “a 71 percent lower risk of dying or a 65 percent lower risk of experiencing complications” as compared to patients treated in a 1-star hospital.

Drug compounder offers cheap version of costly Turing drug

San Diego-based Imprimis Pharmaceuticals will begin selling a generic version of Daraprim for $1 per pill, down from its current price of $750 per pill, after national attention was drawn to the drug’s current manufacturer Turing Pharmaceuticals and its business model of buying the rights to rare but necessary medications with no generic equivalent and raising the price astronomically.

EPtalk by Dr. Jayne 10/22/15

This week is one of those “you can’t make this stuff up” kind of weeks. It’s been filled with plenty of hard work, a fair amount of organizational dysfunction, and some pretty cliché observations.

Despite the challenges, I’m working with some genuinely nice people who seem to want to be successful and that makes all the difference. I’d rather work with people who know they have issues and want to try to be better than with people that think that everything is just fine when it’s not.

The practice I’m working with provides a fair amount of cash-based services (mostly cosmetic) and we dealt with some complaints about the lack of support for those workflows by their EHR vendor. It’s been interesting trying to explain why vendors have been spending all their time and energy on MU-related features and functions when the providers don’t care about being meaningfully used.

We did get some quick documentation templates done for a couple of their most common procedures, so that was a big win. One of the partners was so happy with the new workflow that he offered to give me some complimentary services. I wasn’t sure whether I should be excited about that or offended that he obviously thinks I need some work.

The physicians also have traditional primary care patient panels, but it feels more like a sideline rather than their focus. They’re trying to get in step with current primary care trends, but it’s a hard sell when you can make more money smoothing wrinkles, lightening dark spots, and making irksome leg veins go away.

Since they’re in a building on the hospital campus, several of the physicians hit the physician lounge for lunch every day even though they don’t admit their own patients. They’ve been taking me with them and it’s been enlightening to see what some of their peers think about the state of healthcare IT since I haven’t done much work in this part of the country.

I almost spit my sweet tea across the table when one physician said that since he was going to switch EHR vendors in the spring, he was going to go ahead and apply for a MU hardship exemption. He’s got connectivity issues with his current “lousy” system and has decided to just stop charting electronically. I’m not sure that qualifies as an extreme and/or uncontrollable circumstance, but he’s welcome to try. The vendor in question has tens of thousands of physicians who have successfully attested, so it’s an interesting position to take.

The practice is one of the first I’ve been in recently that still has pharmaceutical representatives call on the physicians. Most of the reps I’ve encountered over the years are hard-working and spend a lot of time dealing with cranky physicians as they haul samples from their company cars (used to be a lot of Ford Taurus-equivalent sedans, but now I’m seeing a fair number of minivans). The highlight of the week was the sales rep that pulled up in a new Maserati that cost more than my first house. He turned out to be EHR vendor’s regional sales exec. I guess he’s not hurting for business.

While I was fielding agenda changes from the client (who apparently thought of 20 other projects for me to work on during the time I was en route), I got a couple of emails from family members. My grandfather had a bone marrow biopsy last week and was told the results would be available in eight days. He dutifully called the office at the end of the eighth day after hearing nothing, only to be told that the physician would be out of town until October 29 and no one else in the office could give him results.

He sent his primary care doc a message through his patient portal trying to get the results, but was asking me for advice (as were his wife and my aunt). I thought it would be better to try to get in touch with the hematologist’s partners, who would presumably have access to his chart and would know what question the bone marrow biopsy was to answer or what condition was to be confirmed or ruled out. Even if he could see the results in the hospital system, I didn’t think this particular primary care physician would be likely to give them since he wasn’t the ordering physician.

I suggested that they call the hematologist’s office again and ask what the physician’s coverage arrangements are while he is out of town, and if they were told there aren’t any, that they mention the words “patient abandonment” and see what happens. This isn’t a question of a patient misunderstanding how he was to get the results – his discharge instructions clearly said to call for results in eight days. As a physician, I’m horrified at this kind of a process failure and the stress and worry it’s causing the patient and his entire family.

A couple of hours, later the PCP responded, basically saying he doesn’t know much about interpreting bone marrow results but that it “doesn’t look that bad.” That’s not exactly a vote of confidence for a worried patient. I saw the screenshot of the secure message and he definitely could benefit from a little coaching on how he explains things to patients. We’re still waiting to hear back from the hematologist’s office, who said their office manager would be calling to explain the cross coverage arrangements. Like I said, you can’t make this stuff up.

Turning my attention back to the client’s workflow issues, we identified several more commonly-seen conditions where the EHR didn’t fully meet their needs. I headed back to the hotel to get some additional custom templates built before selecting my next dining adventure. Several readers have commented or emailed about their BBQ preferences. The Carolinas are leading Texas two to one and I’ve received some suggestions I can’t wait to try. Tomorrow I’m finishing the day with a tour of the local Bass Pro, which promises to be something to behold.

Where do you get your local color? Email me.

Email Dr. Jayne.

News 10/23/15

Top News

Quality Systems sells its NextGen Healthcare hospital systems business to QuadraMed, which is part of Canada-based Constellation Software’s N. Harris Computer Corporation. QSI formed its hospital business by acquiring Opus Healthcare Solutions in 2010, ViaTrack Systems in 2011, and the Poseidon Group in 2012. It appears that NextGen will keep its Mirth interoperability product (the announcement didn’t say, but while the hospital solutions web pages are gone, the Mirth ones remain).

Meanwhile, Quality Systems reports Q2 results: revenue up 4 percent, adjusted EPS $0.21 vs. $0.13, beating Wall Street estimates for both.

Reader Comments

From The PACS Designer: “Re: HHD vs. SSD. The need for 500GB or 1TB hard drives for computers will start to diminish with the growth of cloud services. One option that could accelerate the replacement of HHDs is solid state drives (SSD). As the price of SSDs declines they become more attractive to manufacturers who will then shun the HHDs in favor of a 256GB SSD-4GB DRAM system. Western Digital’s acquisition of SanDisk seems to validate the SSD concept of lowering the purchasing costs of systems.”

From So Cal Surf Legend: “Re: Antelope Valley Hospital, Lancaster, CA. Has selected Cerner. Official announcement coming soon.” Unverified, but Cerner was their vendor of choice a few months back. It’s a 420-bed hospital.

HIStalk Announcements and Requests

HIStalkapalooza sponsorships are looking good, meaning I probably won’t have to write a personal (and thus NSF) check for many dozens of thousands of dollars to personally cover the cost. The remaining sponsorship slot is the top-level one I call “Rock Star CEO” that includes:

• 100 invitations.
• A private lounge (capacity 100) with its own bar and food plus two VIP boxes for entertaining prospects, partners, and company executives.
• The company CEO introduces the band, gets four all-access passes, and enjoys a meet-and-greet with the band back stage after their performance.
• An on-stage banner.
• Special recognition from the stage.

Contact Lorre if you enjoy the HIStalkapalooza vibe and want to play a key (and visible) role in producing it for the fun and influential attendees. She would be happy to consider any special needs our Rock Star CEO might have, right down to removing the brown M&Ms.

An anonymous reader donated $50 to my DonorsChoose project, to which I added double matching funds from my anonymous vendor executive and The NEA Foundation to fund a grant for Mrs. Smock’s elementary school class in Buena Park, CA that provides an Apple TV and external hard drive so that students can gain confidence and presentation skills by sharing their ideas with their classmates. Meanwhile, Mrs. Rice sent photos of her Washington third and fourth graders doing programming projects on the laptops we provided, noting particularly an increase in programming interest by the female students.

Early bird registration for the HIMSS conference ($765 for members) ends December 14, just in case you (like I) haven’t signed up yet. I was interested to see in the registration policies that attendee emails aren’t shared with exhibitors, so nobody should get promotional emails, instead having their snail mailbox filled with the usual junk that keeps coming weeks after the conference has concluded. The last policy acknowledges agreement of a condition involving photographic images that isn’t actually listed, so apparently you can take all the pictures you want, not that the old policy stopped anyone anyway. The cheapest hotel still available is Linq at $90. I’m pretty much dreading the conference, especially with the screwy Monday through Friday schedule driven by the overriding desire of casinos and hotels to fleece the weekend tourists.

My Twitter feed has been barraged this week with uninteresting cheerleading updates from Dell’s technology conference. I admit that I don’t think of Dell as a significant, committed healthcare player despite its previous acquisition of companies like Perot Systems and InSite One, any more than I think of other big hardware vendors like IBM and HP as anything more than low-margin vendors dabbling in higher-margin services du jour. I’m interested in whether I’m in the minority and thus created this special poll: how much healthcare influence does Dell have? You can explain what I’m missing in the poll’s comments.

This week on HIStalk Connect: KLAS analyzes interoperability across EHR vendors, naming the best technologies and vendors from a provider perspective. Jawbone wins an injunction against several key Fitbit employees in its suit alleging trade secret theft. Rock Health reports on consumer engagement, outlining which digital health categories are attracting the most attention. Theranos closes out its week of public feuding with the Wall Street Journal with a blog post confirming accusations that has stopped using its finger-stick lab test technology for the time being.

This week on HIStalk Practice: Healthcare.gov bashing ramps up. Virtual tools could be the panacea PCPs have been looking for. Hello Health CEO Nat Findlay explains what physicians need to know about getting paid for CPT 99490. Teladoc celebrates 1 millionth visit. American College of Cardiology members take their EHR usability woes to Washington, DC.  Kenneth Iwuji, RN explains what med students really think about healthcare IT. Practice managers weigh in on how the rise in high-deductible health plans has fueled their technology spend. Hologram house calls become a reality.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

PatientSafe Solutions acquires Vree Health, which offers patient engagement and care management tools. It was owned by drug company Merck.

Post-acute EHR vendor Netsmart acquires behavioral EHR provider Lavender & Wyatt Systems.

Athenahealth reports Q3 results: revenue up 24 percent, adjusted EPS $0.36 vs. $0.27, beating both revenue and earnings estimates. Share price jumped 8 percent in after-hours trading following the announcement.

Microsoft reports Q1 results: revenue down 12 percent, adjusted EPS $0.67 vs. $0.65, beating earnings estimates and sending shares up sharply after the market’s close Thursday. 

The Milwaukee business paper covers the launch of Waukesha-based Intellivisit, which offers virtual diagnosis, triage, and appointment scheduling.

Sales

Behavioral Center of Michigan and Samaritan Behavioral Center (MI) will implement Medsphere’s OpenVista.

Jellico Community Hospital (TN) will implement Medhost’s clinical and financial applications.

People

Micky Tripathi, PhD (Massachusetts eHealth Collaborative) joins the board of The Sequoia Project.

Ed Caldwell (MediTract) joins CarePayment as chief revenue officer.

Announcements and Implementations

DrFirst announces myBenefitCheck, which offers prescribers real-time “what will this prescription cost this patient” advice that uses the patient’s drug benefit insurance coverage to display their out-of-pocket cost. It integrates with 300 EHRs via the company’s e-prescribing system.

TransUnion Healthcare’s eScan solution is named the #1 product in collections outsourcing and AR debt by Black Book.

The Delaware Health Information Network forms a joint program with ISpecimen that will allow researchers to search the de-identified medical information of patients whose lab samples are being stored by DHIN members. The researchers then request the samples that look potentially useful and the hospital ships them to the researcher. It’s an interesting funding source for DHIN, which will then discount its fees for participating members. ISpeciment founder and CEO Christopher Ianelli, MD, PhD was a managing director for investment bank Leerink Swann and co-founded Health Insight Technologies, which was renamed Humedica and then acquired by UnitedHealth group for an undisclosed but assuredly large amount.

Healthgrades research finds that one in six Americans received care in a one-star rated hospital, observing that had they chosen a five-star hospital instead, they would have had a 71 percent less chance of dying and a 65 percent risk reduction for complications. It also observes that hospitals may excel only in specific areas, such as the 14 Chicago hospitals that earned a five-star rating for heart attack treatment but had a one-star rating for total knee replacement, hopefully helping consumers understand the “focused factory” concept similar to the idea that you don’t order the steak at a seafood restaurant just because it’s on the menu.

T-System posts a conceptual video that will be presented to the ACEP Scientific Assembly next week that describes how cars equipped with GM’s OnStar system could send details of an accident to a T-System-equipped ED before the patient arrives. The OnStar system can predict severity of injury using vehicle, crash dynamics, and occupant information.

Imprivata Cortext is named in a KLAS secure messaging report as the most-considered product for physician-to-nurse communications.

Qualcomm’s Capsule subsidiary earns FDA 510(k) clearance of its SmartLinx Vitals Plus patient monitoring system.

Cedars-Sinai becomes the zillionth health system to get involved with a health accelerator, which would seem to be late in the game except for the fact that those that preceded them appear to have accomplished basically nothing anyway. It would be interesting to survey all of those eager startups who are seeing firsthand just how monolithic, indecisive, and change-resistant big health systems accelerator operators are.

A CoverMyMeds study finds that 70 percent of EHR vendors are committed to offering electronic prior authorization, up from 54 percent in March 2015.

Park Place International announces an expanded set of high availability solutions for Meditech and 100 other healthcare applications via its OpSus Healthcare Cloud and Microsoft Failover Clustering Services.

Privacy and Security

A Germany-based cybersecurity company says that 27 percent of all website malware attacks targeted healthcare-related sites so far in 2015.

Other

An unfocused article in left-leaning magazine Mother Jones blames left-leaning Judy Faulkner and Epic for lack of interoperability, blasting a blitzkrieg of marginally related facts that seem overly focused on how much money Epic makes and how elaborate its campus is. It observes that HITECH didn’t address interoperability. The reporter misses the fact that EHR vendors deliver what customers demand and few turf-protecting health systems are interested in sharing information with their competitors even if their EHR already supports that capability. The reporter concludes the piece by expressing his frustration that his multiple providers don’t share his information, conveniently not bothering to ask those providers why that’s the case. He also complains about the lack of information sharing by his hospital (George Washington University Hospital), which he fails to note uses Cerner, which he lauds elsewhere in the article for its interoperability as evidenced by the DoD deal and joining CommonWell. Lastly, he misses the point that providers weren’t required to buy anything from Epic, Cerner,or anyone else to collect HITECH bribes – they only had to use them in the prescribed manner. It’s valid that HITECH was mostly a waste of taxpayer money and that interoperability is nearly non-existent, but the market forces that created that situation aren’t nearly as simple as he describes.

The Albuquerque newspaper digs into the tax records of Presbyterian Healthcare Services to find that three of its highest-paid contractors are connected to its EHR. The health system paid Epic $14.5 million, T-Systems North America $9.9 million, and Leidos Health $9 million. Presbyterian has spent over $200 million on Epic. It has $1.5 billion in annual revenue and paid its CIO $429K last year.

Jamie Stockton of Wells Fargo Securities sent over their latest analysis of MU Stage 2 attestation. Epic led the hospital numbers with 97 percent of eligible hospitals attesting, while the lowest-performing vendors (in the 50 percent range) are Medhost, Allscripts, and Healthland. Epic and Athenahealth lead the MU Stage 2 physician attestations at just over 70 percent, while users of systems from Allscripts, NextGen, Greenway, Cerner, McKesson, and GE Healthcare have an extremely low attestation rate. All of this may be more of an indictment of the MU process than whose system they’re on. 

Siemens Soarian user SoutheastHealth (MO) will move to Cerner Millennium, although they will stick with Soarian billing.

Prescription compounding firm Imprimis Pharmaceuticals will sell a generic version of Daraprim – the old rare-disease drug whose new owner increased the price 5,000 percent to $750 per dose – for $1 per custom-made capsule. The San Diego-based company says it will start making cheap versions of other one-source generics whose price has skyrocketed, exploiting the fact that compounding pharmacies are not required to submit their products through lengthy and expensive FDA approval. Shares of Imprimis are traded on the Nasdaq, where the company has a market cap of $57 million.

Cherokee Nation’s health services are live on Cerner.

A child at St. Christopher’s Hospital for Children (PA) is given a tenfold overdose of cancer chemotherapy due to a manual dose calculation performed from instructions on a custom roadmap that contained a typographic error.

Weird News Andy codes this story as W20.8XXA, as a man napping under a tree in a San Francisco park is struck on the head by a falling 16-pound pine cone. He’s suing the US Department of the Interior and the park for $5 million, which his attorney says he will need for long-term care.

Sponsor Updates

• Experian Health will exhibit at the Healthcare IT Transformation Assembly October 25-27 in Miami.
• PDS IT will exhibit at the Midwest 2015 Fall Technology Conference October 25-27 in Detroit.
• The SSI Group and Streamline Health will exhibit at The Summit of the Southeast October 28-30 in Nashville.
• Surgical Information Systems will exhibit at Anesthesiology 2015 October 24-28 in San Diego.
• Iatric Systems, Leidos Health, Nordic, and Obix will exhibit at the Midwest 2015 Fall Technology Conference October 25-27 in Detroit.
• Extension Healthcare will receive the Greater Fort Wayne Business Weekly 2015 Innovation Award in the technology category for its alarm safety and event response platform.
• The local paper interviews retiring Healthwise founder and CEO Don Kemper and his wife, SVP Molly Mettler.
• InterSystems is recognized for the second year in a row as a leader in the Gartner Magic Quadrant for operational database management systems.
• Intelligent Medical Objects will exhibit at Netsmart’s Connections 2015 user group meeting October 25-28 in National Harbor, MD.
• LiveProcess will exhibit at the 2015 Vermont Healthcare and EMS Preparedness Conference October 22-25 in Jay.
• MedData will exhibit at the ACEP Scientific Assembly October 26-28 in Boston.
• Phynd Technologies http://welcome.phynd.com/eBookoffers a new e-book, “The Benefits of a Unified Provider Management Platform.”
• Navicure will exhibit at MedTrade Fall Conference October 27-29 in Atlanta.
• Netsmart will exhibit at the Ohio Council Annual Conference October 22 in Columbus.
• Orion Health hosts the 2015 North American Healthcare Collaborative October 26-28 in Scottsdale, AZ.

Blog Posts

• Green Eggs and Hippocrates (PatientKeeper)
• Inside Secure Texting: Reaching On-Call Physicians & Surgeons (Practice Unite)
• A Rising Star is Born (Phynd Technologies)
• HHS’ ICD-10 Code is Here to Stay (Porter Research)
• ONC’s Interoperability Roadmap: Keeping the Focus Where it Counts (Surescripts)
• Are you ready for bundled payments? Increased quality and safety reporting measures? (Nordic)
• Here’s why I Heart HIT, as an executive and a mom (Wellcentive)
• Before you hire that backfill support team, ask yourself 5 questions (Hayes Management Consulting)
• 5 Best Practices When Attorneys General Get Involved in Your Data Breach (ID Experts)
• The Payment Experience Patients Want (InstaMed)
• It’s Out There for the Taking: Time to Saddle Up and Grab Your Data by the Horns (Liaison Technologies)
• LifeImage Company Party Photo Album (LifeImage)
• It’s the Weekend – Let’s Be Careful Out There (MedAptus)
• SayIt Code Fast service helps providers adapt to ICD-10 requirements – at the point of care. (NVoq)
• Road Dog’s Top 10 Realities of Healthcare Reform (Forward Health Group)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 10/22/15

Genetic Testing Company 23andMe Returns to Market

After a two-year hiatus, personal genome testing vendor 23andMe resumes offering direct-to-consumer reports on DNA-based risk for diseases like Alzheimer’s and cancer. 23andMe was shut down by the FDA in 2013 for marketing the service to consumers without approval.

Theranos Founder Elizabeth Holmes Attempts To Clear Up The Bad Blood With WSJ

Theranos CEO and Founder Elizabeth Holmes follows last week’s very public feuding with the Wall Street Journal by attending the WSJ Live conference this week, where she sat for an on-stage interview about the allegations being made about her company.

Sasse Will Block All HHS Nominees Until Feds Provide CO-OP Answers

Karen DeSalvo, MD will likely have to wait for her assistant secretary for health at HHS nomination to be confirmed, as US Senator Ben Sasse (R-NE) promises to block consideration until the administration addresses the high rate of failure for co-op insurance plans established under the ACA.

Former ONC policy chief Jodi Daniel heads to D.C. law firm

Jodi Daniel, JD, MPH has joined Washington DC law firm Crowell & Moring. She left her position as ONC’s policy director last month.

Readers Write: ICD-10 is a Win for Patients

ICD-10 is a Win for Patients
By Ken Bradberry

There has been conversation about how the ICD-10 transition will impact unsuspecting patients. Maybe a procedure is delayed due to an inaccurate code or a bill is incorrect. These things will almost certainly happen. While the first days have gone by without significant disruption, it is inevitable that bumps will occur, as with any major technological implementation.

The real story is how much patients have to gain from the transition. ICD-9 was over 30 years old and didn’t keep pace with the dramatic advancements in the healthcare industry. Consider this short list of examples:

• Laser and laparoscopic surgeries were not performed at the time ICD-9 was implemented, but are common medical techniques today.
• Treating a heart attack 30 years ago was generally limited to medications to treat pain and an irregular heartbeat. Today, doctors can quickly evaluate what is causing the attack and treat accordingly – bust clots with new drugs, insert a stent to prop open a narrowed vessel, even sew new vessels into the heart during surgery.
• The first HPV vaccine approved by the FDA in 2006 has significant potential to prevent cervical cancer and is widely recommended by the Centers for Disease Control and Prevention for girls and young women.

This is just the tip of the iceberg in terms of how far medical advancements have come in the last 30 years. There has also been significant change in our health with newly discovered medical conditions and the rate at which diseases are diagnosed. For example, the CDC reports melanoma rates have doubled over the past 30 years, but chickenpox cases in the United States have dropped sharply since the vaccine became available in 1995.

Clearly the healthcare landscape today is almost unrecognizable from where it was 30 years ago. Patients have different healthcare concerns and conditions and have many more options for prevention and treatment.

ICD-10 has about five times as many codes as ICD-9. The codes are much more specific in describing a diagnosis and treatment plan, allowing for providers and payers to have a more detailed and accurate conversation about a patient’s care. This will not only improve accuracy of statements and bills received by a patient, but also improve health safety and outcomes.

Here is an example of ways a patient may benefit from ICD-10 throughout the healthcare experience:

• Diagnosis. During a routine medical exam, a spot is detected on a patient’s lung that requires additional investigation. The healthcare provider orders a series of procedures that require ICD-10 coding to be completed. Because ICD-10 codes are more granular, scheduling the procedure with the right resources is more likely, and therefore a more accurate and timely diagnosis is possible. The precision offered by ICD-10 will not only lead to a more precise diagnosis, it will also provide the provider with more insightful information to guide treatment plans.
• Eligibility determination. This same patient has health insurance which requires testing, procedures, and treatment to be authorized. The ICD-10 codes provide the payer more specific information on the services being provided, which can result in a timelier eligibility determination. This can avoid unplanned cost to the patient and frustration working through a billing issue.
• Quality outcomes. Improved clinical documentation under ICD-10 will help reduce medical errors and also lead to more meaningful discharge data that can help reduce readmissions.

In order to quickly navigate the hiccups caused by the massive transition and quickly get to the point where patients are experiencing real benefits, it’s critical for all stakeholders involved in the delivery of care to choose a partner who can successfully lead them through the complexity of ICD-10.

Ken Bradberry is chief technology officer of Xerox Commercial Healthcare.

Readers Write: The Benefit of Price Discrimination

The Benefit of Price Discrimination
By James Foster

In his Monday Morning Update for 10/12/15, Mr. HIStalk first affirmed the effectiveness of the market in selecting among EHR vendors. Later, in response to a price survey, he expressed frustration with disparate costs of services, saying, "I still don’t understand why providers shouldn’t be required to offer their lowest prices to everybody." His complaint here is with what economists call "price discrimination.”

There are two general justifications for price discrimination: (1) differences in costs to the seller and (2) differences in value to the buyer. Cost differences may explain things like quantity discounts, since even if the widgets cost the same to produce, the marketing and sales costs are less if the seller has to deal with fewer buyers.

Even with the same quantity of what seems to be an identical product or service, there may be hidden costs that can justify a difference in price. For example, the price for a television purchased on credit in a poor neighborhood may be much higher than the price for the same model paid for in cash at a suburban Costco. Here the product is not just the electronics, but also the transaction costs involved in offering credit to poor-risk buyers.

Differences in value to the buyer are no less real and can be justified as a way to ensure that the goods are available at all. Most of us are familiar with the fact that adjacent passengers on the same flight can pay very different prices for the trip. On the one hand, this seems unfair ("I still don’t understand why providers shouldn’t be required to offer their lowest prices to everybody"). On the other hand, it is often the case that if everyone were charged the same price, the product or service could not be supplied at all.

That is, if the airline ticket prices were uniformly high, fewer people would make the purchase and the total revenue would not be sufficient to cover total cost. Likewise, if prices were uniformly low, the planes would be full (aren’t they already?) but the total revenue still would not be sufficient to cover total cost.

In order to provide air travel, airlines must segregate buyers into those that place lower value on the trip (vacationers who could drive or choose a different destination) and those that place a higher value on the trip (business travelers). This discrimination serves to benefit travelers who would not make the trip unless they still have some value over the price.

Healthcare providers face similar challenges as airlines: capital costs are high and marginal costs are low. Yet charging everyone the same (high or low) price would not yield enough revenue to pay for the equipment and staff. Therefore, quantity discounts are offered to large groups (represented by credit-worthy insurance plans) who can take their business across town, while unknown individuals who buy on credit typically face higher prices.

If this still seems unfair, before calling for more government regulation through price controls, we should investigate how government regulation might be contributing to problem. There are a few areas in healthcare where prices are standard, published, and declining over time, such as Lasik eye surgery. These typically are procedures where the consumer is responsible for the full price of the service and takes time to investigate before making a purchase.

Instead of imposing price controls (which have been disastrous in a variety of industries), we should look for policy changes that encouraged more consumer involvement and responsibility.

James Foster is director of operations for GemTalk Systems of Beaverton, OR.

Readers Write: No One Likes the Waiting Game

No One Likes the Waiting Game
By Janie Tremlett

No one likes waiting in line with seemingly no information about when the wait will end, especially when sick or nervous about seeing a doctor. The frustration doesn’t end when you’re called out of the waiting room. Need to get vital signs captured? X-rays taken? Blood drawn? Most likely each of these steps occur in different locations and with different practitioners.

Confusion on the part of the patients about where to go and who to see, combined with staff confusion about where the patient is in the process, can make for a less than optimal experience for both the staff and the patients. In an age where providers’ revenue is contingent upon their patient satisfaction scores, managing patient flow and delivering a superior patient experience is more important than ever. A few ideas …

Intelligent Patient Queuing

Average wait times by provider or facility can be displayed on queuing display monitors and can be updated dynamically when a patient is called off the queue. For added convenience, patients can be summoned off the queue in method that is preferred by them, whether it be via an SMS text, an email, or a phone call. They don’t have to be tethered to a waiting room chair waiting for their names to be called. Instead, they can grab a bite to eat in the hospital cafeteria or take care of any other issues.

Patient and Family Preferences

It sounds simple, but it cannot be emphasized enough: patient demographics need to be understood. Patients in waiting rooms are often anxious and sometimes frustrated if they’ve been waiting there a while. Giving them a way to keep busy while they wait, over and above the typical waiting room magazines, can go far. Providing toys and games to children in a pediatric waiting room setting makes sense, but how many waiting rooms have you been in that provide Wi-Fi for adults? Likewise, offering entertainment infotainment that is pertinent to a certain demographic — like screening live athletic games in a sports medicine office — would resonate with patients.

Patient Communications

We can expect, if you haven’t seen it already, a significant expansion in regards to mobile communication within healthcare. One of the benefits of this expansion is the new ease it brings in communicating with patients. Providers can send reminders about appointment dates and times to patients via SMS as well as give patients insight into expected wait times pre- and during service. Affording patients the ability to communicate to their providers in this same way is key. When a patient can easily and conveniently communicate any delays or early arrivals he or she is experiencing, the hospital staff can then re-route that patient or other patients to accommodate the change in schedule.

Real-Time Dashboards

With real-time reporting and dashboards, staff can track a patient’s whereabouts and status at any point as well as the time spent in each location. With this information, hospitals and other providers can identify any breakdowns in processes or bottlenecks in certain departments so adjustments can be made quickly. If patients routinely spend too much time waiting to get their blood drawn, staff can be reassigned to the lab so more patients can be seen. Likewise, if a patient is waiting to see the doctor but the doctor is running late, the patient can be directed to the lab to get blood work done if there is availability there.

Way-Finding and Patient Tracking

Way-finding, real-time location systems (RTLS) technologies, and Bluetooth beacon technologies are rapidly becoming part of hospital IT infrastructure. Within the hospital, geo-location services hold great promise for patient flow management, such as being able to guide a patient to locations relevant to their appointment, track assets (such as key equipment used to move or discharge patients), and monitor staff actions, such as time spent with patients and how often a patient was seen.

Patient tracking also enables context-specific messaging for visitors, like targeted health promotion campaigns based on a patient’s specific movements and location. For example, offering reminders to patients to get their annual eye exams as they walk by the eye clinic in a hospital.

Early implementations of way-finding and patient tracking solutions have not married patients’ whereabouts to staff workflow. Tethering these two is helpful so staff can mitigate problems and issues as they arise and where they arise. If staff realize they’re running behind, for example, and a patient happens to be waiting in the hospital cafeteria, the staff could capitalize on their knowledge of the patient’s location and send the patient a voucher for a free coffee or something similar to enjoy during their wait.

Pleasing patients isn’t always easy, but ensuring that they move through their hospital or provider’s office quickly and efficiently can help satisfy them. Leveraging patient self-service, intelligent workflows, and reporting can create an information-rich tool for staff to monitor patient flow and an empowering experience for patients.

Janie Tremlett is GM of patient solutions at Vecna Technologies of Cambridge, MA.

Readers Write: The Patient Perspective (aka, Who Just Knocked the Floor Out from Under My Feet?)

The Patient Perspective (aka, Who Just Knocked the Floor Out from Under My Feet?)
By Teri Thomas

On the plane back from a short vacation in the Caribbean, my throat and head began to ache. It worsened until I suspected strep throat. 

After waiting 30 minutes (in a room with other ill people) at the nearest urgent care, I was curtly informed that my insurance no longer covered my care there. Miserably, I drove to the next closest urgent care while I called my insurance company for guidance. They directed me to their web site and asked me for names of individual physicians. However, I just wanted the nearest place to get a strep test. 

I pulled into the next urgent care lot and gave my insurance company their address. Not covered. Third choice was covered, so I waited in the queue and eventually was swabbed. After an hour or so, they informed me it was negative and sent me home with “Tylenol and rest.” I felt a little ashamed to have wasted their time and resolved to toughen up.

Two days later, my sore throat had worsened. I was spiking fevers over 102 and my headache became the worst in my life. My body ached and shook and the pain made light and normal sounds hard to tolerate. I held my head in my hands while my husband drove me to the ER.

The ER nurse gave me a medication. When I asked her what I it was, she said, “la-la.” I found it strange (I had no idea what la-la was), but since it hurt to talk, I let it be. Then the doctor came in and asked me what pain medication I was given. I was embarrassed — all I knew was that the nurse called it la-la. Strangely, he seemed OK with that and he didn’t choose to clarify or comment (it was Dilaudid). They drew blood and did a spinal tap, suspecting meningitis. Things began to move around me, giving me the feeling of being an object instead of a person.

They admitted me to the hospital, bundling me in blankets for chills and medicating the pain, while trying to figure out what my illness was. Each doctor gave me a different diagnosis, often confidently. The epidemiologist said, “It’s dengue.” I had chest x-rays and was told pneumonia. The next doctor said I did not have pneumonia. 

My husband and I wanted the doctors to talk with each other. It didn’t appear that they did, as my husband or I had to inform each doctor about what the others had said. The neurologist asked me questions, but never shared his conclusions. I had to painfully recount the course of my illness to him and the others.

Respiratory therapy was a lifeline because they stayed in the room enough for me to be sure I knew who they were. A curious thing to me was the feeling that I existed “in part” to the various specialists. I was a CNS, or pair of lungs, or a Caribbean vacation. 

Some of the doctors seemed to go as fast as they could in their questions. I felt like a speed bump in their race to their next (maybe more important?) patient. As a patient taking pain medication, it was difficult for me to keep up with them, and since I didn’t have time to prepare for a new visitor (they were a surprise), I gave regretfully jumbled and incomplete information. 

After explaining my history and situation for the third time, I hand wrote the timing, sequence of events, and main symptoms on a piece of paper for new physicians or providers to read. It seemed strange that they didn’t seem to want to read it.

It meant a lot to have someone look me in the eyes.

My attending was a foreign-born hospitalist who directed his dialogue to my husband as if I weren’t there. Being a fairly assertive person, I asked him to please include me. With his mouth, he said, "What can I do for you?" yet his eyes and body language said, "You are wasting my time." 

After being denied by nursing, I asked him for the results of my labs and he said he couldn’t do that. He then asked which ones specifically, and only then verbally answered for those specific tests I could think of the top of my head. A printout or online access would have been much better. Not getting information about my own body was incredibly frustrating. It felt disrespectful, as this was happening to ME.

There was a big sign directly in front of my bed that said, "Medications, always ask– explanation, dosage, side effects." Not once did a doctor or nurse ever offer side effects or dosage information. During times of decent pain control, I found the sign humorous.

In writing this, I struggled to find the best word to sum up how the admission felt. Words that come to mind include humiliating, confusing, and castrating (in the sense of taking away one’s strength). I was a strong, educated, independent woman, used to being on top of things (and directing others) with a solid understanding of healthcare, medical terminology, and hospital operations. Suddenly, I had no control over my schedule, no idea who or what was coming next, was highly vulnerable due to pain and pain medications, and I was afraid — something painful and strange was going on in my body. 

My toilet was set with a plastic catcher to measure my urination, but it sat there overflowing because nobody emptied it. There was a white board in my room with some basic information (e.g. name of my nurse), but it was often incorrect. The pain meds made it hard to track what was going on, yet I seemed to be the owner of communicating my situation to all of the changing players around me. I started taking my own notes in a notebook to ensure I was telling people the correct medications. 

The alarms, blood pressure cuff squeezes, and noise outside my room meant I slept fitfully at best. When I did sleep, I had intense nightmares that caused me to wake in an utter panic. Maybe from my mystery illness, maybe from the medications. Either way, it was intense, and I was grabbing for any sense of control or understanding that I could. 

I was reaching for blocks of reassurances (seeing my labs directly, seeing my problem list or diagnosis notes, being told what or who was coming up and when). Simply hearing my care team collaborate and come to me informed and with a unified hypothesis would have made an enormous difference.

Eventually my blood work showed I was stabilizing. The pain began to subside enough that I — knowing the risks of hospital-acquired infections — asked to go home and recover there. I was told a few weeks after discharge that two blood tests were negative for dengue fever, so I never did find out a definitive diagnosis. I got a copy of my H&P and discharge summary and found it humorous to see how little useful information was included, yet there were numerous references to how pleasant I was (surprising, as I was in terrible pain and struggling to be pleasant, but also not very relevant). 

It certainly could have gone better, and I’m sure for some patients, it does. I can almost hear the comments, “My patients don’t want their lab information; it would just confuse them.” Fair enough. Each patient is different. However what they have in common is a desire to feel respected and listened to. 

If folks are interested, I’m happy to post what happened after that—the experience with post-hospital care coordination, billing, how this relates to HCHAPS, as well as concrete suggestions and lessons learned. Do let me know. Having worked in healthcare for 25 years, this experience has energized me to continue to try to make things better. 

Teri Thomas is vice president of Epic Systems of Verona, Wi.

Morning Headlines 10/21/15

IBM Reports 2015 Third-Quarter Results

IBM reports Q3 results: total revenue was $19.3 billion, down one percent from 2014, EPS $3.34 vs. $3.68. Q3 marks IBM’s 14 straight quarter in which revenue fell. Stock price dropped 5.7 percent on the news.

KLAS publishes inaugural interoperability study

KLAS publishes its first interoperability report, concluding that private vendor HIEs are the best value-to-effort interoperability option, and reporting that Athenahealth is the easiest system to connect with, followed by Epic and Cerner.

UCHealth-Aspen hospital partnership improves record system

11-bed Aspen Valley Hospital (CO) will partner with the University of Colorado Health to implement Epic within its facility.

Jack Adcock death: Accused doctor ‘called off resuscitation’

In England, a doctor at Leicester Royal Infirmary is fighting manslaughter charges after missing abnormal lab results for a pediatric patient in part because the hospital’s computers system had failed. As the patient deteriorated a Code Blue was called, which the doctor halted because he mistakenly believed there was a DNR order in place.

Curbside Consult with Dr. Jayne 10/20/15

I wrote last week about interoperability, mentioning that attempting to connect through Direct has added confusion for providers like me who have multiple practice situations or multiple locations. A reader commented, “vs. how many fax numbers to create an out-of-paper trail with?”

That’s a very good question. It points to a larger problem with EHRs – one that most if not all providers complain about – which is the shifting of work from staff to providers.

Sometimes this is in the name of efficiency. Why have the patient wait for the referral to be entered when the provider can just do it at the point of care? Why have the provider have to tell a staffer when he or she can do it real time?

In many cases, this is a misguided attempt at efficiency. Although we can reduce the number of steps in a process, that’s not everything we look at when we map workflows. We also need to look at the cost of various people doing various tasks. It often doesn’t make sense for providers to do certain steps that EHR workflows are trying to force them to do.

Other times this is in the name of patient safety. In its purest form, this makes sense. Having providers enter medication and laboratory and diagnostic orders can prevent transcription errors and allow them to acknowledge warnings and alerts. It’s a good use of some of the most expensive employee hours in the office. Unfortunately, that thinking has driven a lot of work upstream that organizations haven’t yet redistributed to where it is most appropriate.

In the paper world, my referral process involved a single page flow sheet where I marked what to send in the referral bundle and who to send it to, along with a diagnosis. My medical assistant knew the short list of common referrals and where to send the packet. They managed that list of fax numbers and locations, not me. They knew whether to send the packet to the West Office for a Thursday appointment or to the South Office for anything else.

Now that the referral workflow has been embedded into the provider workflow in my EHR, I’m supposed to manage those facts while I’m sitting in the room with the patient, because they system wants me to complete it before I move on.

Of course, I could simply send an electronic task to my staff and ask them to do it, but that takes me out of my standard workflow as well. Don’t get me wrong, I’m excited about the ability to exchange secure messages with consultants and colleagues and have a copy added to the chart automatically, preventing phone tag and manual note-writing. But if it’s too complicated to find my key providers, I’m going to struggle.

Two of the three systems I use on a regular basis have no way for the physician user to create their own address book or contacts list outside of the practice. One has a robust partial search where I can search a metropolitan area for a given physician. The other requires me to know the specific postal city associated with my target’s ZIP code. Honestly, I need to just search for Dr. X who is a cardiologist in the Chicago area. I have no idea whether they’re in Oak Park or Oak Brook and neither does my patient.

These are usability issues as well as workflow issues. I can’t help but think that if vendors did more trialing of product with real-world physicians they would be better able to identify these things up front. We know from recent publications that vendors vary widely in how they perform usability testing (if at all) and how valid the results might be.

I’ve been on some usability focus groups as a participant and it’s hard to manage bias and dominant behavior by some members. I’ve also supported usability testing for vendors and know that it’s hard to find knowledgeable participants who are willing to take time out of their busy schedules to participate in a usability study unless you throw ridiculous amounts of money at them. Even then the output varies widely.

There are also physician psychology issues at play when work gets redistributed. Physicians realize how lean their offices run and can be reluctant to shift work to staff members that are struggling to get out of the office on time to pick up their children or tend to other obligations. Employers may be unwilling to pay overtime or to approve the hours needed to actually do the work, so someone has to take care of it and often that is the provider. There is also a perception that it’s quicker to just do the work yourself rather than ask someone else to do it. Couple this with a lack of time and energy to do the actual process improvement work needed to fix the underlying workflow issues and it’s a recipe for dissatisfaction all around.

I’m working with a practice this week that has engaged me to do some workflow re-engineering, so this is in the center of my thoughts. I’ve worked with them before and the issues are complex. They only took about 20 percent of my advice last time, and although they initially made progress, ICD-10 and two software upgrades have caused some chaos.

They’re one of the last independent practices in their community and does a mix of traditional primary care and somewhat fringe (read: cash only) services. The owner doesn’t really have a head for where primary care has been going in the last few years and I’m not sure he’s committed to doing what needs to be done to be successful. Frankly they’d be better off transitioning to a retainer or concierge-type practice, but they don’t want to do that either.

It’s shaping up to be an interesting week and I can guarantee no boredom or downtime as I dig in with these folks. Not to mention they’re in one of the best cities in the US for barbecue, so I have nothing to complain about for dining choices this week.

What’s your favorite BBQ locale? Email me.

Email Dr. Jayne.

News 10/21/15

Top News

KLAS rather histrionically reports (placing itself prominently in the story) that vendor CEOs and provider CIOS will “lock arms to make a difference” in supposedly agreeing to unstated objective measures of interoperability as John Halamka reported on his blog October 6. They will then “work closely with Washington to help alleviate the interoperability measurement burden faced by the government.” The obvious problem is that technical standards reflect capability, not reality, and the ultimate test of interoperability is best assessed by patients trying to get all of their providers working from the same basic information. It matters little that a provider’s EHR scores high on interoperability if it isn’t willing or able to share information.

Reader Comments

From Stewart Scrooged: “Re: Ministry Health Care. CEO announces that 500 employees will be RIF’d in what he calls ‘future-sizing.’ Last day for the chosen ones will be 11/28/15. Merry Christmas!” Unverified.  Any organization that lays off employees in November or December is desperate, incompetent, or cold. The best thing about layoffs is that while companies jettison their least-valued employees, their best ones get the message and start looking elsewhere, closing the karmic loop.

From Lab Matters: “Re: Jeb Bush’s health plan overhaul. This is not a repeal and replace proposal. This tinkers on the edges of the ACA. And, not to be cynical, but wouldn’t the reduction in the barriers to entry really benefit his cousin Jonathan? He’s another phony crony wanting more giveaways to the private sector at the expense of the public good. Is the ACA perfect? Not by any means. But fix it. Stop with the ‘repeal’ madness that will go nowhere. Playing to his base by saying that is what he is doing and then NOT actually doing it is disingenuous at best. Sorry, Jonathan. Maybe you are the smart Bush people keep referring to since clearly isn’t Jeb.” Jeb Bush’s health plan says Obamacare has made a messed up health system even worse as the federal government took over one-sixth of the country’s economy, concluding that  it “embodies the liberal idea that Washington needs to and can solve every problem,” hurting middle-income families in the process as premiums increase and healthcare choices decrease. Bush’s health IT proposals involve eliminating the Meaningful Use program and associated penalties and publicly releasing all raw, de-identified Medicare and Medicaid claims data. I agree with a lot of what he suggests, although I think his emphasis on innovation as a solution is probably misplaced, repealing the ACA is unlikely, and the idea that all of America  (including Fortune 100 companies, medical associations, pharma, and their cadre of lobbyists) will obediently line up and scrap a system that made them rich is naive. His main focus seems to be letting the states run healthcare, which isn’t how it was done in those many countries whose citizens enjoy better and cheaper care than we do.

From Pilsner: “Re: Peer60 EHR report. It does not meet the basics to be called credible. Could you please ask for and publish the N value and demographic information?” The report did not cover EHRs in general – it specifically looked at ambulatory “organizations” that are either hospital-owned or independent. It was what Peer60 calls a “First Reaction” report that collects and publishes information quickly rather than exhaustively, which in this case involved 184 respondents, according to the company. It should be noted that Pilsner has a vested interest in Meditech and therefore in questioning the Meditech-unfriendly survey results.

From Follicular Folly: “Re: Cardinal Health. I was bidding for a health IT services contract and was required to take a hair follicle drug test through DC-based Metro Labs. The location was in a tiny hall, the office was beat up, and supplies were thrown all over the shelves as the entire staff conversed in Ethiopian. They said the hair had to be three inches long, and without warning, the manager chopped off two handfuls worth! I reported this to Cardinal Health, who asked what they could do, and I gave them some requests. They removed me from consideration because they couldn’t accommodate those requests. Now I have a chunk of hair missing and can’t get work .” The Yelp reviews for Metro Labs are mostly scathing.

From Mineopie: “Re: Catholic Health Initiatives. Recently entered into a managed services agreement with both Cerner (inpatient EHR) and Allscripts (outpatient EHR), just announced same for Deloitte AMS to manage Epic markets.” CHI announced the Cerner contract in July 2015 and an Allscripts hosting agreement in November 2014. They’ve been working for years with Deloitte, which announced earlier this year that it would turn its CHI Epic work into a service called Evergreen.

From Bilge Water: “Re: tweets. Your social media posts on Facebook and Twitter get good attention from companies. Nice!” Correction – they sometimes get the attention of twenty-something marketing assistants who are assigned the task of making companies look hipper than they really are by tweeting and Facebook posting on their carefully controlling behalf. It’s not as though any big company’s CEO has actually seen what goes out under the company’s Twitter and Facebook accounts, much less that he or she is writing it personally or retweeting it. It’s easy to forget in a Twitter-induced fog of pedantic kindred spirits that that most of the world, including a high proportion of business executives, has zero interest in what’s on Twitter because it’s just people talking to themselves hoping desperately that someone else is listening.

From Yukon Gold: “Re: Medicare Part A hold for outpatient claims due to Local Coverage Determinations needing to be updated in their system. They are targeting an October 23 turnaround, but this is exactly what hospitals worried about — the federal government NOT being ready for ICD-10.  This is a big deal for anyone without large cash reserves that has a payer mix that isn’t mostly commercial.” Unverified.

HIStalk Announcements and Requests

Just over half of poll respondents are interested in Meaningful Use news, while the almost-half that includes me has grown weary of the topic. New poll to your right or here: have you ever been sexually harassed at work? I’ll trust your own definition.

Thanks to Jenn for covering the last couple of posts for me. You will agree with me that she did her job well if you didn’t notice anything different.

I’ve been following the Theranos drama, happy that I had long ago already covered all of the now-hot questions about the company in previous HIStalk posts — that only one of its tests is FDA approved, that its microfluidic methods haven’t been independently validated against traditional ones and make up a minority of its tests, and that the still-small company seems secretive and has a weird but high-powered board. Here’s the thing, though – the microfluidic and nanotainer stuff makes the company sexy to Silicon Valley types and hypes its potential valuation as a technology play, but its real innovation is rock-bottom lab test pricing. Patients will get lab work done no matter how their blood is drawn even though they might prefer the Theranos-exclusive finger stick. Investors might like the company less than before, but patients should be happy that Theranos is trying to break the oligopoly of big lab companies and hospital labs whose technology allows them to process most tests for nearly no incremental cost while charging high prices. Theranos is lucky it isn’t publicly traded yet since the stock would otherwise be tanking on the barrage of criticism.

Ms. L says her Indiana kindergartners love using the two Kindle Fires we bought via the DonorsChoose project, enjoying small-group Kindle Station time every day for practicing letters, numbers, and shapes. I have a few weeks left to use the matching funds generously provided by an anonymous vendor executive for donations of $100 or more. Companies or individuals can follow these steps:

1. Purchase a gift card in the amount you’d like to donate.
2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.

Here’s another DonorsChoose photo I received from Ms. Klotz, whose Illinois kindergarten class received math learning centers from us. She says the students love hands-on math work in practicing measurement, geometry, number operations.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Former HBOC Chairman Charlie McCall has been paying an army of lawyers for years in trying to have his 2009 criminal conviction for securities fraud and his 10-year prison sentence overturned. He failed again this week as the US Supreme Court rejects his argument that his legal counsel was ineffective.

IBM announces Q3 results: revenue down 1 percent, adjusted EPS $3.34 vs. $3.68, with its sexy product lines like Watson, cloud computing, and mobile computing failing to stop the bleeding. Revenue fell for the 14th straight quarter, missing analyst expectations and sending shares down sharply on Monday. Above is the five-year share price of IBM (blue, down 2 percent) vs. the Dow (red, up 55 percent).

MMRGlobal, a self-proclaimed personal health records vendor whose business focus instead is filing patent infringement lawsuits, will conduct a one-for-five reverse stock split in hoping to strike deals with health IT firms (presumably to buy vague, dormant patents to keep their suit-filing lawyers busy). Maybe they should have gone 1,000-to-one since the OTC market shares are trading at $0.0038, valuing the company at $3 million (the price is so low that the major markets just report it as zero). Both share price and revenue are down 70 percent in the past year and cash flow is negative. Bob Lorsch owns 46 million shares, which sounds like a lot until the calculator shows their value as $175,000.

The Right Place, which connects hospitals with nursing homes for patient placement, raises $2 million.

India-based Attune, which offers a hospital information system and medical device integration, raises $10 million in Series B funding from Qualcomm Ventures and Norwest Venture Partners.

Welltok acquires children’s health gamification platform Zamzee from HopeLab, a non-profit started by eBay founder Pierre Omidyar.

Payments and EDI vendor InMediata raises $4 million

Healthcare API vendor Redox raises $3.5 million. 

Sales

West Georgia Health (GA)  chooses Agilum Healthcare Intelligence. 

Cooper University Health Care (NJ) selects eHealth Technologies for record aggregation and analytics.

Baptist Health Care (FL) chooses Allscripts products Sunrise, Sunrise Revenue Cycle Management, EPSi, FollowMyHealth, and dbMotion, beating out Cerner and Epic. Baptist was running McKesson Horizon for inpatient and NextGen for outpatient.

Hartford HealthCare (CT) will implement Glytec’s eGlycemic Management System in its five hospitals.

People

Cynthia Kilroy (Optum) joins Huron Consulting Group as managing director.

Announcements and Implementations

In England, a doctor on trial for killing a six-year-old boy by ordering a Code Blue team to stop trying to save him after confusing him with another patient who had a DNR order admits that she also missed abnormal blood test results that were read to her over the telephone during hospital computer system downtime.

New Zealand announces plans to implement a single national EHR over the next 3-5 years.

Johns Hopkins University School of Medicine and Microsoft will work together on technology that will collect ICU monitor data to highlight big-picture trends for a given patient. They will revise Project Emerge, a Hopkins ICU redesign project that integrates ICU monitoring data via a tablet app.

Aspen Valley Hospital (CO) will implement Epic with the help of University of Colorado Health. The announcement says the implementation will give UCHealth “expanded opportunities for clinical collaboration with the goal of keeping care close to home,” which sounds a lot like using Epic to lock in referrals.

Beaumont Hospital – Farmington Hills (MI) — the former Botsford Hospital — goes live with Epic. They previously ran McKesson Paragon.

Summit Healthcare announces that four hospitals have implemented its Scripting Toolkit – Wellspan Health, Halifax Health, Nathan Littauer Hospital, and Phoebe Putney Health System. Also announced were upcoming upgrades to the product.

Qpid Health announces GA of Qpid Groupers for Epic, a subscription service of clinical content uploaded via an Epic-provided import tool. 

Privacy and Security

Apple removes several hundred apps from its App Store that were found to be using technology developed by a China-based advertising company that collects user information to push targeted ads.

Other

A New York healthcare staffing agency apologizes for running a nurse employment ad in the local Pennysaver that specified, “no Haitians.”

ZDoggMD has turned out some impressive music videos, but now he’s pimped himself out as an Athenahealth spokesperson and is making commercials rather than art. His new one incorrectly blames EHR vendors rather than regulators and bill-payers for the computer work he and his peers are required to perform as a condition of being well compensated, which is like complaining that TurboTax is terrible because it involves paying taxes. He also fails to mention that the employer of those providers (or they themselves) purchased those EHRs voluntarily. Given the functionality requirements of the typical hospital or practice, an innovatively designed new product would look quite a bit like the old ones, excessive clicks and all. We’re the only profession in which the highest-paid workers are expected to peck on computers all day – you would dump your attorney or accountant in a heartbeat if they wasted their expensive time typing while you’re talking. You may also correctly assume that the top-ranking executives of health systems and health IT vendors rarely sit at a keyboard despite their evangelism of the idea for everybody but themselves.

A KLAS interoperability study of minimally described methodology finds that Athenahealth’s EHR is easiest to connect to, followed by Cerner and Epic. That conclusion is pretty much negated by the admission by both vendors and providers that the technology isn’t the problem with lack of interoperability – it’s lack of agreement on standards and the willingness to actually share information.

More drug pricing nonsense and unintended consequences: Congress requires FDA to issue “priority review vouchers” as a reward to companies that develop a drug for underfunded diseases.The vouchers guarantee that FDA will review their next drug in six months instead of its usual 10 months. Drug companies are selling their FDA-issued vouchers on the secondary market, with AbbVie recently buying one from another drug company for $350 million just to cut the FDA’s bureaucratic review time by four months. You can bet that whatever drug they’re developing will be expensive if getting it on the market a few weeks earlier is worth that kind of money.

A study finds the obvious – large health systems are buying up physician practices and then jacking up their prices in using their consumer brand recognition clout to force insurance companies to pay more. What’s unknown is whether those notoriously inefficient health systems will fare better than they did in the 1990s, when they bought a lot of practices only to be shocked by the resulting drop-off in physician productivity.

Weird News Andy says, “I’m not dead yet … well …” in describing a man in India who wakes up as his autopsy begins, only to die later in the ICU.

Sponsor Updates

• Direct Consulting Associates and HDS will exhibit at the Midwest 2015 Fall Technology Conference October 25-27 in Detroit.
• Divurgent and Cerner Health Conference attendees raise $2,000 for Children’s Mercy Hospital (MO).
• Caradigm posts an infographic on clinically integrated networks.
• EClinicalWorks recaps its user conference in a series of posts.
• Clinical Computer Systems posts an integration video for its Obix perinatal database system.
• Extension Healthcare will exhibit at the 2015 CALNOC Conference October 26-27 in Long Beach, CA.
• Healthwise will exhibit at the HealthTrio 2015 Users Group Conference October 26-28 in Tucson, AZ.
• Aprima will exhibit at the AAP Experience National Conference & Exhibition October 24-27 in Washington, DC.
• Aventura and Crossings Healthcare Solutions will exhibit at the 8th Annual Regional DV-NJ Chapters HIMSS Conference October 28-30 in Atlantic City, NJ.
• Bernoulli releases a new case study featuring Hospital for Special Care, “Achieving Clinical Clarity from Ventilator Overload.”
• Forward Health Group will sponsor the American Heart Association’s Heart Innovation Forum in Chicago on October 29.
• CapsuleTech will exhibit at Anesthesiology 2015 October 24-28 in San Diego.
• Impact Advisors publishes a white paper titled “Summary and Analysis of the MU Final Rule: Modifications in 2015-18 and Stage 3 Requirements.”
• Caradigm and CoverMyMeds will exhibit at the Midwest 2015 Fall Technology Conference October 25-27 in Detroit.
• CareTech Solutions launches a new video series, “Women in IT.”
• CenterX CEO Joe Reinardy will speak at the 2015 Real-Time Benefit Verification & ePrior Authorization Forum October 22-23 in San Francisco.
• CitiusTech will exhibit at IBM Insight 2015 October 25-29 in Las Vegas.
• Craneware and its client Parkview Health (OH) will present “Enterprise Pharmacy and Supply Chain Revenue Integrity’ at HFMA’s MAP Event on October 26 in Fort Lauderdale, FL.

Blog Posts

• Galen Healthcare Solutions is THE Best Place to Work (Galen Healthcare Solutions)
• Orthopedics: Specialists Report Top Challenges (Greenway Health)
• Post Go-Live Stabilization: 4 Challenges and Tips for Success (Hayes Management Consulting)
• Complex, Inefficient Workflows are a Cyberattacker’s Best Friend (PatientSafe Solutions)
• CMS updates to MU Stage 3 and 2015 reporting (AdvancedMD)
• An Overview of California’s New Multi-Language Prescription Drug Labels Law (First Databank)
• Navigating the Sea of Innovation: Targeting the Right Audience with the Right Tools (AirStrip)
• 23 Disturbing Statistics about Mobile Security (AirWatch)
• Reducing Hospital Readmissions Through Medication Management (Besler Consulting)
• How Advanced Micro-Segmentation Can Reduce the Risk of Data Breaches (Burwood Group)

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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

Morning Headlines 10/20/15

Healthcare Vendors Agree To Interoperability Metric During KLAS Keystone Summit

12 EHR vendor executives met in Utah last week to establish a vendor-neutral set of metrics that KLAS will use to evaluate vendor interoperability performance moving forward. Participating EHR vendors included: Allscripts, athenahealth, Cerner, eClinicalWorks, Epic Systems, GE Healthcare, Greenway Health, Healthland, McKesson, Meditech, Medhost, and NextGen Healthcare.

Johns Hopkins and Microsoft Collaborate to Redesign Health Information Technology for the ICU

The Johns Hopkins University School of Medicine partners with Microsoft will co-develop an ICU surveillance system that integrates information from various medical devices and monitors for key trends and complications.

Technology Must Let Doctors Be Doctors

Athenahealth CEO Jonathan Bush pens an op-ed calling for a push to improve the user experience for doctors working in EHRs. The op-ed coincides with the launch of a new Athena-hosted public forum on the subject, and a Jay-Z inspired music video from ZDoggMD.

Digital Health Consumer Adoption: 2015

Rock Health publishes findings from its first survey on consumer adoption of digital health technologies, finding that less than 20 percent of the general public engages with any digital health tools beyond online searches for medical conditions and online doctor review sites. Interestingly, the survey found no correlation between adoption rates and age, gender, income, or education.