Cerner unveils an HL7 FHIR-based API that will provide its customers a way to integrate EHR data with third-party apps and other health IT applications.
A local paper covers the October 1 go-live of Meditech at 640-bed Phoebe Putney Health System (GA). CIO Jesse Diaz reports that the switch over generated upwards of 1,000 calls a day in the command center initially, but that in the week since going live the system has stabilized and morale in the hospital is good.
It’s funny how you look at things differently when you’re a physician or healthcare provider. I’m always noticing automated external defibrillators (AEDs) when I’m in public places, especially now that they’re nearly everywhere. Most places have them prominently displayed with clear signage and the cases are either red or bright yellow so they’re easily seen. When I was recently on Capitol Hill, however, I noticed that the AED of Congress sits in a nondescript pedestal in a subdued black case. No matter where your politics lie, it’s somewhat ironic that Congress operates in a different world than what most of us know.
Since the Meaningful Use rules were published earlier this week, hundreds of health IT people were spending thousands of hours poring over them. Several of my colleagues lamented that it was a huge waste of time since there’s a high likelihood that Congress will create legislation to delay the start of Stage 3 beyond 2018. Without my crystal ball, though, to know if that will be true and when it will happen, I had to dig into all 1,300+ pages of goodness like everyone else. You know you’re an informatics geek when you’re joining your informatics friends in tweeting photos of the cocktails you’re drinking while you’re simultaneously reading federal regulations.
After a while, they became mind-numbing and I just had to quit and go to bed. When I woke up, I unfortunately did not discover that MU had all been a dream. I did discover invites to some CMS webinars, though, which helped provide an excuse to procrastinate the reading until I could listen to the highlight reel.
I tried to register for the webinar, but kept getting a Windows Live Meeting error. It finally registered me after trying multiple times over the next several hours. I started working some issues with my clients and discovered that one of them only sent out 70 claims for the first two days on ICD-10. Although they didn’t experience any unusual rejections, that’s a fraction of the number of claims that should have gone out with the average physician seeing 30 patients per day and this being an organization with more than 100 physicians.
My client is the IT department. They engaged me to figure out what’s going on. After entirely too many phone calls, we determined that apparently the operations team decided to switch to a system where 100 percent of patient visits receive review by a certified coder. Unfortunately, they didn’t let anyone on the IT side know, so IT has been chasing their tails trying to figure out what is going on.
Although 100 percent review certainly reduces your risk of miscoded claims, it’s not realistic in most organizations. I think these folks just gave themselves a self-inflicted cash flow problem. I gave the IT department some advice on how to quickly transition from 100 percent review to representative sampling, but I’m not sure they’re going to be able to get the operations management to listen.
Fast forward to Thursday, when I attended the CMS Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs Final Rule Overview webinar. I’m curious about the inclusion of an additional 60-day public comment period. Although HHS is “committed to working with stakeholders,” what are they really going to do with the information? The comment period is limited to Stage 3, so it sounds like they’re leaving the door open for further changes even if Congress doesn’t act.
Webinar pro tips from a seasoned trainer: when you do introductions, put up a slide that lists the name and credentials of the person speaking. The first speaker was introduced so quickly I barely caught her name. The entire time we were looking at the title slide for Elizabeth Holland, who was the second speaker. Her title, however, was not listed. Although many people know “everyone” in the MU community, not everyone knows exactly who you are and why you’re speaking. She did apologize for the overloaded webinar and that people that were turned away – it should have been something they could have anticipated based on the issues with the registration.
Due to the vastness of the 752-page rule, the webinar largely focused on modifications to Stage 2 and in particular what we need to know for 2015. Attendees were encouraged to read the entire document to find responses to their questions.
The highlight reel for MU Stage 2:
No flexibility in using CEHRT certified to previous edition criteria. Providers must use 2014 Edition CEHRT in 2015 and subsequent years until they transition to 2015 Edition CEHRT, which is required for reporting in 2018.
Much emphasis on aligning 2015-2017 Modified Stage 2 measures to Stage 3, which will be required for everyone in 2018.
Alternate measures and exclusions remain largely unchanged from the proposed rule. These help providers who planned to attest for Stage 1 or Stage 2 to be able to meet Modified Stage 2. These were essential since the rule was released later than anticipated. They’re fairly detailed and were addressed as each measure was covered. I got lost in the details on a couple of them, so I’ll do like the presenter and refer you to the Final Rule for details.
CPOE landed at 60 percent for medications, 30 percent for labs, and 30 percent for radiology.
Hospitals are at 10 percent of discharge meds meeting the same criteria.
Transition of care requires use of the CEHRT to create a summary of care record; more than 10 percent of transitions of care and referrals must be transmitted electronically.
Patient education is 10 percent for EP unique patients seen during the reporting period and also 10 percent for EH patients admitted to the inpatient or ED places of service.
Medication reconciliation remains at 50 percent of transitions of care to the EP or EH/CAH.
Patient electronic access threshold is 50 percent to receive access within four days for unique patients seen during the reporting period. For 2015-15, only one patient seen during the reporting period must view, download, or transmit. This goes up to 5 percent in 2017. Hospitals must provide access within 36 hours of discharge for more than 50 percent of patients. The VDT thresholds are the same.
Secure messaging has to be enabled for the reporting period in 2015 on a yes/no basis. For 2016, at least one patient must engage in secure messaging. For 2017, this goes up to 5 percent.
Public health reporting has four measures and several nuances, so I’m going to refer you to the rule here as well. Frankly this was covered 45 minutes into the call, so I had glazed over a bit. I zoned back in when they were talking about a FAQ on this issue, so my advice is to read all the FAQs and act accordingly. (And by the way, they change all the time, so you might want to appoint someone to check them daily.)
No changes to CQMs and the period is 90 continuous days.
For Stage 3:
Removes redundant, duplicative, and topped out measures (no surprises here) and intended to reduce provider burden. Not sure it meets the mark on the latter.
The presenter started talking about specific measures and their changes without a supporting slide. I got completely lost. They were not reviewed in detail.
The comment period closes December 15.
Tips for 2015:
Confirm your stage.
Update your registration information through NPPES including email and payment information as well as surrogate users. Ensure your 2014 Edition EHR identification information is documented.
Reporting periods are any continuous 90 days in the calendar year except for hospitals, which can go back to the last quarter of 2014.
Attestation opens January 4, 2016 and runs through February 29, 2016.
If users claim they can’t meet the requirements because the rule was so late, they should apply for a hardship exception. Expect the FAQ to be up shortly.
I didn’t really expect it, but I would have liked to have them at least acknowledge the fact that they put a 90-day reporting period in place for this year, yet announced the requirements after the last possible 90-day period had already started. I know that’s what all the exclusions are about, but it just seems overly complex when it’s supposed to be simplifying and consolidating things for us. Being able to acknowledge a mistake is also a good customer service move. Vendors still have to support multiple sets of reporting and performance criteria.
As a side note, I’ve never heard the CAH abbreviation for Critical Access Hospitals pronounced as “Caaaa,” so that was a bit jarring every time I heard it.
Please excuse any typos or errors in my summary. I’m frantically typing it after a long day of “real job” work so Mr. H can get it to press.
Have you finished the rule? What are your thoughts? Email me.
Cerner opens client testing of its SMART on FHIR standard that has been released to Millennium production. Demonstrating their SMART on FHIR solutions at CHC next week are VisualDX, xG Health, and Boston Children’s Hospital. The company is also calling for interested developers to become part of its ecosystem. This is what the market says it wants – an EHR vendor (one of only three big inpatient ones) that opens its system to third parties to give more choices to its users. It’s a pretty big deal if you ask me.
Reader Comments
From Light Brigade: “Re: Meaningful Use. Do I detect little interest in the new regulations?” You certainly do from me. The Meaningful Use program, not unexpectedly, has turned into just another government program administered by its own well-intentioned but self-preserving bureaucracy. It has wasted an immense amount of industry energy and taxpayer billions with questionable results. We would have been much better off, as I said when it was first announced as a stimulus program, letting the free market dictate the health IT market rather than bribing providers to either use products they already owned a bit differently or to buy EHRs that weren’t selling without Uncle Sam’s subsidy. I just don’t care any more. The government already sets our healthcare agenda as the largest healthcare payer and provider, getting providers to sell out to keep the Medicare and Medicaid payments flowing while complaining constantly, and MU has turned into one more carrot-then-stick distraction and providers unwittingly made possible by taking those early stimulus checks. The government should be involved in setting standards, but not dictating the terms of provider-patient relationships or mandating technology use. I’m not sure all that money and energy made much of a positive difference for patients whose concerns are more about the cost and availability of insurance and care delivery rather than what’s running on the computer in the exam room. We should be talking about how to fix our screwed up healthcare system rather than how to automate the existing mess using old IT systems that chase old incentives.
From Comfortably Numb: “Re: clicks. A nurse told the Health IT Standards Committee recently that it took her more than 500 clicks to admit a patient. That tells you all you need to know about EHR usability.” Actually, that tells you all you need to know about the US administrative requirements for delivering care and accepting insurance company payments. The number of clicks is a reflection rather than a cause of that complexity. Everybody loves shooting the EHR messenger (Epic in this case) instead of the endless requirements by cheap-seaters for clinicians to capture irrelevant, non-medically contributory patient information.
HIStalk Announcements and Requests
I’ve been playing around with some of the health insurance sites like Healthcare.gov and Stride Health (which seems to be loaded with technical problems related to removing/adding prescription drugs from the user’s profile) under various scenarios. It’s interesting to me that despite their high cost, most of the medical insurance plans those sites suggest don’t kick in at all until the member has paid a $6,000 deductible – the member pays the entire cost of visits, prescriptions, etc. before the plan starts paying 100 percent. The high cost of hospitalization and prescription drugs means that a lot of people will then incur the full $6,000 cost plus the annual premium of around $3,000. I’m not sure all that many Americans have an extra $9,000 lying around. It also strikes me that it’s a leap of faith anyway since you can’t see the fine print when signing up, like which providers are in the network, which ones are accepting new patients, and the cost of any specialty drugs that are covered minimally if at all. It seems to me this means:
People may not bother to buy insurance since it only covers unpredictable catastrophic expenses.
Even people who buy insurance may not be able to pay their high deductibles.
Both of these scenarios, plus higher medical and insurance costs, may make it just as hard for providers to get paid as pre-ACA.
Patients with more financial skin in the game will have incentive to shop around and ask more pointed financial questions of providers.
The ridiculous out-of-network scam is getting worse. ED and hospitalized patients can ask everyone in sight whether they’re in-network providers and still be stuck with huge bill from a provider they didn’t choose. This continues to create hospital trust issues. Imagine if you took your car in for a $30 oil change and later received bills for hundreds of dollars from mechanics the oil change place called in without your knowledge.
Ms. Palmer says her Mississippi third grade students are enjoying the classroom library of 90 books we provided via a DonorsChoose grant, to the point that several students read more than 20 of the new books in the first two months after receiving them.
Listening: new hard rock from Brooklyn’s Highly Suspect, who sounds like Queens of the Stone Age at times. Also: new from Moon Taxi, a polished indie-progressive band from Nashville that’s quickly becoming one of my favorites. They’re on tour playing mostly small venues like the Orange Peel in Asheville and the Majestic Theater in Madison.
I say goodbye and thanks to TriZetto, an HIStalk and HIStalk Practice sponsor since 2011 who, now that they’ve been acquired by Cognizant, demanded brusquely that we cancel their months-overdue sponsorship in asserting that “nobody here has ever heard of HIStalk” (apparently not including the several dozen of its employees are on the email list and whoever manages their Twitter account since they follow me). They were great supporters as Gateway EDI, so-so ones as TriZetto, and non-existent ones as Cognizant. I should offer their spot to competitors like Infosys, Wipro, Tata, and Accenture who might have someone who is familiar with what I do.
This week on HIStalk Practice: Premier dives deeper into ambulatory market with InFlow Health acquisition. Doctors Administrative Solutions buys Spectra Healthcare. Dr. Gregg explains his fondness for ICD-10. Primary care performance metrics are in need of a strategic overhaul. Pulse System acquires Nightingale’s US-based PM business. Brad Boyd offers strategies to mitigate risk during physician practice onboarding. Physician love/hate relationships with technology get even murkier. Flight surgeon and family practice physician gets to the heart of practicing medicine in a time of heightened healthcare IT policy-making. The HIStalk Exhibitor Guide for MGMA 15 goes live.
This week on HIStalk Connect: Startup Health and Rock Health publish digital health funding reports confirming that the industry is maintaining pace with 2014’s investment levels. Mayo Clinic announces the winners of the Think Big Challenge, a developer contest soliciting disease management and general wellness solutions. Dātu Health raises a $10 million Series B invested by St. Joseph Health, an early investor and user of Dātu’s patient engagement platform. Advances in rapid genome sequencing show promise in the NICU.
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
Allscripts promotes CFO Rick Poulton to president and extends CEO Paul Black’s employment agreement for another three years through December 2018. The company has opened a search for a new CFO. Poulton’s pre-Allscripts experience was in the airline industry.
CareSync secures $18 million in series B funding, announcing that its user base has expanded 20-fold in the past four months. The company will hire 500 more employees in the next 18 months. I have to say I never saw that coming – it looked like a great service destined to be lost in a sea of mostly failing competitors who tainted the entire market with their lack of success and focus.
The SSI Group reports that sales for the first three quarters of 2015 exceed its 2014 numbers by 48 percent.
In England, Musgrove Park Hospital goes live on an EHR created as a customized version of open source IMS OpenMaxims software.
UK-based Cambridge Cognition, which offers a dementia detection app, licenses additional tests and a behavioral treatment app that trains people with aggressive behavior on how to better recognize facial cues.
Post-acute EHR vendor Netsmart and KC-based social provider Cornerstones of Care will collaborate on technology innovation.
Hopkins-owned Sibley Memorial Hospital (DC) selects Versus RTLS for its new ED including a personal panic button, staff locator, and asset management.
Intermountain Healthcare chooses American Well to create a $49 video visit service that will launch in early 2016.
People
Barry Volin (Aetna Better Health New Jersey) joins WeiserMazars as healthcare consulting principal.
Valence Health hires W. Roy Smythe, MD (Avia) as chief medical officer.
Aurora Health Care (WI) names Preston Simons (Abbott Laboratories) as CIO.
Culbert Healthcare Solutions hires Randy Jones, DHA (UT Southwestern Medical Center at Dallas) as SVP of consulting services for the Western region.
Zest Health hires Ann Mond Johnson (ConnectedHealth) as CEO.
Announcements and Implementations
The National Association for Trusted Exchange (NATE) turns over administration of its Provider-to-Provider Trust Bundle to the California Association of Health Information Exchanges.
The Social Security Administration joins CommonWell Health Alliance.
Government and Politics
ONC opens a position for a pharmacist to perform policy, advisory, and liaison work.
FDA launches a four-month pilot program seeking to standardize drug company REMS information so that it can be incorporated into electronic systems such as EHRs.
Privacy and Security
In another mail-merge type mistake, Affinity Health Plan (NY) alerts patients that its renewal reminders for the state’s child insurance program contained a different patient’s information on the reverse side.
Valley Children’s Hospital (CA) sues two of its former pulmonologists for downloading records of 164 cystic fibrosis patients from its system in trying to recruit them to a competing practice. Valley Children’s Hospital reported the incident as a HIPAA breach, while the rival practice says doctors have a right to contact former patients to let them know they’ve moved.
Innovation and Research
Boston Scientific announces a remote patient monitoring innovation contest, with winners dividing “up to $25,000 of services in kind.”
Other
The Albany, GA paper shares interesting details of the October 1 Meditech go-live of Phoebe Putney Health System. VP/CIO Jesse Diaz says it was “very challenging” with 1,000 command center calls the first day and a NICU dosing problem, but things are settling down and more orders are being entered electronically than before with a 15-20 percent increase. The health system also opened up a $50 million line of credit to help cover the project’s cost and the potential revenue cycle impact of ICD-10.
St. Luke’s University Health Network (PA) publishes a price list for patients willing and able to pre-pay for bundles of services for common procedures, imaging studies, and ambulatory surgeries. An ACL repair costs $10,270, while most common X-rays run $100. The target market is the consumer I described above who has a high-deductible plan that requires them to pay every penny themselves until their insurance kicks in.
Pathologist Bruce Friedman, MD notes that investor darling lab provider Theranos — whose lobbyists successfully pushed an Arizona law to allow patients to order their own lab tests — now has competition in the state as Sonora Quest Laboratories launches similar cash-only services. I checked out Sonora Quest Laboratories, which turns out to be a Phoenix-based joint venture between Banner Health and Quest Diagnostics that has the largest laboratory testing market share in Arizona with 70 service locations. This is perhaps the first real face-off between Theranos and the established two-company lab market, competing on price in the only state where cash-paying consumers can take full control. Banner had $4.5 billion of revenue in 2013, of which it appears that Sonora Quest Laboratories generated $18 million and parent Laboratory Sciences of Arizona brought in another $80 million if I’m reading their tax forms correctly. The non-profit Banner, which had a $482 million “surplus” that I noticed while perusing their Form 990, paid their HR VP $900K, their CIO an annualized $560K, and their pharmacy director $553K.
Athenahealth’s Jonathan Bush tweeted this selfie with Karen DeSalvo, saying he’s disappointed to lose his perception that all government officials are stiff (maybe DeSalvo lost that same perception about vendor CEOs).
A New York City entrepreneurship site profiles ED wait time system and analytics vendor MedTimers. The company’s founder and CEO is an NYU undergrad.
Weird News Andy calls this story “Recycling Gone Wild.” Dozens of employees of a New Jersey drug company are being tested for HIV and hepatitis after a contract nurse from onsite flu clinic provider TotalWellness who was giving flu shots was caught using the same syringe for everyone.
Sponsor Updates
ZirMed is ranked first for revenue cycle solutions among hospitals under 200 beds in a Black Book survey.
ONC publishes the final draft of its 10-year interoperability roadmap, which calls on vendors to expand API support, asks providers to migrate to value-based reimbursement models faster, and encourages government agencies to clarify privacy and security policies that impact data sharing.
Allscripts CFO Rick Poulton will be the next company president, assuming the role from current CEO Paul Black who has held dual positions as president and CEO since joining the company in December 2012. The company also announces that Black’s contract, which was set to expire at the end of 2015, has been extended through December 2018.
An EU court has struck down the Safe Harbor Framework, a data sharing agreement that allows US-based companies to store the sensitive information of European citizens on US-based servers, a decision that could impact US health IT vendor operating in Europe.
October 7, 2015Readers WriteComments Off on Readers Write: Mission Impossible: Transitioning to Value-Based Care with Health IT Solutions
Mission Impossible: Transitioning to Value-Based Care with Health IT Solutions By Victor Lee, MD
Your mission, should you choose to accept it, is to partake in the nation’s efforts to transition our healthcare system from volume-based care and fee-for-service (FFS) reimbursement models to value-based care.
If you are in clinical practice or hospital administration, chances are that you have accepted this mission. Like Ethan Hunt, what choice did you really have?
Earlier this year, the US Department of Health & Human Services (HHS) announced specific goals for shifting Medicare reimbursements from volume to value. Under this plan, 90 percent of all traditional FFS Medicare payments would be tied to quality or value and 50 percent would be tied to alternative payment models by the end of 2018. What does all this mean?
Now that we’ve characterized the impossible mission, let’s look at some tools you can use along your journey. There are no spy trinkets, laser beams, toxin antidotes, or heavy artillery involved. Rather, I am referring to newer, innovative solutions proven to maximize clinical and financial outcomes such as clinical decision support (CDS) and mobile care coordination.
The Office of the National Coordinator for Health Information Technology (ONC) defines CDS as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” A classic example of CDS is a pop-up alert that provides guidance to clinicians at the point of care. However, the Centers for Medicare & Medicaid Services asserts that there are many other common forms of CDS in addition to alerts, all of which may be used to satisfy the CDS objective within its EHR Incentive Programs. Which ones have you used on your mission?
Admittedly, many providers have already successfully implemented a variety of CDS interventions in their EHR systems or are somewhere along that journey, so the concept of implementing CDS for quality improvement is not new. However, many organizations struggle with keeping CDS updated over time as new information from clinical trials, guidelines, and performance measures emerges.
Fortunately, there are solutions to help with this part of the impossible mission, including third-party evidence surveillance or software applications that analyze CDS from EHR systems to identify potential deviations from evidence-based best practices.
Care coordination has also been part of a national dialogue, with the Agency for Healthcare Research and Quality (AHRQ) including care coordination as one of its six National Quality Strategy priorities. Care coordination is also explicitly required in certain regulations such as Meaningful Use (mentioned earlier) and the Medicare Shared Savings Program, with the latter specifically requiring the use of “enabling technologies” to support care coordination. So clearly the impossible mission is less likely to be completed in the absence of care coordination, but what solutions are available?
A classic example of a care coordination solution is HIPAA-compliant text messaging. However, newer care coordination solutions take this a step further and incorporate person-centered and evidence-based approaches to ensuring safe and timely transitions of care across providers and venues. Some solutions embrace mobile platforms to ensure accessibility at every point of a person’s care journey.
In summary, our nation’s path toward healthcare reform may appear to be daunting if not nearly impossible. However, the HHS prescription for payment reform and its taxonomy for measuring progress toward its goals includes programs that are dependent on lowering costs, promoting care coordination, and optimizing quality of care. Fortunately, advanced solutions are at your disposal today that transform the mission from one that is seemingly impossible to one that is probable if not inevitable.
This message will self-destruct after we have completed the transition to value-based care.
Victor Lee, MD is vice president of clinical Informatics at Zynx Health of Los Angeles, CA.
Comments Off on Readers Write: Mission Impossible: Transitioning to Value-Based Care with Health IT Solutions
The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.
If It Ain’t Raining, It Ain’t Training
One week prior to the Duathlon Long Course World Championship this September, I meandered out for my last long training bike ride. I met with a group of cyclists with whom I share the same coach.
As we tuned our bikes to ride, it began to rain. No worries. I lowered my tire pressure, threw on rain gear, and was ready to roll.
As a member of TeamUSA, I finished in the top 100 at last year’s World’s. My goal was to stay there and help our team’s score. I needed this last ride before the long haul to Switzerland in what is the most difficult course on the circuit, a 150 km ride through the Alps with 16 percent grades and 5,000 feet of elevation change bookended by trail runs of 10K and 30K.
We began our training ride cautiously, given the rain and slick streets. My tires were new and that made the situation that much more risky. As we passed the two-mile mark, I began to feel increasingly comfortable, but wary. I thought about turning around and training indoors, but the words of my ROTC instructor, Sergeant Major Samuelsson, echoed in my mind as it had so many times prior: “if it ain’t rainin’, it ain’t trainin’.” So there I rode near the front of the pack, confidence building.
Samuelsson’s exhortation served me well my entire life, especially as an Army combat engineer officer. When in training mode, it was so tempting to cancel or postpone construction, bivouacs, or drills whenever the weather turned dour. But we knew that could kill us. If we were called into combat, we needed to have trained under the worst possible conditions so we would be ready for anything.
The same principle applies in the civilian work place. If you avoid adversity, you won’t be ready to perform well when you find yourself in less than ideal circumstances. How often have we lost golden opportunities because something did not go as planned and we were unrehearsed in our response?
I am comfortable working through challenges in real-time and don’t panic because I know it makes my team and organization stronger. I have led through countless application and technical go-lives where we had success because we had persevered through adversity in the buildup. It is part of growing up.
That day in the rain, we were making a hairpin turn and our peloton slowed appropriately. Before I could react, I took my first cycling crash. Down. Hard. I braced myself for impact from riders behind me. Thankfully, everyone avoided or skidded around me.
I was pretty shaken as I listened to my body for damage and inspected my bike. We were both injured, but well enough that I limped back to my bike shop. My bike repaired and my body bandaged, I gave thanks that neither bike nor body were irreparable in time for World’s.
The weather forecast for Zofigen called for rain. While the days preceding the event were warm and sunny, race day was wet and cold. The first hour was mostly uphill, so the slick streets weren’t too much of a concern. Once we crested the highest point of the course, a steep, technical, narrow, alpine descent beckoned us.
While I questioned my judgment for riding in the rain one week prior to World’s, it all became clear. I was thankful for the experience, fall included. I was better prepared to handle my bike under extremely dangerous conditions. I was confident, albeit cautious, in my approach.
The rain dissipated in time for our second and third laps of this 50K loop and slick roads were no longer a factor. There were many accidents that day on this hill. I am convinced that without training in the rain, I would have ended up a statistic on the pavement and not have fared as well as I did. I fell out of the top 100 duathlete in the world category that day, but remained proud to help TeamUSA.
Whether in sport or profession, it is critical to train under all conditions. Don’t take the easy road and cancel or modify your path because circumstances are less than ideal. Just deal with it as is. You never know when the real world is going to throw you a storm or two, but when you’ve trained for it, you will remain confident. Dealing with adversity will be second nature. Not only will your odds of success increase exponentially, but you will build confidence in the people around you.
Raining? Awesome! I wouldn’t want it any other way!
Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.
CMS publishes an update addressing both MU3 and its proposed modification to Meaningful Use in 2015 through 2017. The updated rules set the 2015 MU reporting period at 90-days, and makes MU3 optional in 2017, but mandatory in 2018.
John Halamka, MD and CIO of BIDMC, reports that every major EHR vendor CEO met in Salt Lake City last week, where they discussed data sharing and agreed to “objective measures we can use to quantify interoperability.” Halamka says that details of the meeting and the agreement will follow in the coming weeks.
HELP committee members Senators Bill Cassidy (R-LA) and Sheldon Whitehouse (D-RI) introduce legislation that would establish an EHR 5-star rating system and also require that EHR vendors file an attestation stating that they do not engage in information blocking.
Orion Health is added to the Leidos-Cerner DoD contract. Orion’s Rhapsody integration engine will be used to connect Cerner Millennium with civilian facilities.
CMS’s proposed revised Meaningful Use standards will be published on Friday, October 16 with a 60-day comment period following, but are available now as a pre-publication PDF. It calls for a 90-day reporting period, removes some requirements, expands interoperability-related standards, encourages the use of APIs, and makes Stage 3 optional for 2017 and mandatory for 2018.
Reader Comments
From MHealthcare: “Re: Spectrum Health, Grand Rapids. Announces Project Nexus, which will replace its existing systems (Epic outpatient, Cerner inpatient, and McKesson HealthQuest financials) with Epic.” Unverified.
From Light at the End of the Tunnel: “Re: psychologist-assisted blinding. Is there an ICD-10 code for that?” A clearly disturbed North Carolina woman who says she suffers from body integrity identity disorder (which causes healthy people to want to be disabled) claims in a sensationalistic website’s video that a sympathetic psychologist intentionally blinded her with drain cleaner. I seriously doubt that, especially since she says they used numbing eye drops first and psychologists can’t use medications (only psychiatrists can do that since they are physicians). She also claimed in another attention-seeking video (in which she used a different name) that her blindness was accidental. She’s running a $4,000 fundraising project to buy canes for 35 students of a school for the blind in Indonesia, of which $875 goes for the canes and the rest for a two-week visit to the school by the woman and her fiancé. She concludes, “Don’t think I’m crazy. I just have a disorder.”
From Flamekist: “Re: US Coast Guard. Will not renew its contract with Epic after spending five years and $60 million. Not a single USCG clinic went live. Rumors are it is considering upgrading CHCS instead. This is in direct violation of a federal mandate for EMR compliance.” Unverified. UPDATE: Epic verifies that USCG won’t renew its contract. Leidos was the Coast Guard’s implementation and integration vendor. Implementation delays were due to integration issues and twice the entire system was accidentally overwritten, causing missed dates unrelated to Epic.
From Hootie: “Re: Experian breach. The 15 million people should be provided with free identity theft and credit protection services from Experian. That will make them feel safer, I bet.” An interesting aspect of the huge breach is that even encrypted information was taken, suggesting that the hackers used high-level user credentials. I’d bet it was another phishing attack. It appears that the stolen information is already being offered for sale on the Dark Web.
From Brian Too: “Re: ICD-10 vs. Y2K. Thanks to all who made a positive contribution. The AMA is specifically exempt from thanks. They took a lower-level modernization issue and exploited it for political purposes. The number of absurd statements that came out of there (and from their supporters) was astounding. Some silence from those quarters would be a nice change.” Unless endless whining counts as silence, I wouldn’t bet on it.
HIStalk Announcements and Requests
Mrs. McDermott reports that her New York City fifth and sixth graders are using the four Kindles we provided via a DonorsChoose grant to practice their math fluency skills, including during breakfast and lunch, using the IXL app. She says they think it’s cool because they can write their problems directly onto the screen with their fingers. She’ll use it next for her after-school tutoring groups.
Welcome to new HIStalk Gold Sponsor ID Experts. The Portland, OR-based company has since 2003 provided software and services that help organizations manage cyber risks and data breaches. Software offered includes Radar (managing incident response and flagging notifiable breaches) and MIDAS (detecting medical identity theft by engaging members to securely review their claims). The company also provides cost-effective forensics and breach response services to some of the country’s largest organizations as well as offering consumers identity theft restoration and monitoring solutions that have a 100 percent success rate. The company offers a case study from University of New Mexico Health Sciences Center and Health System, which uses Radar to manage breach incidents and perform risk assessments. Thanks to ID Experts for supporting HIStalk.
I cruised YouTube for ID Experts videos and found this overview of its Radar incident management system.
Grammar and usage peeve: using “drop” to describe something new, as in “CMS dropped the MU rule.” That riles me as much as “went missing” to describe someone whose whereabouts are undetermined.
Webinars
October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Cegedim subsidiary Pulse System will acquire the US practice management system business of Canada-based Nightingale Informatix Corporation.
Cureatr opens its Midwest headquarters in Carmel, IN with three employees and three additional hires planned.
Newly formed, Singapore-based AntWorks acquires Lynchburg, VA-based EHR/PM vendor Benchmark Systems for $5 million, expecting a top-line annual revenue of $10-12 million. The company says it will announce a second healthcare acquisition by the end of the year.
Royal Philips acquires 35-employee, Orlando-based ED consulting firm Blue Jay Consulting to expand its enterprise managed services offerings.
Shares in telemedicine provider Teladoc dropped 20 percent Friday on news that insurer Highmark won’t renew its contract. Above is TDOC share price since its July 1 IPO (blue, down 45 percent) vs. the Dow (red, down 6 percent).
Sales
Wilderness Health (MN) chooses eClinicalWorks for population health management.
Rush-Copley Medical Center (IL) will implement Merge PACS, iConnect Access, and iConnect Enterprise Archive.
McLaren Health Care (MI) chooses Cerner for EHR, revenue cycle, and population health management. McLaren selected McKesson Paragon and Allscripts EHR in 2010 and will replace both.
People
Oneview Healthcare hires Monica Lightman (AMC Health) as northeast region VP.
Announcements and Implementations
Orion Health announces its participation in the DoD’s EHR project, which will use its Rhapsody Integration Engine to link Cerner Millennium to civilian facilities. The company’s shares jumped 9 percent on New Zealand’s stock exchange after the announcement since Orion was not originally listed as a Leidos partner in the project.
Premier will accept vendor applications for its Innovation Celebration 2016 product showcase through December 11.
Cerner will integrate the Society for Hospital Medicine’s Project BOOST (Better Outcomes by Optimizing Safe Transitions) toolkit into its Readmission Prevention Solution.
Aprima will incorporate education, gamification, and rewards solutions from HealthPrize Technologies into its patient portal.
Health API vendor PokitDok eliminates fees for several provider-insurer transactions, including enrollment, eligibility, claims processing, authorizations, and referrals.
Divurgent launches RevInsite, a hospital revenue cycle diagnostic and analytic solution.
IBM launches a consulting organization for its Watson and analytics products.
Speakers at the Midwest Fall Technology Conference in Detroit October 25-27 include Carla Smith (HIMSS), Chuck Christian (Indiana HIE), Donna Roach (Via Christi Health), Joe Francis (Detroit Medical Center), Judy Murphy (IBM), Michael Zaroukian (Sparrow Health), Russ Branzell (CHIME), Sue Schade (University of Michigan Hospitals), and Mary Alice Annecharico (Henry Ford Health System). Registration is $295/$395 (HIMSS member and non-member) and rooms at the Detroit Marriott at the Renaissance Center are $159 per night. There’s also the Vikings vs. Lions that Sunday.
Government and Politics
HHS OCR launches a HIPAA page (announced via a tweet) for mobile health app developers. It allows users to submit questions and suggest areas in which HIPAA guidance can be improved. OCR doesn’t say exactly how it will address submitted questions.
As originally reported by reporter Alex Ruoff of BloombergBNA, HELP committee members Senators Bill Cassidy (R-LA) and Sheldon Whitehouse (D-RI) introduce the TRUST IT act that would require ONC to develop an EHR star rating system using stakeholder-developed criteria and user feedback, with automatic decertification of low-rated products. The bill would require EHR vendors to attest to their level of openness as part of certification. Providers or vendors found to be blocking information exchange would be liable for a fine of up to $10,000. The bill also calls for vendors to be fined for failing to participate or for not improving their low-rated products, with the proceeds funding a “revolving user compensation fund” that would reimburse users of decertified EHRs for their costs to replace them.
Mental Health America and Netsmart express support for legislation that would allow providers to share addiction treatment medical records via HIEs and ACOs with the patient’s consent.
DocGraph finds problems with the referral data sets published by CMS and ProPublica, noticing that files inconsistently covered periods ranging from 12 months to 48 months due to misunderstood Freedom of Information Act requests. DocGraph Data Journalist Fred Trotter warns that customers may have used the information to inappropriately sever relationships with specific physicians or even to stop services in certain markets.
Innovation and Research
Israel’s Center for Digital Innovation and Allscripts will create an Israel-based center to connect that country’s startups to the US healthcare market, including access to the developer programs of Allscripts. The non-profit Center for Digital Innovation was launched a few weeks ago in partnership with Allscripts. Ziv Ofek, the founder of Allscripts acquisition dbMotion, is founder and CEO of CDI.
Technology
Microsoft didn’t appear to have much luck selling its Band wearable, so it releases a new version that has a curved display. It also costs $50 more at $249. A vendor gave me one of the original ones at the HIMSS conference, but I reboxed it just an hour after putting it on despite being impressed by its sensors because it was huge, bulky, and rigid. My experience and everything I’ve read suggests that wearables have run their course with little effect on health, just like the millions of closets that hold a dusty, infomercial-pitched healthy juicer.
Other
BIDMC CIO John Halamka, MD says all major EHR vendor CEOs met last week, approving objective measures of interoperability that will be published by an independent entity.
A KLAS report on secure messaging finds over 100 vendors that offer products, many of which KLAS considers as entry-level solutions offered by companies with no other healthcare domain expertise who offer few interfaces. Strategic solutions include rules-driven message prioritization and escalation, alarm management routing, and integration with multiple systems. TigerText leads both market share and mind share, but its price is high for basic functionality, providing opportunity for primary competitors Imprivata, Vocera, Voalte, Spok, Cerner, and Doc Halo.
I speculated a few days ago that Martin Shkreli’s Turing Pharmaceutical must have bribed generic drug manufacturers to not produce an alternative to Daraprim to protect his 5,000 percent price increase for the 62-year-old drug. It turns out he’s smarter than that – the company sells the drug only to company-approved buyers. The FDA requires generic manufacturers to test their drugs against the brand name product, so Shkreli blocks them from obtaining Daraprim, leaving them unable to perform the tests. Meanwhile, Shkreli’s only slightly more restrained drug company peers have been steadily raising prices for years, even for drugs whose demand is slipping, according to a Wall Street Journal report that finds most drug company profits come from price increases. It quotes a former drug company CEO’s statement to investors, “If there’s price increases that can be taken and delivered to shareholders, we’ll go get it, but I do think we got to make sure we take a long enough view and you don’t start to put this thing in a box, where you get the backlash.”
A CNN article seems to blame Google-owned free navigation app Waze for the death of a tourist in Brazil who was killed when the street name she entered took her into a drug gang-controlled neighborhood, where someone fired 20 bullets into her car. The city of Niteroi, it turns out, has two streets with the same name, one in a trendy tourist section and the other in one of the slums where 20 percent of Rio de Janeiro’s citizens live. Perhaps that’s a market opportunity for GPS app vendors – cross reference their directions with police records to avoid dangerous parts of town just like they avoid unpaved roads (or maybe it’s an opportunity for cities to not just turn over known sections of town to criminals).
Weird News Andy says this story is nothing to sternutate at: a 12-year-old girl has been sneezing 12,000 times a day for a month. WNA adds the ICD-10 code of R06.7, also relating that his brother once lost 10 pounds after hiccupping for three weeks. WNA also points out a story describing how a Montefiore Medical Center OR tech who had gone to the ED with a finger injury was found dead in a locked third-floor bathroom three days later.
Sponsor Updates
AirStrip calls for eliminating interoperability barriers as part of the 10th annual National Health IT Week.
Aprima Medical Software will exhibit at the Patient-Centered Medical Home Congress October 9-11 in San Francisco.
Bernoulli releases a new case study, “Beyond Alarm Management,” featuring client Wesley Medical Center.
The local news features Aurora Health Care’s implementation of Clockwise.MD’s online reservation system.
CompuGroup Medical will exhibit at the Symposium for Clinical Laboratories October 7-10 in Las Vegas.
Wellcentive is ranked as the #1 vendor in customer satisfaction and client experience in Black Book’s financial solutions category of “managed care payment / reimbursement solutions.”
Healthfinch CEO and co-founder Jonathan Baran is featured in a video interview on Madison Noteworthy.
Michael Barbouche, CEO of Forward Health Group, is also featured in a Madison Noteworthy interview.
EClinicalWorks exhibits at The Second CAPG Colloquium through October 7 in Washington, DC.
Extension Healthcare and Saint Joseph Hospital will participate in the AAMI Foundation alarm management safety event October 14-15 in Boston.
October 5, 2015Dr. JayneComments Off on Curbside Consult with Dr. Jayne 10/5/15
Now that we have the official ICD-10 go-live behind us, we can breathe a little easier. But it’s not time to let our guard down. In fact, if one more person tries to tell me it was a “non-event,” I’m likely to scream. The fact that things have gone smoothly so far is largely due to the millions of dollars and hours spent making it go as well as humanly possible.
Although I haven’t seen any major hitches, the majority of practices I work with have had only a small percentage of their claims processed. Many practices haven’t even sent claims out the door yet. They’re waiting for providers to finish their notes, for coders to review them, for managers to harass the providers to finish the notes, for pathology to return so codes can be determined, and more.
Two business days is far too early to judge whether this transition has been successful. I think it’s going to take at least two to three weeks to fully understand whether there are going to be cash flow lags or other downstream impacts. Long story short, it’s too early to let our guard down.
Our colleagues on the revenue cycle side need to be watching carefully and communicating as soon as they suspect there might be issues. Although Medicare has said it will not penalize physicians for coding without the ultimate level of specificity as long as the diagnoses are in the ballpark, I haven’t heard from many payers that they’re willing to look the other way.
Still, for those of us that have been heavily invested on the training side of things — particularly on the provider and coding aspects of the transition — the bulk of our work is behind us. This week I’m doing a handful of remedial training sessions for providers who either didn’t pay attention the first time they were trained or had valid reasons to miss.
One of my customers today has been on family leave with a new baby and warned me that he feels like he’s been “under a rock” as far as keeping up with things. He did well with the training, though, and asked a lot of good questions. Based on his performance with practice scenarios, I think he’ll be fine. He said that compared to the recent upheaval of his life as he knew it coupled with ongoing sleep deprivation, ICD-10 seems like a piece of cake.
A lot of people are asking me what I’m going to work on now that I have some relative free time. I’m going back to helping practices work more efficiently and effectively with their EHRs. I’ve already scheduled several clients both large and small for optimization visits. They know I’m going to go through their processes with a fine-toothed comb and look for ways to make them more efficient or at least less stressed. Some will be micro workflow within the software itself, but I’d estimate that nearly 80 percent of what I do is macro process work.
There are plenty of non-IT processes that need tweaking in many offices. Some may be straightforward, such as reducing the need for patients to call the office for medication refills. In a typical primary care office that hasn’t addressed this yet, I can generally free up a staffer for two to four hours a day by streamlining the process. I work with providers to help them understand the benefits of refilling medications for a year at a time (or at least through the next scheduled visit) or to help them consider a refill protocol where nurses or other staffers can do some triage. We educate patients that they can request refills through patient portals or directly through the pharmacy, which allows us to handle them electronically vs. on the phone. We set up efficient processes for those medications that can’t be handled electronically, such as controlled substances.
This is pretty basic stuff that many organizations addressed during EHR go lives. But there are plenty of people out there whose practices were just fighting their way through EHR training and didn’t spend any time on practice redesign or clinical transformation. Now that they have the technology, they’re having to circle back to figure out the best ways to use it. They’re also realizing the continual squeeze that comes from increasing payer and regulatory burdens. They need to free up time for staffers to start doing new work that’s going to bring revenue to the practice – things like care management, patient outreach, and population health.
I’m also seeing a fair number of practices that want my help with technical projects. Some of them bought tools and technology that they never implemented because their attention has been pulled by Meaningful Use and ICD-10. Now that they have a bit of a comfort level with both of those challenges, they’re circling back to see how they can use their new toys or to see if there are features or functions in their EHRs that they missed the first time around. Maybe they were just too busy or maybe they weren’t philosophically ready for them, but it’s always good to revisit and see if you already have tools that can be of help.
I’m doing two population health implementations for small practices. Both of them have solutions from their primary EHR vendors. One never went through training and the tool has just been sitting on the virtual shelf. The other went through training but never fully implemented it, largely due to perceived lack of staff. They recently added a part-time role for care management and population health, so we’re going to dig in and get a program up and running. I’m familiar with the tool they’ll be using and it’s decent. The biggest challenge they’re going to have is figuring out how to narrow their populations to the most high-risk or high-yield patients.
I think physicians see population health solutions and the ability to find all your patients that have X disease or X need, and reach out to them. It’s an attractive concept for those of us who went into primary care to help prevent disease or help patients maximize outcomes. However, the reality is that many of us have been collecting a lot of data, and if we tried to act on all of it, we’d quickly outstrip our practices resources to handle it. That can lead to some difficult decisions for physicians.
In the absence of real risk profiling data, they have to select whether they want to target the oldest or the sickest patients because they’re at the highest risk of complications. Or perhaps they should target the youngest because they have the longer time-burden of disease in their futures and the greatest opportunity to change. They also have to figure out how much staff capacity they have. Do they have enough open appointments over the next several months or do we need to do a project to burn down the appointment backlog first? Do they have enough phone lines to handle return calls from digital outreach and enough people to answer them? Do they have enough hours in the day?
Physicians are always surprised when I suggest small pilot programs first. Many of them are so used to trying to do everything for everyone that it’s counterintuitive to ask them to do less than that. My goal is to do a smaller project where they can be successful, then build on that to involve more patients or more conditions. This lets change happen organically in the practice rather than it being a complete upheaval. We’ve already had enough of that in medicine. We need to try to stop doing everything at once and just take it one day at a time.
October 5, 2015InterviewsComments Off on HIStalk Interviews Bill Anderson, CEO, Medhost
Bill Anderson is chairman and CEO of Medhost of Franklin, TN.
Tell me about yourself and the company.
I’ve been involved with Medhost since 2007. I was originally an investor and a board member. We’re about a $200 million revenue company with both enterprise products and population health and consumerism products.
What has been the market reception following the company’s name change a little over a year ago?
We’ve acquired two different companies to go with what was originally Healthcare Management Systems. One being the original Medhost EDIS company and the second one being the Acuitec perioperative system, which was the old Vanderbilt system. Simplifying our inpatient system has been well received by the marketplace. The consolidated branding makes the company much more understandable to our customers and other constituencies.
What are the steps involved in kicking off talks about an acquisition?
We believe that we’re as much a distribution company as a technology company. The number one criterion for either buying a company or spending money internally is to try to understand what our customers’ needs are. Ideally we can anticipate those needs before they actually understand they need them.
In those two cases, for instance, these were very critical profitability centers for facilities. We believed that offering not just good enterprise departmental solutions, but best-of-breed leading solutions, was something that was going to be important to our customers. The ED and the operating room are two places they have to make money to make money. It’s really very customer driven.
You told me when we spoke last time that your main acute care enterprise competitors were McKesson Paragon and Meditech. What has changed since?
They’re both still substantial competitors. We are seeing some more competition from Cerner’s Works product, but it is in many cases more difficult to come down-market than it is to go up-market because of the complexity of the product. But largely the competition is very similar to what it was the last time we talked.
The inpatient market differentiators are usually facility size and the complexity of the app as well as the cost of buying and running these applications. How has the dynamic changed as Cerner and Epic push into smaller hospitals and large hospitals are buying their smaller competitors?
I may give you more of an answer here than you’d like. One of the things we are very concerned about is the profitability of hospitals in the middle market. Let’s say that is 50 beds to 150 beds. What has happened today is that regulations have increased the fixed costs to those facilities by mandating a lot of different systems — mostly in the IT area — and other activities. At the same time, the average revenue per customer is dropping. You see a continuous stream of news articles about the crisis in rural hospitals, particularly.
As a result, I’ve seen analysts say things like, we’re going to take 40 percent of the total facilities out of the system or 30 percent of the beds out of the system in order to get facilities to a reasonable profitability. We look at this and we say, the total cost of ownership is something that today is not only a good business practice to be conscious of, but it’s absolutely essential to the survival of these hospitals.
We’ve tried to have — and I think hospitals in general are looking for this — what I would call segment-appropriate features. Physicians, for instance, would like to have all the features you can possibly get, but the more complex the system, the more cost is added to it. We believe that total cost of ownership is a very key thing. We’ve tried to manage our systems to be able to help our customers do that.
One of the things that I always point to is that back in the mid-1980s — I used to be in the banking software business — there were about 18,000 banks in the United States. Today there are about one-third that many. If you look at the reasons that happened — increased regulations, access to capital, all those types of things — the same types of things are happening in the inpatient facility business. We’re very conscious of trying to help our facilities control costs because it’s in our self-interest to have them survive.
Banks invested heavily in technology to keep customers from tying up an expensive live person, such that most people now hardly ever go into the physical bank. Does healthcare have the incentives to deploy that kind of automation?
I’m not sure that you can have the same level of automation in healthcare that you have in banking with self-service. But one of the reasons we’ve heavily invested in our YourCareUniverse product suite is to help facilities manage two different digital communities, which we think are important to them — a digital community of consumers and then a digital community of providers and patients who are actually in the healthcare arena.
We think that is the analogy to the banking industry. Our facilities are going to have to learn how to manage these digital communities. It’s not going to be so much of a community-based facility as an area-based facility in the past. For instance, we have a little hospital out in Texas that covers eight counties in Texas. There’s a lot of real estate in eight counties in Texas. They need the ability to not only interact with the community, but with their patients.
The second thing we’re starting to see and having our customers tell us — particularly our big customers – is that consumerism is really starting to bite. Similar to the banking industry, you will see that things that were previously done inpatient may be moved to outpatient, whether an ambulatory surgery center or a physician’s office or some other venue outside the four walls of the hospital. Things that may have been done in a physician’s office are going to be moved out to things like MinuteClinics and urgent care offices and maybe even to self-service with the consumer, with the patient. I see very clear parallels to the banking industry.
Healthcare providers in general are saying, we’re going to be ready for this shift, because while you see it starting to happen, it’s going to take some time. The people who are preparing for that shift today, we think, are going to be the long-term winners as the market consolidates.
Are your clients confused about who their competitors and potential partners are?
It’s very challenging environment. Because of things like access to capital and the systems that are required, you see — not only in the large integrated systems, but in geographic areas — hospitals partnering up with larger facilities. You mentioned Epic moving into the smaller facilities. This is an example of how large geographic areas are handled by a large facility integrating in smaller facilities. That’s what’s happening a lot.
I think it is going to continue to be a challenge for healthcare providers to understand what the best partnership strategy will be for them. Some of these customers of ours are going to end up being purchased by other customers. Some of them are going to affiliate with ACOs or large facilities. Some of them may be in an area where they can go it alone. I don’t think there will be a single strategy because there are so many different factors involved about what the market is, the financial strength of the entity, and what the competition looks like.
We have significant EHR adoption in the inpatient and ambulatory markets. Are post-acute care, home care, and behavioral the next frontiers in trying to move patient information from paper to electronic so that it can be shared?
Yes. We’ve got a number of really large customers and they have many different types of facilities as well as clinicians and ambulatory systems. One of our frustrations — even though we’ve built tools to help tie all those together – has been getting cooperation from other vendors. No one wants to be disintermediated away from their customer.
What is clearly the right answer for the facility and the right answer for the patient — which is to provide a totally integrated system that exchanges data and allows you to make orders and do all sorts of other things — is really very difficult to execute because there’s not alignment of economic interest there.
Companies ranging from tiny app developers to big enterprise companies like Salesforce are trying to figure out patient engagement. What technologies are needed and what will determine whether a vendor is successful?
We think that there will be a market evolution similar to what happened in the inpatient business. Many facilities, particularly big facilities, used a best-of-breed strategy and effectively brought components of a total system based upon individual features of that system. I think in the long run, customers are going to say — just as they are starting to say in the inpatient market, in the enterprise market — that it’s really difficult to manage a system that is cobbled together from a number of different vendors. The clear trend is a single provider for your inpatient systems.
Our approach — and what we think will be most likely to win in the long term — is that we have focused on not just having good individual components like analytics or a CRM system, but that we have a totally integrated system. That’s what the customer is going to ultimately demand.
For instance, when we did our patient portal, instead of having a tethered portal to an EHR, we built a private HIE. We’ve got both an ambulatory and an inpatient-certified Meaningful Use portal on top of that. On top of that, we have both an analytics system and a CRM system that allows you to not only track patients and all their data, but to aggregate data within a community.
Where I believe this is going to become particularly important is if in fact the Meaningful Use guidelines for view, download, transmit actually go to 25 percent. Our understanding of the regulations is that in a community, if you had information as a clinician in the hospital system and you had a single portal for both the ambulatory and inpatient providers in that community, you could effectively pool traffic. There are going to be instances where not only the market, but regulation is going to require that you have this totally integrated system, because otherwise you’re never going to get to a 25 percent view, download, and transmit standard, for instance.
What possibly unusual assumptions are you using for the company’s next five years?
Our assumptions are threefold. In the inpatient market, we believe that there are probably at least 1,000 facilities in our relevant market space — the short-term, acute-care market — that have not made durable enterprise product selections. While it is a mature market, at some point in time, as customers and the market get over the Meaningful Use trauma, they’re going to start replacing systems that are not going to meet their long-term needs or they will have a question about whether that vendor is going to be there for them five to 10 years from now. One of our assumptions is that consolidation in the vendor market — just like consolidation in the provider market — will happen sooner rather than later.
The second assumption we’ve made is that while people talk about population health, and while we have a complete population health solution, we think the most important thing is going to be addressing the consumerism needs. Specifically as more and more healthcare moves out of the inpatient setting, in order to survive as an inpatient provider, market share is going to become increasingly important. Therefore, the number one skill set that our customers don’t have today that they need to build is marketing.
We’ve started to provide tools to help them to market to the community. That includes our YourCareEverywhere content site, which is a co-branded content site. If you’ve looked at most hospital Web sites, it’s about the hospital, not about the consumer. We’re big believers in that if you’re going to engage with a consumer, you have to provide them continuous value — not just value when they’re a patient — as well as an analytical solution and a CRM solution that allows you to market to the community based on needs.
We think our focus on the consumerism side of the equation is much different than most of our competitors in the middle market.
Do you have any final thoughts?
Today I believe there is a determination being made between the facilities that are going to be survivors in consolidation and those who are not going to survive as standalone entities or even as entities at all. In many cases, unfortunately, the management of the facility does not really understand that that’s happening today. If you’re too late to address these specific issues, such as consumerism and partnering and things of that nature, it may be too late by the time you are willing to address the issues.
Comments Off on HIStalk Interviews Bill Anderson, CEO, Medhost
Teladoc stock dropped more than 20 percent on Friday after news broke that one of its largest customers, insurance provider Highmark Inc., would not renew its contract. Losses continued on Monday as its stock price shed another four percent.
Rock Health publishes its quarterly digital health investment report, concluding that, with $3.3 billion in investment activity, 2015 is outpacing 2014’s record-breaking year by a narrow margin.
An ONC blog post published by National Coordinator for health IT Karen DeSalvo, MD highlighting the latest patient engagement findings, claims that in 2014, “over half of individuals who were offered online access to their medical record viewed their record at least once.” DeSalvo goes on to say that ONC is developing a policy framework that outlines best practices for using patient-generated health data in research and care delivery.
New Hampshire-based hospitals Dartmouth-Hitchcock, Elliot Health System, and Frisbie Memorial Hospital partner with Harvard Pilgrim Health Care in a joint venture called Benevera Health that will provide care and share financial risk for 80,000 local residents.
Mercy Health goes live with its $54 million telehealth command center, where 290 clinicians are monitoring 2,400 beds spread across 33 hospitals, providing a wide range of services including telestroke, teleICU, and remote specialist consultations.
Texas Health Resources and the University of Texas Southwestern Medical Center agree to merge EHRs and coordinate patient care across 27 hospitals throughout North Texas.
A study in the UK finds that 27 percent of primary care visits could have been avoided with better use of technology and care coordination. The report found that PCPs spent the time equivalent of 15 million appointments rearranging hospital schedules and chasing test results.
Mercy Health opens a $54 million telemedicine center, where 290 clinical employees will monitor patients in 33 hospitals covering four states. The service, which seems to be marketing itself to other hospitals without actually saying so, offers teleICU, telestroke, nurse on call, electronic visits, specialist consultations, a sepsis monitoring service, skilled nursing facility monitoring, home monitoring, remote hospitalist services, chronic disease management, and analytics services. Consider the implications of offering services like these to small and rural facilities that have physical proximity to patients and a desire to improve their health, but that also don’t have the resources to do so on their own.
Reader Comments
From PM_From_Haities: “Re: Allscripts. Borrowing more money with terms that require it to pay 50 percent of the company’s excess cash flow each fiscal year if it doesn’t meet certain leverage ratios.” The SEC filing is over my head, so anyone with corporate finance expertise is welcome to comment. Above is the one-year price chart of MDRX (blue, down 9 percent) vs. the Nasdaq (red, up 6 percent). Your $10,000 worth of Allscripts shares purchased five years ago would be worth $6,769 today, while the same investment in Nasdaq index funds would be valued at $19,600. Had you bought Cerner shares instead, your $10,000 would be worth $28,450.
From Doctor Mom: “Re: ICD-10. Our doctor’s system combined the correct ‘juvenile dermatomysositis” with the incorrect ‘juvenile polymyositis’ to create a new code for the combined non-existent disease. Otherwise, no issues for us.” I haven’t heard of any significant ICD-10 issues, other than one reader who said his insurance declined a prescription refill because of its existing ICD-9 diagnosis code but approved it when the pharmacist fixed the code. It’s too early to claim victory since ICD-10-based claims haven’t yet been paid, but I’m already feeling sorry for all the vendor and provider people who spent a ton of time preparing for the conversion that everyone is now saying was uneventful, implying in Y2K-like fashion that it all was a false alarm that could have been ignored. It was only a non-event because a lot of people did their best to make it so.
From The PACS Designer: “Re: ICD-10. Now that ICD-10-CM is officially in use worldwide, it will be vitally important that no shortcuts creep into the clinical decision solutions. For instance, if you encounter a present for a ‘burn due to water-skis on fire’ — V91.07XA — you should not enter the present as V9107XA, v91.07xa, or v9107xa.”
From Frank Poggio: “Re: Blue Cross Blue Shield poll question. In 1939, the AMA started Blue Shield and in 1942 AHA created Blue Cross because healthcare costs were too high and volume was down. To drum up business, they both came up with the idea to sell a medical insurance policy. Unions loved it and employers thought of it as a low-cost benefit. One insurance for both was not possible because they didn’t trust each other and physicians wanted to remain as independent as possible. The split was perpetuated when the Feds created Medicare in 1966. The Feds could have forced the two together (a la ACO) but the politics were too tenuous, so the Feds created two separate payment programs — Medicare Part A (hospital) and Medicare Part B (doctor) to mirror BC/BS. Then in 1972 as the health insurance industry matured, the Federal Trade Commission became concerned that doctors and hospitals selling insurance was a conflict of interest. The AMA had to spin off Blue Shield and AHA split with Blue Cross. As time moved on and healthcare costs grew, the Blues saw themselves more as insurance companies than part of the medical establishment. Many of the Blues merged and eventually morphed into today’s UnitedHealth, Anthem, Wellpoint, etc. Not much is different today as providers are trying to protect their revenue, and since the friendly Blues have morphed into nasty enemies, why not create your own more friendly insurance program? Here we go again.”
HIStalk Announcements and Requests
Two-thirds of poll respondents characterize Blue Cross Blue Shield (the association of companies) as a villain vs. the one-third who think they are a hero. Mobile Man explains, “Necessary evil? Absolute power corrupts absolutely? Follow the money? The ‘business of healthcare’ is an oxymoron? You name it …” New poll to your right or here: should consumers be allowed to order their own lab tests?
I received photos from teachers whose DonorsChoose grant projects we funded: Ms. Bruder from New York (electronics kits), Ms. Thomas from Georgia (a math exploration station), and Ms. Lemos from California (two Amazon Fire tablets).
Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.
Last Week’s Most Interesting News
ICD-10 goes live with few reported problems.
EClinicalWorks will spend $50 million on a new building in preparation for doubling its Westboro, MA headcount to 2,000.
MedAssets announces a restructuring plan that includes laying off 180 employees.
Mayo Clinic-backed Better announces that it will shut down its technology-powered personal health services company on October 30.
Leaders of the Senate’s HELP committee continue pressing HHS to change Meaningful Use Stage 2 and to delay Stage 3.
Patients sue two DC-area health systems for refusing to provide electronic copies of their medical records and charging them thousands of dollars for paper copies.
A study by researchers from England finds that most consumer health apps give bad advice, fail to secure user information, and provide no documented health improvement.
Webinars
October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
This might be a clue that the frothy health IT investor bubble is about to burst: hospital asset tracking vendor Kokicare files its IPO documents even though it has existed for just five months, it has no website, and its official address is the home of its founder, who still works full time as a sales director for another software company. The company, which has no record of previous funding, is hoping to sell $330,000 worth of shares.
People
Falcon Consulting hires Bill Wilson (IBM) as VP of strategic services, Steve Hayter (Providence Health & Services) as VP for technology solutions, Dan Stoke (Medfusion) as VP of client relations, and Paul Tinker (Grant Thornton LLP – not pictured) as executive director of clinical services.
Announcements and Implementations
In Texas, Texas Health Resources and UT Southwestern Medical Center announce plans to create a single cooperative network that will include using a single “compatible interactive IT platform,” which should be made easier since both organizations use Epic.
Privacy and Security
Experian, which offers identity theft and credit protection among its financial and data brokering services, is itself breached, exposing the information of 15 million people who had credit checks performed when requesting service from cell phone provider T-Mobile. Experian was scammed a couple of years ago into selling the in-depth financial information of 200 million Americans to a guy in Vietnam who was reselling their financial identities online to any willing fraud operator.
The August theft of two portable hard drives from the electrophysiology lab of Sentara Heart Hospital (VA) exposes the information of 1,000 patients. The drives were not stored in a secure location and were not encrypted, although the hospital says “we’ve stepped up our procedures.”
Other
A study of primary care practice visits in England finds that 27 percent would have been unnecessary with better use of technology and and coordination with other providers. One in six of the visits could have been handled by pharmacists or nurses.
Walter De Broweur, CEO of Tricorder-aspiring device manufacturer Scanadu, lists concepts he thinks will be important over the next five years:
Mobile health technology impact is lagging because it fails to pass the “toothbrush test” in which users go to several times each day. He says that means letting consumers aggregate their own information and then present it to their doctor with their own point of view.
The “industrial medical complex” will yield to consumer demands only when consumers start to collect their own health-related data such that it adds more value than the EHR contributes.
Big companies will take over preventive care.
Consumers will automatically collect their own data into digital dashboards and contact providers only when needed.
Algorithms will take over medication prescribing, which is the main reason people see doctors, with telemedicine as the first step into avoiding time-wasting appointments just to get prescriptions.
Regular, automatic collection of health data will become more important than the snapshot of health that’s involved in a typical office visit.
Sponsor Updates
Wellcentive will exhibit at the NAACOS Fall Conference, October 8-9 in Washington, DC.
Nordic launches a strategic affiliate management training program.
Valence Health will exhibit at the CAPG Colloquium October 5-7 in Washington, DC.
VisionWare will exhibit at AEHiX15 Fall Forum October 7-9 in Orlando.
Huron Consulting Group closes its acquisition of Cloud62.
ZirMed is featured in a TechRepublic feature on parental leave policies and work-life balance.
Sunquest will participate at CAP October 4-7 in Nashville, TN and at ASHG in Baltimore October 6-10.
Zynx Health will exhibit at the 2015 ANCC National Magnet Conference October 7-9 in Atlanta.
ICD-10 goes live with few announced problems, with October 1 marking the beginning of the second, shorter countdown until claims have been submitted and processed. At least we will finally be free of reporters who think they’re being clever in entertaining us with allegedly fun, obscure ICD-10 codes. Above is a photo Cerner tweeted out of its ICD-10 war room, another of Practice Fusion’s support team, and the command center at Ministry Health.
Did anyone have a physician office visit scheduled for Thursday? How did it go?
Reader Comments
From Puerile Excuses: “Re: State of Mississippi RFP. All vendors were required to attend an all-hands call this week or else they would be excluded from the bidding. Despite several rounds of roll calls, nobody from Accenture or Oracle spoke up to verify their attendance. It was a pretty big call to miss given that this is a multi-million dollar award over several years. It will be interesting to see if they talk their way back into the race.”
HIStalk Announcements and Requests
Mrs. Hicks from California reports that the math manipulatives provided by our DonorsChoose project were a big hit, saying her elementary school students wanted to start using them right away and are benefiting from hands-on, high-impact activities.
Mr. Weightman’s Indiana students have already received the 25 sets of headphones we funded just three days ago, using them to tune out noise as they’re working on math and reading skills.
Mrs. Kennedy shared photos of her Virginia elementary school students using the sidewalk chalk and learning games we provided for summer school.
I filed an Office for Civil Rights complaint in early July after my MU-attesting, Epic-using Stage 7 EMRAM hospital refused to give me an electronic copy of my medical records, saying they don’t provide electronic versions to anyone other than doctors. I still haven’t heard back from OCR nearly three months later.
A usage gripe: “breaches” happen when a hacker gets your data, an army breaks through a fortified wall, or a whale surfaces. “Breeches” are what you wear during equestrianism, the part of the cannon that the shell goes through, or in describing babies who are born butt-first.
This week on HIStalk Practice: The Primary Health Care Performance Initiative launches to enhance data quality and sharing globally. Conflicting surveys show that physician spending is up on technology purchases, yet choosing and implementing new technology is of low priority. AAFP delegates discuss EHR irritation, physician burnout at annual congress. HHS awards $685 million to regional and national health networks as part of its Transforming Clinical Practice Initiative. Pennsylvania eHealth Partnership Authority Executive Director Alix Goss stresses the importance of HIE to physician practice success. Physicians vent their frustrations at AMA/Massachusetts Medical Society event.
This week on HIStalk Connect: Two Washington, DC-based hospitals are sued for charging patients hundreds of dollars for access to electronic copies of their medical records. Researchers in England find multiple clinical and data security issues with apps included in the NHS Health App Library. Mount Sinai reports initial results from its Apple ResearchKit-based national asthma study. Online consumer health startup HealthTap unveils a new app aimed at the employee wellness market.
Webinars
October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
EClinicalWorks buys a third office building in Westboro, MA for $21 million, planning to double its headquarters headcount to 2,000 as its annual revenue approaches $400 million. The company will spend another $30 million to renovate the interior.
Premier subsidiary Premier Healthcare Solutions acquires InFlowHealth, which offers physician practice improvement software, for consideration valued at up to $35 million.
PerfectServe raises $21 million in a new financing round.
MedAssets announces a restructuring plan that includes an 180-employee layoff, closing one office, and reducing professional service and vendor fees. It estimates a pre-tax restructuring expense of $11 million, almost all of it in workforce reduction costs, between now and the end of the year.
Mayo Clinic-backed Better, which offers a technology-enabled personal health assistant services for $50 per month for a family, announces that it will shut down on October 30. The company had raised $5 million in a single April 2014 round.
Konica Minolta acquires Viztek, which offers digital software and hardware imaging solutions.
Sales
Children’s Hospital of Philadelphia (PA) chooses PeraHealth’s real-time clinical deterioration surveillance software.
People
A DC-area innovation site profiles Maria Horton, a former Walter Reed ICU nurse and CIO who is founder, president, and CEO of federal security contractor EmeSec.
Aetna hires Gary Loveman, PhD (Caesars Entertainment) as EVP/president of its Healthagen consumer technology business. His primary accomplishment for the struggling Caesars was keeping the company afloat after it took on $22 billion in debt in a leveraged buyout, laying off 12,000 people and earning himself $90 million in share appreciation as the company’s largest business unit filed bankruptcy this past January.
Data management system vendor Flywheel hires Imad Nijim (Lexmark Healthcare) as COO.
Announcements and Implementations
LiveProcess announces its ED Coordinator collaboration solution, which allows ED managers to align resources based on demand to accelerate patient flow.
Princess Margaret Hospital (Bahamas) goes live on Surgical Information Systems.
Leidos and Virginia Tech will collaborate on student-conducted research on the big data challenges of EHRs, with Leidos funding a graduate fellowship in advanced information systems.
Six HIMSS chapters will host the Midwest Fall Technology Conference in Detroit October 25-27. Some of the HIStalk sponsors who are sponsoring the event include Airwatch by VMware, Merge Healthcare, Xerox, Caradigm, Orion Health, Leidos Health, Burwood Group, PDS, Fujitsu, and CoverMyMeds.
Government and Politics
Senator Lamar Alexander (R-TN), chairman of the Senate’s HELP committee, gives the administration five reasons that Meaningful Use Stage 3 should be delayed:
Few providers have qualified for Stage 2 and Stage 3 will make it even harder.
Medicare assigns penalties and bonuses based on MU compliance.
Big hospitals are saying the industry needs more time.
A new GAO report found that MU is standing in the way of EHRs talking to each other.
The final MU3 rule should reflect the still-incomplete interoperability work between the committee and the administration.
The White House notes the five-year anniversary of Blue Button, also noting that the next step is widespread implementation of APIs to allow consumers to collect their information from multiple sources into whatever app they want to use.
An HHS OIG report finds that the state of Oklahoma overpaid nearly $900,000 in Meaningful Use payments because it didn’t understand the required timeframes. It also inappropriately received $128,000 in federal reimbursement because it submitted duplicated payments.
Other
UNC Hospitals (NC) quadruples its operating income to $115 million for the year, for which it gives some credit to its Epic implementation.
Forbes names its list of the 400 riches Americans, which includes #35 Patrick Soon-Shiong (NantHealth, $12.9 billion), #121 Elizabeth Holmes (Theranos, $4.5 billion), and #256 Judy Faulkner (Epic, $2.6 billion).
An East Texas judge shuts down the country’s most prolific patent troll by denying its 168 lawsuits for a patent that covers “storage and labeling information,” with 87 of those lawsuits filed in a single April week in an attempt to beat the deadline for tighter filing rules. However, the same Texas lawyer that created eDekka (whose only business is filing patent lawsuits) also represents the country’s #2 and #3 most prolific patent trolls.
Cleveland Clinic Florida offers $49 online doctor video visits.
AAFP President Wanda Filer, MD, MBA, who started her term Thursday, says of EHRs,
I’m now on the fourth EHR of my career. One was such a dismal product that we simply walked away from it. Physicians have heard a lot of good sales pitches, and we’ve seen a lot of people who weren’t involved in clinical care leading us to the health IT "promised land." This has been a difficult journey for many of us, but the Academy is working with stakeholders to turn this situation around and help ensure that EHRs help, rather than hinder, physicians in practice.
The IT team of Centura Health (CO) will play Epic in a fundraising basketball game on October 20, complete with cheerleaders, music, and a concession stand whose sales will be donated to DonorsChoose.
A Florida man is arrested for posing as a doctor in interviewing a woman for a nursing assistant position, which included touching her breasts and attempting to demonstrate (on her) the correct way to take a rectal temperature.
Sponsor Updates
Iatric Systems will exhibit at the Hospital and Healthcare IT Reverse Expo Fall 2015 October 5-7 in Los Angeles.
Influence Health will exhibit at the National Association of ACOs event October 8-9 in Washington, D.C.
Ingenious Med and MedData will exhibit at the MAHAP-MPAA-HFMA Michigan Revenue Cycle Conference October 7-9 in Mt. Pleasant.
InterSystems will exhibit at the iHT2 Health IT Summit October 6-7 in Chicago.
Sunquest and Partners HealthCare announce GA of a new version of the GeneInsight genetic information solution.
Intelligent Medical Objects will exhibit at the MUSE International Medical Users Software Exchange October 7-8 in Liverpool, UK. * Liaison Technologies will exhibit at the Merck Global IT Summit 2015, Americas October 6-7 in Somerset, NJ.
Netsmart will exhibit at the Michigan Premier Public Health Conference October 6 in Thompsonville.
Nordic’s Kevin Dumser and his son’s battled with childhood cancer is featured in the local paper.
Extension Healthcare and its customer Saint Joseph Hospital (CO) will present ideas on clinical alarm improvement at the AAMI Foundation clinical workshop in Boston, MA on October 14-15.
NTT Data will present on health innovation at the Gartner Symposium/ITxpo 2015 October 4-8 in Orlando.
NVoq will exhibit at the American College of Pathologists Annual Meeting October 4-7 in Nashville, TN.
Experian Health will exhibit at the Idaho Hospital Association’s annual meeting October 3-6 in Sun Valley.
Recondo Technology increases scores by over 15 percent in the latest KLAS Mid-Term Report.
Patientco’s partnership with Halifax Regional (NC) is featured in the local paper.
PatientKeeper documents the success Ob Hospitalist Group (SC) has had with the company’s Charge Capture software.
PerfectServe will exhibit at the FSN Renal Reunion October 2-4 in Bonita Springs, FL.
The SSI Group and Stanson Health will exhibit at the 2015 Fall Hospital & Healthcare IT Conference October 5-7 in Los Angeles.
Summit Healthcare will exhibit at the MUSE International Medical Users Software Exchange October 7-8 in Liverpool, UK.
Surgical Information Systems will exhibit at the OR Managers Conference October 7-9 in Nashville.
Surescripts will host its 2015 Customer Forum October 5-7 in Washington, D.C.
I volunteered to take one for the team today, covering the 11 p.m. to 7 a.m. shift so I could handle any of my practice’s ICD-10 issues personally. It’s usually pretty slow until 6 a.m. and lets me get some sleep in an incredibly comfortable recliner, so I figured I’d be able to get home and have my mini command center up and ready for my consulting clients by the time most of them started adding diagnoses to their charts.
Since we run 24×7, we decided to schedule a mini-downtime from midnight to 1 a.m. to do some testing and make sure everything switched over automatically as our vendor assured us it would. That’s one of the benefits of having hosted software – they do all the upgrades and handle the transition timeline. On the flip side, when things go bad, there’s not much you can do to fix it. We had prepared just about as well as anyone could and have been running dual coding for several months.
This has allowed us to shake out some problems with the ICD-9 to ICD-10 crosswalk and make sure that we were confident our most frequently used diagnoses were converting cleanly. The dual coding in our application is a little odd, though – it takes the ICD-9 code and maps it to SNOMED and then to ICD-10. I guess it’s not using the CMS General Equivalency Mappings, but something else under the hood. That progression would lead to some occasional oddities, but nothing too major had cropped up.
Although I’m not officially in charge of the EHR, I’ve had plenty of opportunity to kick the tires, but as they say, there’s no test like Production. We do a fair amount of workers’ compensation, so ICD-9 isn’t going away any time soon. We’ll still have to do some ongoing conversion to get those claims out the door.
My first surprise of the day occurred before midnight. Apparently some odd mapping was going on, where the ICD-9 code for a symptomatic venomous insect bite was being mapped over to the ICD-10 code specific to venomous snakes. Because the diagnosis code also drives the patient discharge instructions that are printed for them to take home, I had to fix it right away rather than leave it for the billers to take care of.
I also noticed some weirdness with our diagnosis favorites lists. Our discharge instructions for common conditions like sinusitis and bronchitis were no longer linking up correctly. I had someone re-test it about 30 minutes later and they were both working correctly, which led me to suspect that perhaps the vendor was doing some work leading up to the midnight deadline that we weren’t aware of. Alternatively, maybe they were switching everyone over on the Eastern time zone timeline regardless of where they were physically located.
The biggest problem I saw before midnight was one where somehow a diagnosis of “separated shoulder” became mapped over to O32.2xx1, which is “Maternal care for transverse and oblique lie, fetus 1,” which makes no sense whatsoever. We opened a support ticket and flagged the chart for follow up. That was about the time we were scheduled to drop to paper for an hour, so we went ahead and made the switch.
I only had two patients in progress when we went to paper, one for a laceration and the other stopping by to get a flu shot on the way home from work. Neither was a problem as far as documenting on paper, so I let our “official” IT people get on about testing the direct documentation of ICD-10 without dual coding. They quickly ran through our top 50 diagnoses without problems so we decided to go ahead and start documenting in the EHR again before any other patients showed up. I was eager to see how it would function, but the overnight was quiet, so I hit the recliner.
At about 5:30 a.m., we had a couple of patients, one of whom was a workers’ compensation patient coming by for a clearance before returning to work. The patient had already been in and was diagnosed with an ICD-9 code previously, so I just sent that back out on the claim without any conversion. Thank goodness for the “use previous diagnosis” button! The next couple of patients were for easily-documented conditions – cold symptoms and migraine. Both could have been treated at home, but unfortunately both employers required work notes for time missed. Sidebar: In my next life, I’d like to fix all the waste introduced into the healthcare system by employers requiring work notes.
My relief physician showed up early to see how bad it was going to be, but I didn’t have much data to provide an opinion. I signed out the now-empty board and headed home to get ready for my personal clients. The morning has been surprisingly quiet with only a handful of issues, mostly providers who needed help getting their favorite codes added. While researching a couple of issues, I came across some bizarre codes. One was T63.483 “Toxic effect of venom of other arthropod, assault” which I hope I never have to code in practice.
I’ve been monitoring Twitter and it looks like Athenahealth posted their first claim adjudication pretty early this morning. I’ve not heard much from other EHR vendors, but would be interested to hear how things are going both there and at the clearinghouses. We won’t know the true impact until claims make the full circle and payments start coming in.
Senator Lamar Alexander (R- TN), chairman of the Senate’s HELP Committee, continues with his efforts to delay the implementation of MU3 by publishing a list of five key reasons for the proposed delay, adding “there is broad and bipartisan interest in seeing the administration take its time to get this done right.”
UNC Hospitals (NC) reports an operating income of $115 million, quadrupling its 2014 figure. The system credits added beds and its Epic implementation for the financial turnaround.
Massachusetts-based practice management vendor eClinicalWorks buys a 192,000 square-foot office building as it makes plans to add 1,000 employees to its workforce.
A GAO report on EHR interoperability concludes that the five major barriers to improved interoperability are cost, inadequate data standards, variation in state privacy rules, poor patient record matching technology, and a lack of trust between sharing entities.
A Raytheon-Websense security report finds that cyberattacks on healthcare entities surged 600 percent in 2014 and the industry now experiences 340 percent more security attacks than the average industry. Researchers explain, “Criminals often move to the easiest targets, and with retail and banking becoming more secure, healthcare networks became a prime target.”
MedAssets, an Alpharetta, GA-based healthcare performance improvement company, will lay off 180 full time employees, or five percent of its total workforce, by the end of 2015.
Online consumer health startup HealthTap announces plans to move into the employer wellness market with an app that offers telehealth consults, treatment planning, and patient reminders.
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