Morning Headlines 7/7/15

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

AMA announces that after negotiating with CMS, the two have agreed on changes to the ICD-10 transition plan that will provide a one year grace period in which ICD-10 claims without the appropriate specificity documented will still be accepted.

Meaningful Use Program: Why it failed and how to save it

Niam Yaraghi, a Brookings Institute fellow in the institution’s Center for Technology Innovation, suggests that MU2 failed because clinicians were never presented with a compelling reason to fully embrace health IT. He proposes mandating efficiency improvements in hospitals and practices, and then granting providers the flexibility to adopt whatever IT solutions they need to achieve those goals.

Despite regulatory troubles, DNA testing firm 23andMe raises more money

Personal genetics vendor 23andMe raises $80 million of a planned $150 million Series E funding round, its first investment activity since 2012, before it ran into significant regulatory problems with the FDA.

$237 million Tuomey judgment upheld by federal appeals court

A federal appeals court upholds a $237 million False Claims Act verdict against Tuomey Healthcare System (SC), exceeding the hospital’s annual revenue. The fine stems from charges that in the early 2000’s Tuomey knowingly filed thousands of illegal claims worth $39 million to Medicare.

Happy Data Independence Day!

Former national coordinator for health IT Farzad Mostashari, MD launches #DataIndependenceDay, a call to action for the public to request electronic copies of their medical records and then share their experiences.

Curbside Consult with Dr. Jayne 7/6/15

During my travels, I’ve been catching up on my journals. Given my current clinical work, I read both primary care and emergency medicine journals, and then there are the informatics articles that appear across a number of specialties.

I was amused by an editorial about cystic fibrosis in the June 15 edition of American Family Physician. It states, “The continuity and closeness that a family physician has with these patients has the potential to be a stabilizing and encouraging force in assisting with compliance and disease prevention, enabling patients with CF to maximize their quality and quantity of life.”

One of the main complaints I hear from primary care physicians across the country is an increasing lack of continuity. Patients are forced to change insurance when their company decides to update plans, or their providers may be dropped from insurance panels due to cost or quality profiling. Generally speaking, most primary care physicians I know entered the field because they wanted to have longstanding relationships with patients and wanted to help those patients live longer, healthier lives. Considering the average physician compensation across specialties, they certainly didn’t get into it for the money.

Because of my IT work, I’ve spent the last several years practicing in non-continuity settings such as urgent care or the emergency department. Although I occasionally work as a locum tenens in primary care practices, in those situations I usually see acute visits or overflow patients that can’t be accommodated by the other physicians in the practice. Not every practice has the luxury of bring in a locum when a physician is on vacation or leave, however. Many of them end up referring patients to local urgent care centers or walk-in clinics in order to address their needs.

Capacity isn’t just a problem when providers are out. In many of the practices I encounter, the physicians are carrying patient panels that are much larger than they should be to deliver quality care. This results in patients being directed to urgent care centers more often than they should, as well as patients electively choosing the urgent care route due to access and convenience issues. This in turn can drive up the cost of care and lead to increasing fragmentation. Physicians are carrying larger panels not only due to decreases in the primary care workforce, but also in attempts to tweak their payer mix to ultimately bring in more revenue.

Although we can celebrate interoperability and the portability of our health information as a way to smooth this fragmented care, that’s only part of the answer. There is a certain element of quality provided by being able to see a physician who knows you well over time. Merely having more pieces of information doesn’t always give physicians the information they need to provide the best care for their patients.

As the population ages and the burden of chronic disease increases, patients become more complicated. With the technology boom, we’ve seen an increase in the options available to manage patients and this also drives up the complexity of care. Complicated patients with complicated problems require more time and thought to manage. I can’t imagine how personalized medicine is going to play into the mix. We can throw layers and layers of technology at the problem, but that approach seems to frequently create additional problems.

In some situations, new therapies lead to the need for increasingly personal conversations with patients about whether a treatment is right for them and what the various costs and benefits might be. Additionally, we don’t have long-term studies on some of these treatments, so we’re trying to predict risk with our patients without adequate data.

In one of my journals, there was a write-up about a new diabetes medication that has a unique mechanism of action. This may be perceived by many patients as new and improved, but there is no long-term data on the morbidity or mortality benefits of the drug. In one study, it was shown to be equally effective as traditional therapies. My translation of “equally effective” is “no better than,” but there’s quite a different emotional response depending on which words you use.

Although the medication is newly approved and heavily marketed, it comes at a cost. A one-month course of treatment costs $335 compared to the “equally effective” older drug which costs $4 per month. It also is associated with higher risk of urinary tract infections and bladder cancer. Having that conversation with a patient you know well and who trusts your advice is very different than with a patient with whom you don’t have an established relationship. It’s hard to provide culturally competent care (one of the new markers of quality) when there’s not adequate time to develop rapport or resources to form an assistive care team.

The newer models of care delivery include Patient-Centered Medical Homes and other structures designed to deliver care in our increasingly value-based models. We’re offering physicians reimbursement for care coordination and increased payments for higher quality. However, it creates a chicken-or-egg cycle where you have to have more staff to form and train a care team to get more money, which you need in order to have more staff, etc. It’s easy for those of us in the IT and policy trenches to think that physicians should just cut their pay to hire staff. Although that might work in a physician-owned practice, it certainly doesn’t work in employed situations.

Regardless of employment status, new medical school graduates are coming out with record debt – another reason not to choose primary care. Most of the new physicians in my community are entering practice with over $300,000 in student loans. Even at a 30-year repayment it’s like having an extra mortgage payment (or two). Many of those new grads opt for employed positions because they can’t take the financial risks required to open their own practices (assuming someone would even loan them the money to do so with that kind of debt). They wind up in a different kind of bind where their hospitals or employing health systems control staffing and expenditures and often create barriers to developing effective care structures.

I know by this point some readers are wondering what this has to do with healthcare IT and why it’s in HIStalk. In the field, I see many practices where work is being shifted up to providers rather than down to support staff due to increasingly complex systems. A recent engagement involving multiple EHRs revealed clinical reconciliation processes that were so confusing that physicians were reluctant to have anyone else perform the task. Even as an advocate for work redistribution, I agreed with them. I saw two different patient portals in use, both of which had serious usability issues and one that had some potential patient safety issues. Although they may have performed well in some kind of laboratory testing event, they were not meeting the needs in the complex realities of the average office.

Vendors need to have clinicians on staff as well as a network of client and non-client physicians to test new products and proposed changes to products. This also goes to other types of users – clinical, financial, etc. We need to see technology vetted in more real-world environments if we expect to be able to revolutionize how care is delivered. We need vendors to be more nimble and use best practices to translate emerging federal and payer requirements to viable code. We need processes and procedures (both vendor and governmental) that allow product delivery in enough time for practices to implement upgrades and features without the rush and chaos we currently see.

Having better systems, processes, and workflows will help mitigate what sometimes feels like an assault on our nation’s caregivers. It might even convince some physicians who might otherwise be motivated to leave or curtail their practices to consider staying. Ultimately, it might even result in better care.

What are your thoughts about the future of medicine? Email me.

Email Dr. Jayne.

Morning Headlines 7/6/15

Theranos receives FDA clearance and review and validation of revolutionary finger stick technology, test, and associated test system

Palo Alto-based lab test vendor Theranos announces that it has secured FDA clearance for its testing process, which it says is cheaper, faster, and requires a smaller sample than traditional lab tests.

Aetna Agrees to Buy Humana for $34.1 Billion

Aetna will acquire Humana for $34.1 billion, or $230 a share, a 23 percent premium over Humana’s closing stock price on Thursday.

In Health Law, a Boon for Diet Clinics

The New York Times analyzes a component of the ACA that requires insurers to cover nutrition and obesity screenings and the effect the requirement is having on the for-profit weight loss industry.

Deadline confusion threatens EPAS rollout to new hospital

In Australia, the Royal Adelaide Hospital, a new 800-bed facility being constructed in South Australia, may fail to bring its Allscripts EHR implementation live prior to its scheduled 2016 opening because it mixed up its own go-live deadlines and has been struggling with clinical adoption issues.

Monday Morning Update 7/6/15

Top News

Lab testing upstart Theranos earns FDA approval for its herpes simplex test, the importance of which isn’t the test itself, but rather the fact that the company sought and earned FDA’s stamp of approval for its overall technology that had been labeled by some scientists as secretive and clinically suspect.

Reader Comments

From Pithy Mood: “Re: Quality Systems, Inc. The company just issued a proud announcement that its management team and CEO won a bunch of awards, including CEO of the Year. Why are there rumors that he was pushed out?” It’s not as though some prestigious, metrics-driven, non-profit organization of executive peers chose the just-retired, 63-year-old Steven Plochocki as the best CEO in the country given that QSII shares sell today for the same price now that they did when he took the job in 2008. The “CEO World Awards” are run by a public relations firm – companies pay to apply to a seemingly endless list of categories, with the winners then earning the opportunity to buy advertising, banquet tickets, memorabilia books, trophies, and other vanity junk. The troubling aspect is that a company would even bother to apply knowing how little any resulting award would mean. Plochocki was one of 13 “CEO of the Year” winners. Even his admin got in on the act by being the only announced winner in the “Admin Assistant to the CEO” category. Maybe she’ll replace him.

From X-Industry Consultant: “Re: Leah Binder’s WJS column. I’m tired of the ‘health system CIOs are idiots – why can’t you be like other industries?’ narratives. How many IT implementations from other industries has she studied? I’ve worked on dozens and huge failures abound – the FBI abandoned a $170 million system, Pfizer a $100 million clinical trials system. Give me an industry or government agency and I’ll give you a failure that dwarfs anything in health systems. The industry difference is that health system CIOs manage dozens of business models and hundreds of applications. Not many industry or government CIOs have the political, workflow, technology, and public policy skills to manage IT in a large IDN or AMC. I applaud Leapfrog’s constant pushing for better IT, but this column isn’t helpful.” The opinion piece titled “The Fatal Cost of Hospitals’ IT Ignorance” is naive about how healthcare IT works, where “ignorance” isn’t the cause of many or most problems. Binder says few IT leaders can make technology work culturally, conveniently absolving the non-IT operational leadership of responsibility in hanging the “responsibility without authority” albatross around the CIO’s neck. Mostly she’s griping that not every hospital chooses to run Leapfrog’s medication warning system checks, which as useful as it might be, is hardly the best measure of IT competence. Many hospitals are averse to standardization, transparency, and practicing evidence-based medicine, so it’s no wonder plugging in a new IT system (even successfully) doesn’t change anything. While I’m amazed and awed at how Amazon’s site works, I don’t necessarily assume they could do a better job of developing hospital systems than the vendors and provider IT leadership we already have. We’ve built an illogical, consumer-indifferent, paternalistic, billing-intensive, and political healthcare system that defies efforts to make it better that involve simply automating the underlying mess.

From Pickleballer: “Re: Cerner’s support of the former Siemens applications. Zane Burke originally said Cerner would support Invision, MedSeries4, and Eagle for 3-5 years, but a CIO friend says contract language obligates Cerner to provide updates for bug fixes and HIPAA only, not Meaningful Use Stages 2 and 3. If true, that’s a nasty clause that could hospitals many millions of HITECH dollars when had Cerner just said so upfront clients could have planned ahead.” I have an inquiry in with Cerner and will let you know if they respond. UPDATE: Cerner provided the following response:

Before the acquisition, Siemens Health Services communicated to its clients in person that they would continue to support MedSeries4 and Invision for clinicals and financials, as well as Eagle, but wouldn’t support the clinical components of Invision or MedSeries4 for Meaningful Use 3. Cerner affirms that communication. Additionally, we are providing new regulatory enhancements and other operational excellence improvements for MedSeries4, Invision and Eagle financials, and we have existing client support commitments on all three solutions that extend into the next decade that we will continue to honor.

From Bella: “Re: bachelor’s degree in HIM through UIC online. I’m interested but don’t know how hard it will be. Has anyone completed it? I could do a post-baccalaureate certificate or the degree to earn RHIA certification – which route is better?”

From Blue Canoe: “Re: VA suicide risk EHR algorithm. I read that Cerner presented the same concept on the Hill earlier this year. Do you think something like this would be a factor in the DoD’s decision?” I doubt it will be a primary consideration, especially since the concept hasn’t been fully proven at scale and both Allscripts and Epic collect the same patient information and could run the same algorithm against it. The idea probably impresses IT-naive politicians, so it really depends on how much they influence the DoD’s decision.

From Pure Shortening: “Re: McKesson Connected Care & Analytics. Reorganized, including subsidiary RelayHealth.” Unverified. I’m not really sure what’s going on there if anything, other than McKesson sold its care management business out of that division a few weeks ago. RelayHealth, which always seemed to be the darling of McKesson CEO John Hammergren, hasn’t put out many press releases lately and the folks I knew there are gone. That whole product area would seem to be the most promising to McKesson, which is slowly backing away from some of its other health IT businesses such as the decision to retire Horizon, which gave competitors some nice new sales. RelayHealth still seems like the company jewel to me.

HIStalk Announcements and Requests

Seventy percent of poll respondents think that HIPAA has had a positive impact on privacy. Reader Michael says small practices don’t understand it and doubt that HHS actually enforces it, while Mak likes the concept of snooping penalties and ensuring that patients can get their own records but he’s not a fan of the Washington “forever” jobs it created or penalties for looking at information that is widely available everywhere, including in the government’s own insecure systems. New poll to your right or here:  have you as a patient used a provider’s portal within the past 90 days?

Welcome to new HIStalk Gold Sponsor LiveProcess. The Burlington, MA-based company offers HealthCORe, a team communication and collaboration solution that is used for emergency incident response, coordinating severe weather events, managing staff callouts, monitoring ED capacity and mobilizing staff as needed, coordinating hospital-to-hospital patient transfers, and managing care transitions. They have a lot of industry long-timers involved, including Sentillion co-founder Rob Seliger as executive chairman, Terry Zysk (MedVentive) as CEO, and Kelly Flood (Perceptive Informatics) as VP of client services. Thanks to LiveProcess for supporting HIStalk.

I found this LiveProcess HealthCORe overview on YouTube.

I still have matching money available for DonorsChoose donations. A company’s $1,000 will not only magically turn into $2,000 worth of funded teacher projects, it will also earn the donating company a mention right here on HIStalk for helping kids who need it.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, or HIStalk Connect. Click a logo for more information.

My grammar (and related) gripes for this week include use of overly casual contractions (such as “it’ll” and “it’d) when writing; calling any sort of lame and usually obvious tips “hacks” to make them sound more edgy; writing “would of” instead of “would have;” incorrectly saying “literally” for emphasis when “figuratively” is obviously correct; redundantly writing a currency figure in the form of “$1 billion dollars;” and the name of a restaurant chain I just noticed, LYFE Kitchen, in which LYFE stands for “Love Your Food Everyday,” whose misspelling suggests food that is mundane rather than enjoyed frequently unless they correctly change their name to the admittedly less-clever LYFED. I’ll also bring up an Independence Day special in differentiating between “grilling” (cooking over high heat) and “barbequing” (smoking over low heat), with the large number of folks who proclaim they’re doing the latter actually doing the former. 

Last Week’s Most Interesting News

• Allscripts spends $200 million to buy 10 percent of NantHealth, whose chairman Patrick Soon-Shiong invested $100 million of personal funds in Allscripts as his company prepares for an IPO.
• An AHRQ-funded study finds that use of patient portals and secure messaging create problems for both patients and providers, concluding that they don’t affect outcomes unless rolled out as part of a comprehensive program.
• A CVS study of chronic disease patients finds that patients prefer using online portals to communicate with their physicians, slightly more than those who like email or mobile apps.
• A federal grand jury indicted a citizen of an unnamed country outside the US for using information stolen in a UPMC breach to file fraudulent tax returns.

Webinars

July 14 (Tuesday) noon ET. “What Health Care Can Learn from Silicon Valley.” Sponsored by Athenahealth. Presenter: Ed Park, EVP/COO, Athenahealth. Ed will discuss how an open business structure and strong customer focus have helped fuel success among the most prominent tech companies and what health care can learn from their strategies.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.

Acquisitions, Funding, Business, and Stock

Elsevier acquires London-based clinical decision support vendor InferMed.

Aetna will buy Humana for $34 billion, paying a share price premium of 23 percent. I can’t imagine the FTC will find the idea of bigger, fewer insurance companies to be good for consumers, but Aetna seems to be confident they’ll get approval to close the deal. The Affordable Care Act has been very good for insurance company shares.

Shares of video visit provider Teladoc began trading Wednesday, with shares jumping 50 percent on IPO day in raising $270 million for the company, which lost $17 million on $43 million in revenue for 2014.

Sales

Encompass Home Health & Hospice chooses HealthMEDX Vision as the EMR for its private duty pediatric services.

People

Medical second opinion vendor 2nd.MD names Patrick McGinnis, MD, MS, MBA (Memorial Hermann Healthcare System) as chief medical officer. He’s also a flight surgeon in the US Air Force Reserve.

Consumer engagement platform vendor Datu Health hires Jeff Johnson (Intermountain Healthcare) as SVP of strategy.

Announcements and Implementations

ADP AdvancedMD announces its Patient Relationship Management suite that includes patient forms, a check-in kiosk, and a patient portal.

Government and Politics

An interesting requirement of the Affordable Care Act is that insurers pay for obesity screening, which has for-profit diet clinics (including some run by hospitals) salivating at the prospect of earning up to $3,000 per patient per year for overseeing questionably effective weight loss programs.

Privacy and Security

A USA Today article urges people who drive rental cars to clear their personal data from the Bluetooth-paired entertainment system, which stores their phone number, contacts, and call logs for the next renter to find. It also points out that navigation systems retain addresses and the rental company’s black box tracks a lot of undisclosed information.

The Guardian profiles Deanna Fei, one of two AOL employees whose premature babies cost the company $1 million, causing the company’s $12 million salary CEO to publicly blame Obamacare and the cost of “two distressed babies” as the reason he cut the company’s 401(k) plan for everyone. Deborah Peel of Patient Privacy Rights told Fei that CEO Tim Armstrong had violated HIPAA in referring to her daughter in a way that made it obvious who he was talking about. Peel says, “I saw her story when the idiot CEO of AOL was stupid enough to take action with the 5,000 employees and tell them he was changing their 401(k) benefits because of $2m premature babies. You’d think that somebody who runs a technology company would understand privacy, but no.” I’m not sure the CEO really violated HIPAA since he’s not a health plan, provider, or clearinghouse, but I’ll agree on the “idiot” part – he also fired the company’s creative director in front of 1,000 co-workers for shooting video during an internal conference call about layoffs and reorganizations.

Other

The management of South Australia’s Royal Adelaide Hospital is struggling to get its new clinical system ready for the January 17, 2016 opening of its replacement hospital after confusion over the go-live date, which the hospital’s management thought was mid-April 2016 until early last year. The auditor’s report also notes that South Australia Health had “lodged a formal claim” against Allscripts to recoup project delays after Allscripts failed to deliver critical parts of the billing system, with Allscripts agreeing to pay $10 million in November 2014. SA Health named Allscripts as vendor of choice for the 80-hospital, $225 million project in November 2010 and signed the contract a year later, with the last cost update coming in at $317 million over 10 years, which SA Health expecting that “the approved EPAS rollout would result in an overall favourable position of $11 million over 10 years to 2020-21.” The government had to put the stalled rollout on hold last year following physician complaints about poor usability and claims that it was causing medication errors.

HealthStream co-founder and CEO Bobby Frist gives $1.5 million worth of his personal company shares to 600 non-management employees, which he announced in a video phone message to each employee by saying, “This stock grant is being personally funded from me, so this is from me to you. Thank you again and enjoy being an owner of the company.” He holds shares worth $154 million and lives in a pretty grand Nashville estate judging from photos I found by Googling.

Several readers sent a link to ZDoggMD’s R. Kelly remix of “Ignition” called “Readmission.” ZDoggMD, who is actually Zubin Damania, MD, founded Las Vegas primary care clinic Turntable Health. He says his “medical humor & dope rhymes” are “slightly funnier than placebo.”

Weird News Andy ponders, “What’s a Grecian Urn?” and concludes that it’s a lot more in Germany than in Greece, whose self-created and ever-worsening financial mess has caused a brain drain that includes 5,000 emigrated doctors since 2010, 3,500 of which have relocated to Germany, Greece’s largest lender.

Sponsor Updates

• Orion Health is named to “2015 Careerbuilder Top Companies to Work For in Arizona.”
• Hayes Management Consulting posts “System Implementation: 4 Stumbling Blocks to Avoid.”
• Paula Gwyn of CareTech Solutions is appointed to the HIMSS Innovation Committee.
• Extension Healthcare offers “Caregiver Alarm Crisis – What is Your Story?”
• Galen Healthcare Solutions posts “For the Users, By the Users: ERUG 2015.”
• Greenway Health offers “Improving medication adherence through education, communication.”
• Madison Regional Economic Development visits Healthfinch on its Innovation Location tour.
• Holon Solutions offers “Incentives are Good, but Tobacco Cessation App Can Improve Patient Success.”
• Impact Advisors offers “LEADing Your LEADers!”
• Influence Health offers “Why Mobile Should be a Top Priority in Your Online Marketing Strategy, Part II.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 7/2/15

Teladoc shares surge 50% in healthy IPO debut

Dallas-based telehealth vendor Teladoc raises $157 million in its IPO debut, valuing the company at $620 million. Stocks closed at $28.50, up 50 percent on its first day.

The Fatal Cost of Hospitals’ IT Ignorance

Leah Binder, president and CEO of Leapfrog Group, publishes a Wall Street Journal editorial suggesting that poor health IT implementations are plaguing US hospitals because the health care industry lags behind in technology and, as a result, hospital administrators lack the experience needed to successfully implement the new systems.

Doctors See Big Cybersecurity Risks, Compliance as Key for Hospitals

A survey of 272 physicians, administrators, and health IT professionals finds that physicians have a significantly lower opinion of their hospital’s ability to defend against a cyber attack than health IT professionals and administrators, and are far more likely to cite EHRs as the hospital’s primary vulnerability.

CMS: Hospitals can attest to first year of ‘meaningful use’ this summer

ONC will allow hospitals participating in Meaningful Use for the first time this year to attest this summer rather than waiting until January 1 as it had previously planned. 

Readers Write: Building Pillars of Success on a Foundation of Failures

Building Pillars of Success on a Foundation of Failures
By Randall N. Spratt

As the days fly by toward my retirement later this year, I’ve spent some time reflecting on my 40-year career in information technology. It feels like just yesterday I was receiving my diploma from the University of Utah, eager to jump into my career and make my mark. As college grads begin to enter the workforce, I hope that sharing my path and insights may help them build the foundation of their own leadership aspirations.

I started my technology career as a junior Fortran 77 programmer. I was good — I mean really good. I could write 10,000 lines of code without ever writing down an idea. I could produce a bug-free, error-free compile the first time. I was so good that I was quickly promoted to manager. However, it turned out that being a good programmer did not mean that I was a good manager.

On the brink of retirement, when I look back at my career, I realize that I built pillars of success on a foundation of failures. In my first management position, as a programmer, I would tell everybody how to program. When they failed, I would just do it for them.

I found myself working harder and being less effective because I wasn’t managing — I was doing. Somewhere along those first few management jobs, I had my first ah-ha moment: it was my job to deploy resources to help people do their jobs, not to tell or simply do.

Strong leaders know when to let go. They are effective in sharing a common vision with others and they make conscious — and sometimes difficult — decisions about what they do with their time.

As a programmer, I had 100 percent control over what I did at work. Every single line of code came out of my hand. No one else had anything to do with whether or not the program worked. Now, as a CIO and CTO, I have absolutely no control over anything. It has been a steady process of learning to relinquish control and replace it with influence and coaching while providing opportunities to collaborate as a team. 

It took me some time to realize this, but as soon as I did, it immediately strengthened my management skills and things got a lot easier. Eventually, I began to spend more of my time traveling to our customers’ locations to install laboratory information systems. While on site, I gained a better understanding of the customer’s needs. I realized that what I was installing wasn’t necessarily what our customers wanted. To help solve this problem, I wrote more code. I felt that I knew what the end users wanted better than anyone else in my own company.

Once again, I began to fail because I took my eye off of the job of management. I was now a manager of managers. My job was to make sure that our customers were well served and that their voice was heard. The answer wasn’t to write more code — the answer was to relay information gleaned from the customer to the groups I managed so that we shared a common vision, a common set of goals, and a common understanding about what we were trying to accomplish for the customer.

It was very time consuming. The more responsibility I got, the more work there was to do, the more people there were to talk to, the more relationships there were to build, the more details there were to cover, the more people there were to appraise, the more raises there were to give.  Everything took more and more time.

This led to my second ah-ha moment: work is part of life but, for some people, work is life. My career and leadership path would depend on how well I knew myself and how I decided to spend my time.

No matter where we are in our careers, we all have one thing in common — we have only 24 hours in every day. No more, no less. After choosing to spend some number of those hours asleep, our paths diverge. We choose when we wake up and we decide what to do once we’re awake. Some of us wake up earlier and choose to go running, while others start later and sit with the paper and coffee. Some fire up email, some talk to a spouse or a friend. But each one of us makes choices about how to use our time.

At that point in my career, I discovered I would never understand the term work-life balance. It is not about balance, it’s about choices, decisions, and how you choose where to spend your 24 hours. Sooner or later you are going to be faced with tradeoffs and decisions. You can’t be a top developer or a CIO of a company and think that you’re still going to service every hobby, every person, and every relationship in your life in the same way. 

I created the time to be a leader in my field and I often had to give things up. Throughout the years, I gave up sports and many hobbies. As I began to have children, I chose to spend more time with my family and gave up time with friends. These choices were made consciously, with a deep knowledge of myself and a realization that although I was letting go of some things, I was gaining others.

As I look back at my career, I can recall many choices — some lucky, some wise, some painful, and some necessary. Writing code was easy — just me and the keyboard. The results spoke for themselves. Cultivating the skills to become a leader was much more subtle and nuanced, but in many respects, far more rewarding.

Randy Spratt is CIO and CTO of  McKesson Corporation.

Morning Headlines 7/1/15

Allscripts Takes $200M Equity Position in NantHealth and Expands Strategic Alliance to Enhance Precision Genomic Medicine at Point of Care

Allscripts invests $200 million in billionaire Patrick Soon-Shiong, MD’s startup NantHealth, taking 10 percent ownership of the company in return. At the same time, Soon-Shiong personally invests $100 million in Allscripts. The two have formed a partnerships to integrate and market their respective product offerings together.

Patient Use of Email, Facebook, and Physician Websites to Communicate with Physicians: A National Online Survey of Retail Pharmacy Users

CVS publishes findings from a study of customers with at least one chronic condition, finding that 37 percent reported contacting their physician by email within the last six-months.

Epic chosen as new electronic health record system for UC Irvine Health

UC Irvine Health (CA) announces that it will implement Epic as its next EHR.

Vietnamese 7th grader devises comprehensive, handy medical software

A seventh grader in Vietnam has coded a program designed to help doctors and medical students review the latest medical research for conditions they see regularly. The system includes 300 evidence-based treatment plans and is now being used at Hau Giang General Hospital’s Internal Medicine Faculty.

News 7/1/15

Top News

Allscripts takes a 10 percent equity position in NantHealth for $200 million in cash, while NanthHealth billionaire founder Patrick Soon-Shiong personally invests $100 million in Allscripts. Co-development plans include product integration and work on personalized medicine. NantHealth is rumored to be mulling IPO plans, while Allscripts shares have dropped 16 percent in the past year.

Reader Comments

From Dr. N: “Re: EHRs. EHRs were developed out of coding and billing frameworks. This does not relate to MDs and patients. SOAP still remains the most efficient and meaningful format. However, click boxes, no doubt, would be helpful for meta data, also important. Software has the ability to pull down from the SOAP narrative format data to the click boxes. Minimal new language may need to be used by the MD in the narrative. I personally retired rather than using the completely useless EHR formats available. The current EHRs are subtly and obtusely changing MD thinking processes and predominately to the negative.”

From Libby Litigator: “Re: Blue Shield of California. You mentioned that a former executive claims he was fired for trying to reduce the company’s outsourcing payments to Cognizant. BSCA’s former CTO also filed a lawsuit claiming he was fired for pointing out issues with Cognizant. His new employer CEO also worked for Blue Shield as a policy guy and got tired of trying to defend its non-profit status after he saw how it operated. Has anyone ever done that on the hospital side?” That is indeed a fascinating story, as former BSCA CTO Aaron Kaufman says his CIO boss fired him the day before he was due his $450K bonus for 2014 after Kaufman questioned selection of a particular vendor. BSCA countersued Kaufman in claiming that he charged $100,000 in personal expenses to his company credit card. Some of those charges involved a bowling party night out Kaufman spent with his girlfriend, “Sharknado” and “American Pie” actress Tara Reid, which made BSCA doubly unhappy because “inappropriate” photos like the one above made their way into the public eye. Kaufman said he had to use his company credit card because the wife he was divorcing had locked up his accounts. Most interesting (other than a healthcare CTO successfully wooing a Hollywood actress, even a minor and fading one like Reid) is how a supposedly non-profit insurer can justify paying a CTO an annual bonus of $450K. Kaufman is now EVP/chief product officer of SocialWellth, which earns top buzzword scores in unintelligibly describing its app certification business that it bought from the defunct Happtique as, “a digital health company that enables payers, providers, and employers to prescribe curated digital health assets and services to their end consumers at relevant touch points in their health journey, and in turn, receive actionable data to deliver value based care. Our profile-driven mobile computing platform integrates and aggregates mobile health apps, devices, and content while leveraging activation currency and social engagement to deliver personalized well-being experiences for consumers.”

HIStalk Announcements and Requests

It’s been four days since I faxed a form requesting my electronic records from a hospital and they haven’t responded. The only other method of contact listed is to call the HIM department, so I’ll do that next. I’m feeling the presence of an increasingly non-electronic bureaucratic wall.

Webinars

July 14 (Tuesday) noon ET. “What Health Care Can Learn from Silicon Valley.” Sponsored by Athenahealth. Presenter: Ed Park, EVP/COO, Athenahealth. Ed will discuss how an open business structure and strong customer focus have helped fuel success among the most prominent tech companies and what health care can learn from their strategies.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.

Sales

PremierMD (FL) chooses the eClinicalWorks EHR and population health management suite.

UC Irvine Health (CA) chooses Epic.

UAB Medicine (AL) selects Athenahealth’s AthenaCoordinator Enterprise for patient access, referrals, and care transitions.

People

Verisk Health hires Sean Creighton (CMS) as VP of risk adjustment solutions.

A North Carolina newspaper’s review of 2014 CEO compensation of the state’s largest companies places Premier CEO Susan DeVore highest at $24.9 million, the first time a woman has topped the list. PINC share price is up 32 percent in the past year, valuing the company at $1.4 billion, of which DeVore holds around $8 million worth.

Alternate site billing systems vendor Brightree hires Lori Jones (AirStrip) and Shaw Rietkerk (MModal) as EVPs.

Announcements and Implementations

Wellcentive awards a $5,000 Medical Scholarship for Veterans to former Marine Captain Anthony DeSantis, a fourth-year medical student and Tillman Military Scholar at University of South Florida who was deployed to Fallujah, Iraq in 2007-2008.

Innovation and Research

A seventh-grade student in Vietnam creates Health for Everyone, prize-winning software that contains clinical information, treatment plans, a drug-drug interaction checker, and a weekly medical quiz. The local hospital’s internal medicine department is using it,  proclaiming it to be “a wondrous, time-saving device which also updates doctors’ and nurses’ medical knowledge and expertise.”

Other

A Wall Street Journal article called “How to Take Charge of Your Medical Records” urges patients to serve as their own data hub instead of relying on providers and their incompatible systems to send information back and forth. The reporter got a bit confused in thinking that the Blue Button website contains actual Medicare and VA patient information and the article takes a puzzling turn into the privacy of wearable device data, but it was otherwise a pretty good consumer-focused overview. I was interested that the ICEBlueButton app from Humetrix displays a QR code on a smartphone’s lock screen that paramedics can scan to display emergency medical information, with a $20 per year option to also immediately alert their emergency contacts.

An AHRQ-funded study finds that providers like the convenience of allowing patients to upload information via their patient portal, but patients themselves struggle with usability issues and rarely upload anything. Secure messaging was accepted by both groups but sometimes caused provider workflow and workload problems. The study concludes that health IT improves outcomes only if used as part of more comprehensive programs and poor application usability impedes workflow.

Analysts from Goldman Sachs estimate that digital technology (in the form of the Internet of Things) will save $300 billion in annual US healthcare costs and generate $32 billion in revenue. My cynical experience is that the latter is much more likely to be realized than the former. One person’s excess costs is another person’s income and that other person often hires lobbyists, lawyers, and trade groups to keep the excess costs flowing into their pockets. 

Eaze, the California company whose fast-track marijuana delivery service is known as “the Uber of pot,” jumps into telemedicine with with EazeMD, which consumers can use to obtain a medical marijuana card following a $25 video visit with a physician.

Tuesday night (June 30) is Leap Second, where the world’s clocks adjust for the slowing in the Earth’s rotation by adding an extra second to the day. Amazon had problems the last time it happened (in 2012) but has since changed its systems to add a tiny bit of time to each day rather than all at once.

A New Zealand doctor whose patient died after he unknowingly prescribed an inappropriate drug says he will no longer rely on his EHR’s automatic warnings and will instead review the records himself. The doctor says he doesn’t remember receiving a computer warning. The local hospital was also blamed for failing to integrate its systems after acquiring another practice.

A decently designed survey of CVS pharmacy customers with at least one chronic condition finds that 37 percent have communicated with their physician by email. Around half are interested in tracking health, refilling prescriptions, and looking up information, with their preferred method being via online portals, which finished slightly ahead of email or mobile apps. Oddly, the study commentary opines that patients prefer email and Facebook to physician portals even though its results indicate otherwise. Nearly 20 percent of respondents said they have contacted their physicians on Facebook, which will surely alarm hospital risk managers everywhere. The study is disappointing only in that it took two years for it to wind its way through the bowels of journal publishing – the survey was performed in May and June of 2013, a decade ago in social media time.

Unrelated but bizarre: two airline pilots from Argentina are fired for posting a YouTube video in which they turn over the controls of their plane during takeoff to a model who has been featured in Playboy. The passengers are filing suit against the airline, while the model says she will sue the pilot and co-pilot for sexual harassment in claiming they fondled her while fastening her seat belt.

Weird News Andy titles this story “Child to Be Raised By Wolves” in expressing relief that mom and baby Romulus are fine. A pregnant woman gets lost in a national forest while driving to her parents’ house and is stranded for three days when she runs out of gas and her cell phone battery dies. She gives birth and is finally rescued by Forest Service rangers responding to the forest fire she accidentally started.

Sponsor Updates

• John Moore, managing partner of Chilmark Research, will deliver the keynote address at Galen Healthcare’s Galen Partner Advisory Council in Boston August 3-4.
• ADP AdvancedMD offers “Flag these ICD-10 codes for the Fourth of July.”
• Team AirStrip wins the San Diego International Triathlon Mixed Relay.
• AirWatch offers “IDC confirms: AirWatch by VMware holds largest EMM market share.”
• Besler Consulting posts “Making the Case for Dedicated Observation Units.”
• CapsuleTech offers “AMIA Task Force Calls for Simplification and Speed in EHR Use.”
• Caradigm offers “Super Clinically Integrated Networks will Lead the Way to Population Health.”
• CareSync publishes “Project Manager Field Research.”
• CitiusTech celebrates its 10th anniversary.
• CoverMyMeds offers “CoverMyMeds – As Secure as Ever.”
• CTG participates in the 20th annual Ride for Roswell to raise funds for the Roswell Park Cancer Institute.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/30/15

Source Data Capture From Electronic Health Records: Using Standardized Clinical Research Data

The FDA will host a demonstration day for vendors to showcase technology that will help it mine EHRs for automated clinical trial data capture.

Despite Threats, Senate Appropriations Bill Currently Remains Free of ICD-10 Delay Amendment

Though a number of competing bills have recently been introduced in Congress to delay or outright cancel the upcoming ICD-10 transition, AHIMA reports that the Senate Appropriations Bill remains free of any language that could derail the transition.

Improving prediction of fall risk among nursing home residents using electronic medical records

Researchers develop an algorithm that uses either EHR data or MDS 3.0 data to predict fall risk for patients in the nursing home setting, finding that EHR data was almost 10 percent more accurate at forecasting falls.

Texas medical fraud case screams for tighter auditing by feds

The Dallas Morning News looks back on the $18 million Meaningful Use attestation fraud scam that left the owner and CFO of Shelby Regional Medical Center (TX) in jail, citing it as a key example of why the program needs more stringent audits.

Curbside Consult with Dr. Jayne 6/29/15

I agree with Mr. H that this is a slow time of year for healthcare IT news. Not only is it a slow time for news, but it seems to be a slow time for overall productivity as well.

I’m working with a client right now that is having a hard time getting anything done. Their teams are extremely lean and most staff operate without a backup, so vacations have a significant impact. Additionally, it feels like when we have the right people in place from the client side, there is a good likelihood that someone will be out from the vendor side.

I did some work a couple of years ago that involved a Swedish vendor. We were up against an extremely tight timeline because we had been warned that the entire company (literally) would be on vacation for four weeks during the summer. I remember thinking they must be terribly progressive, some kind of Scandinavian high-tech outlier going to extremes to keep their staff happy. After a little digging, we determined it wasn’t that unusual at all – since the late 1970s, Sweden has mandated five weeks of vacation for their workers. Many take the majority of them in the summer.

There are a variety of reasons that approach wouldn’t get very far in the United States. In addition to the political and economic factors opposing it, think about the planning needed to pull it off. Even for a small company, it would involve a great deal of strategic planning to ensure that the time off is factored into all projects. It would also require that projects are actually executed on time so that there are no last-minute pushes into the vacation.

In digging into the economic factors, though, I wonder if the return on investment for something like that might be real. If you look at the lost productivity encountered at a hospital like my current client, it’s significant. Workers are continually coming to the office late or leaving early for a variety of issues: traffic patterns are different with children out of school; childcare situations may be less predictable during the summer months; and tourism picks up in the city, resulting in parking and other logistical issues. We’re also seeing more people working from home to keep an eye on their children, resulting in a greater percentage of online meetings with barking dogs, background noise, and the occasional yelling dad who forgets to use the mute button.

I was looking for information on countries with more liberal vacation policies and came across this great Washington Post summary. It discusses the work of Swedish environmental psychologist Terry Hartig, who notes that those returning from a relaxing vacation tend to return to the office relaxed. I see more and more people “vacationing” with their smartphones, laptops, and piles of documents. Not only are they not enjoying their time away, but I’ve also seen feelings of guilt for those back in the office who feel bad for having to contact them. For those staffers who manage to avoid calling in for meetings, there are productivity-sapping discussions when their colleagues discuss the Facebook posts of those who are soaking up the sun.

Hartig’s research looked at prescriptions for anti-depressant drugs in Sweden over more than a decade. When people vacationed simultaneously, there were fewer prescriptions. The article (from 2014) lists the annual cost of depression at $23 billion a year in the US, so we can add that into the ROI calculation. Hartig also notes that Europeans spend less on healthcare and live longer than Americans – and have 20 to 30 vacation days a year. US companies seem to be cutting back on vacation unless it’s contractually mandated.

A couple of years ago, my health system did a “realignment” of vacation and sick time policies. They essentially declared that ours were too generous and out of line with other employers in our metropolitan area. We had previously been allotted seven corporate holidays and two personal holidays. The personal holidays were originally intended to allow employees to have time off for those holidays that were not corporately-declared, such as Christmas Eve, New Year’s Eve, Columbus Day, Presidents Day, Martin Luther King Day, Veterans Day, etc. if they were important to the employee. The HR people found out that no one else offered anything like that, so the personal days were cut.

That began a race to the bottom that ended with not only the elimination of the personal holidays, but all personal days in general. They also reduced the ability to carry over vacation days from year to year and eliminated the existing vacation buy-back program. They announced the new carry over rules during the last two months of the year. Many departments were getting ready for a major system migration after the first of the year and vacations weren’t being approved, resulting in many more employees who had to lose it rather than use it. Managers were given virtually no flexibility to accommodate their employees. The end result felt a lot like theft.

The Washington Post piece also notes that “the US is the only advanced economy with no national vacation policy (unless you count Suriname, Nepal, and Guyana).” Nearly 25 percent of workers have no paid vacation at all with those who do have vacation averaging 10-14 days a year. When I left my CMIO role, the vacation policies were a total patchwork. Employed physicians in direct patient care were allotted 15 vacation days and five continuing medical education (CME) days for a total of 20 days plus the corporate holidays. Administrative physicians had the same number of vacation days and holidays, but were allocated no CME days. I suppose that means that once you are an administrator you either lack the capacity to learn or the organization assumes you already know everything.

Anyone less than a manager title only got 10 vacation days, regardless of seniority. Even the sick-time policy was confusing. Hourly employees could take their time in one-hour increments but salaried employees had to take it in four-hour blocks. Although they told us that as salaried employees we had the ability to take an hour off here and there without formally requesting it, there was a lot of pressure to make up any time out of the office. The net result was that very few salaried employees were actually able to take advantage of their sick time unless they were seriously ill.

Losing vacation and sick days is fairly common, with the article mentioning an estimated 577 million unused days each year which equates to “$67 billion in lost travel spending and 1.2 million jobs.” Adding that to the ROI, I’m starting to wonder if we can afford to NOT take more vacation. It also mentions some interesting political facts:

• In 1910, William Howard Taft proposed giving American workers two to three months of paid vacation each year.
• John Muir recommended compulsory vacationing as better for the country than compulsory schooling.
• The 1938 Congress proposed the 40-hour work week, a minimum wage, and two weeks paid vacation.

I’m taking several vacations this summer, mostly to make up for the lack of them during the last several years. I also have the luxury of being my own boss right now, so it’s much easier than before to schedule a vacation. It’s a bit harder to execute, though, since I’m a corporation of one. Even when clients are understanding and know I will be out of the office, it takes a conscious effort to disconnect. Checking my phone is tempting but it usually results in at least half an hour of work, so I try not to do it at all.

I’m staging all my projects for the next couple of weeks in preparation for some wilderness adventures. I can’t wait to be not only out of the office but in a place that literally has no cell towers or electricity. It also has no running water, but I’m not exactly looking forward to that. I’m sure some of my fellow travelers will be bringing solar chargers or Biolite stoves, but I’m not even taking anything with a USB port.

What’s your strategy for disconnecting when you’re out of the office? Email me.

Email Dr. Jayne.

Morning Headlines 6/29/15

Indictment In UPMC Stolen Identity Scheme

A federal grand jury in Pittsburgh returned a 21-count indictment against a foreign suspect charged with filing 900 fraudulent tax returns using the information of UPMC employees, The employee’s data was compromised in a 2014 breach that impacted 62,000 employees.

State Of Software Security – Volume 6: Focus on Industry Verticals

A Veracode report finds that healthcare is poor at keeping up with security policy compliance, with 80 percent of tested healthcare applications containing cryptographic issues, and only 43 percent of known issues being corrected.

Electronic Health Records Come Under Fire in Ventura County, Calif.

The Ventura County (CA) civil grand jury says that the Ventura County Health Care Agency failed to adequately prepare for its $50 million implementation of Cerner across two hospitals and 40 clinics. The new system, which the director of the Health Care Agency says is working fine, reportedly caused frequent crashes and problems generating prescription labels.

Monday Morning Update 6/29/15

Top News

A federal grand jury indicts a foreign suspect for using employee information obtained in the 2014 hacking of UPMC’s computer systems to file 900 fraudulent federal tax returns that netted a group of conspirators $1.5 million.

Reader Comments

From FM: “Re: Brian Weiss’s article. Great article, Brian. The ‘HIE of one’ is the most simple, and most disruptive, way to achieve interoperability, and all enabled by simple technical building blocks (Direct, C-CDA) plus our inalienable civil rights. All we have to do now is ask. #GetMyHealthData.” I’m doing my own HIE of one, as you’ll read in the next paragraph. I invite readers to do the same and report their results. We keep talking about information blocking, so let’s name names in trying to wrest an electronically transmitted C-CDA from providers who have eagerly lapped from the Meaningful Use trough and therefore should be able to provide one.

HIStalk Announcements and Requests

I am accepting Brian Weiss’s suggestion that we all become Open Provider Authorized Testing Bodies in requesting an electronic copy of my discharge summary from my one and only hospital admission, which lasted less than a day. It’s an EMRAM Stage 7, Epic-using, MU2-attesting medical center that should be able to send a C-CDA to my newly created Direct address (via Carebox, signup for which took 10 seconds). I suspect clashes with a clueless bureaucracy are in my future as I’ve already had to print a confusing HIM-centric paper form, fill it out (minus my medical record number, since it’s ridiculous that they expect patients to know that), and fax it back (using a free Internet fax service since I don’t even have a landline, much less a fax machine). I’ll be interested to see how they verify my identity and respond to my request for an electronic copy, which could be either easier or harder since they use an outsourced release of information company. The form didn’t even ask what method of delivery I preferred, so if it weren’t for the fact that they’ll probably call up wanting a per-page fee paid before sending me my records, I would probably get a package of paper in the mail by default.

Speaking of Brian’s article, I’ll offer a counterpoint to his suggestion that getting a copy of your own C-CDA means the sender’s EHR is open. That’s a great start, but it doesn’t do a whole lot for interoperability with other providers. It’s annoying for health systems and practices to send out C-CDAs to patients, but it’s downright threatening for them to open up their full patient information to competitors, which is what you would want as the subject of the overused “unconscious in the ED” scenario.

Poll respondents are split as to whether the EXTREME criteria adequately define open, interoperable EHRs. The no-voters unfortunately didn’t tell us what the authors missed. IP address analysis showed no evidence of ballot box stuffing, but I noticed that most of the Epic-based respondents chose “no.” New poll to your right or here, as suggested by a reader’s comment: is HIPAA’s impact on privacy positive or negative? It seems like an obvious “positive” on first glance, but as the reader points out, HHS gave providers complete control to use patient information without consent and with minimal disclosure requirements, pretty much killing the idea that patients own their data (not to mention that the full law failed to accomplish the “P” of insurance portability that didn’t happen until ACA). Rampant misinterpretation of HIPAA, where providers conveniently claim that anything they don’t want to do is prohibited by HIPAA, is a different issue.

Need consulting help? Consider using the RFI Blaster, which lets you send a brief description of your project to one or several consulting firms via one simple online form, also allowing you to choose your desired method of contact (phone number is optional, in other words). The CIO of a large health system suggested I create it and he’s had success using it since it puts him in control while requiring little of his time or energy.

I’m on a pet peeve streak, apparently. For those who latched onto the trite phrase “not so much,” it’s as eye-rollingly out of touch as a leisure suit. I’m also annoyed at the traffic-desperate “news” sites that repeatedly tweet out old stories like “Epic CEO to donate 99 percent of fortune” over and over again for many days (the actual story was published 12 days ago and they’re still tweeting about it, while another just-tweeted story was posted 22 days ago) hoping to eventually con followers into clicking. It’s also like CNN, which keeps old stories high on the page hoping bored passers-by will click out of instinct, which at least isn’t as bad as milking minimal impact stories (still-missing flights or still-fleeing prisoners) while ignoring less entertaining but far more important topics, such as whether Greece will default or the impact of terrorist attacks in Tunisia.

It’s going to be an easy read today because nearly nothing is happening in healthcare IT this holiday week. I won’t waste your time passing off junk as news.

Last Week’s Most Interesting News

• The Supreme Court upholds the legality of the Affordable Care Act’s subsidies for residents of states that don’t run their own health insurance exchanges, leaving ACA intact and sending shares of insurance companies and for-profit hospital companies soaring.
• Google confirms that it is developing an industrial-grade, prescription-only wristband that will collect patient and environmental information for clinical studies.
• Aurora Health Care (WI) takes a lead investor role in StartUp Health.
• A Federal Aviation Administration RFI discloses its intentions to connect its pilot medical exam system to government EHRs, hoping to detect safety-endangering medical conditions such as depression.
• Video visit provider MDLive raises $50 million in funding.

Webinars

June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.

July 14 (Tuesday) noon ET. “What Health Care Can Learn from Silicon Valley.” Sponsored by Athenahealth. Presenter: Ed Park, EVP/COO, Athenahealth. Ed will discuss how an open business structure and strong customer focus have helped fuel success among the most prominent tech companies and what health care can learn from their strategies.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.

Announcements and Implementations

Private equity firm co-founder Joshua Harris donates $5 million to create a precision wellness center at Mount Sinai Hospital (NY).

Privacy and Security

Google is caught secretly installing audio listening software as part of its Chrome browser extension that allows it to respond to audio commands.

A Veracode report finds that healthcare implements security poorly, with 80 percent of applications having cryptographic issues such as weak algorithms and  only 43 percent of known vulnerabilities being fixed. Still, healthcare scored much higher than the bottom-dwelling government. The numbers aren’t necessarily relevant, however, since they include only those self-selected organizations that engaged Veracode to assess their software risk.

Other

A grand jury finds that Ventura County, CA prepared poorly for its $50 million Cerner implementation, with frequent downtime causing care delays. The agency defended itself by questioning why their project required a third review, with the jury foreman explaining, “We had complaints from the public concerning what happened after the system was live. There were still an awful lot of complaints.”

Bristol Hospital (CT) lays off 5 percent of its workforce in four areas, one of them the IT department.

The City of Pittsburgh drops its lawsuit challenging UPMC’s tax-exempt status and UPMC does the same with its countersuit, with the cash-strapped city hoping that more cordial relations will save legal costs and possibly convince UPMC (as well as Highmark, the University of Pittsburgh, and Carnegie Mellon University) to chip in some of the $20 million the city wants non-profits to pay toward their consumption of city services.

A former executive of Blue Shield of California files a wrongful termination lawsuit claiming that he was fired for trying to reduce its use of outsourcer Cognizant. He claims that a Cognizant VP tried to bribe him by offering, “You can join me for a party at a sex club in Sacramento. We have some very beautiful women there.” The company fired him for sexual harassment of women, saying his homosexuality was irrelevant.

Weird News Andy says this was an easily made termination, although firing isn’t enough. The Detroit Fire Department terminates an EMT who refused to respond to the house of an eight-month-old baby whose mother called 911 to report that she wasn’t breathing, with the EMT providing as an excuse to the dispatcher, “I’m not about to be on no scene 10 minutes doing CPR. You know how these families get.”

Sponsor Updates

• Valence Health announces Penn professor and author Ezekiel Emanuel, MD, PhD a keynote speaker for its value-based care conference in Chicago September 30 – October 2.
• Aventura describes implementation of its Roaming Aware Desktop at Republic County Hospital (KS).
• Surgical Information Systems announces that motivational speaker Denise Ryan will keynote its Go!2015 User Meeting August 23-26 in Atlanta.
• T-System will exhibit at TxHIMA June 28-30 in San Marcos, TX.
• Zynx Health posts “Going Beyond the Web and Mobile Tech: Enhancing the Patient Experience Through the Next Wave of Digital Innovation.”
• Valence Health will exhibit at the Health Technology Research Alliance & Council Summit June 28-30 in Gettysburg, PA.
• ZirMed offers “How to reduce time spent working denials by 66%, streamlining front-end tasks to spend more time on patient care, and ANI news.”
• Voalte offers “With Humility Comes Many Blessings.”
• West Corp.’s Laura Bramschreiber offers “Helping patients graduate to good health” on the HIMSS Future Care blog.
• ZeOmega offers “Payer/Provider Collaboration: What Works?”
• Xerox Healthcare offers “Data Science That Simplifies Healthcare Delivery Analytics.”
• Verisk Health partners with the Association for Community Affiliated Plans to provide its members with healthcare analytics education and results-driven programs.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Startup CEOs and Investors: Brian Weiss

We Need Open Providers (An Alternative View on Open EHR)
By Brian Weiss

Open EHRs, Soft Drinks, and Leprechauns

Just under a year ago, having surfaced the disturbing and shocking possibility that EHR vendor marketing claims may not all be objectively measured and verified, Mr. H issued a challenge to have someone (other than EHR vendors) define what an “open” EHR really is. That call was answered by two PhDs named Sittig and Wright and a summary of their work was recently published on HIStalk.

You know Mr. H must be pretty excited about something when – despite his admirable track record of correctly calling out flawed survey/study methodologies by others – he set up this week a Yes/No survey with the guidance that if you provide the answer he wants (in support of the self-declared “consensus” about what a great job Sittig and Wright did) you can just vote “yes”, but “if you vote no, it’s only fair that you click the poll’s Comments link to describe what they missed.” Since not everyone is prepared to challenge (in writing) the work of well-credentialed experts, I’m thinking that might introduce a little unintended skew into the survey results.

I think it’s always good for HIStalk when Mr. H is passionate about a subject. However, if we’re going to go after questionable marketing claims, I think it would be great if Mr. H challenged readers to draft measurable standards for claims in other industries as well. For example, what criteria must a cola beverage meet to legitimately claim to be “The Real Thing” or to “Change the Game?”

Does the DoD purchase soft drinks for its personnel? If so, maybe we can get Congress involved here as well. Granted, we probably should stick to the IT realm in general and open IT systems in particular, where the government has demonstrated a strong track record. I’m sure you have also been impressed with the government work being done on Open Personnel Management Systems, which enable a much more efficient global process on security clearances without all that redundant background checking work by multiple countries.

So, no reason to limit ourselves to health IT. I noticed that Sittig and Wright established as a must-have criteria for EHRs that, “An organization can move all its patient records to a new EHR.” Can we do that in other IT areas as well so that purchasers of all IT systems always know they can change their mind at any time? How about with cellular phone plans?

But I digress. Mr. H has earned the right to establish what it is we should be debating and defining, and if he wants us to figure out whether Goofy is or isn’t a dog, what a Leprechaun is, or what an open EHR really is, I’m there.

Send Me the Encyclopedia

I actually don’t have any issues with the specific criteria proposed by Sittig and Wright for defining the mythological creature I’ll call Nessie and they refer to as an open EHR. Even if I did, how can I argue with a summary when I can’t even begin to fathom the precise definition of most of the terms it uses? We can spend years debating what it means for an EHR to provide “role-based access,” “where data are stored and what they mean,” “controlled clinical vocabulary,” “record-locator service functionality,” “existing metadata,” “appropriate support and maintenance,” or “authorized users.” This is how Meaningful Use regulations get to be thousands of pages long.

I’m also not really sure which EHR vendors can actually submit their products for evaluation since the authors of the summary indicated that any vendor that chooses to “maintain a degree of control over access to their software for financial, security, intellectual property, and reliability reasons” can’t be considered “truly open.” And I fear some EHR vendors might fall into that category.

Again, I digress. All in all, I think the Sittig and Wright piece is a pretty good summary of conventional thinking on what constitutes an open EHR.

Welcome to our Dysfunctional Family

My issue is not with the proposed definition of what an open EHR is or isn’t. My issue is that I think we’re focused on the wrong approach to achieving our goals. Like the “National Health Network” or “Beacon HIEs” or “Interoperability Alliances” before it, debating the definition of an open EHR is like looking for a lost wallet where the lighting is best rather than where it might actually be found.

What is it we are looking for? I think Sittig and Wright say it pretty well: “… to address the needs of patients, so they can access their personal health information no matter where they receive their healthcare; clinicians, so they can provide safe and effective healthcare; researchers, so they can advance our understanding of disease and healthcare processes… and software developers, so they can… create new applications to improve the practice of medicine …”

Why is open EHR where the light (of Congress, HIStalk, and so many vendors and providers in the HIT world) is shining, but not where we can find the answer? I think Sittig and Wright started to also say that pretty well: “…in addition to having all EHRs meet these technical requirements, we must also begin addressing the myriad socio-legal barriers (e.g., lack of a unique patient identifier, information blocking, high margin fee-for-service clinical testing) to widespread health information exchange required to transform the modern EHR-enabled healthcare delivery system.”

In my view, “myriad of socio-legal barriers” is a huge understatement. EHR vendor product features (open or otherwise) are a tiny fraction of the issue. And what about all the new forms of healthcare data sources like telehealth, urgent care centers, mail-in clinical or genetic lab tests, personal monitoring devices,  and everything else that isn’t an EHR (open or otherwise)?

Don’t Forget To Update Me on Progress Next Decade

What I think we are capturing in a potential Mr. H-driven consensus on the definition of an open EHR is another meaningless piece of a puzzle that, when complete, will give us a vision of what a theoretical fantasy healthcare world might look like in “one decade from now” (meaning, one decade from whenever you choose to take a look, for eternity).

I have no illusion that the people who are still reading this article are going to be convinced by what I’ve written. And even if all three of them are convinced, I don’t think that will alter the course of the ongoing Congressional hearings, ONC roadmaps, standards body committees, industry consortiums, EHR vendor leader visions, and everything else driving all the never-ending work on “legacy approaches to healthcare data interoperability.”

Plus, other than my youngest son (who is already rapidly changing his mind), does anybody else think that I know more than everyone else? Given the more qualified, more experienced, and smarter people working on this stuff, not only won’t I stop them, I really don’t want to. What if they are right and the emperor is in a stunning getup?

My plea is only this. Let’s also consider an alternative, parallel approach. One from the world I termed (in my not-academic, 20-minute study titled A Tale of Two Healthcare Worlds) “CCHIT” – consumer-centric healthcare IT.

In the few words I (really don’t) have left in this article (even my beloved three readers are now fading fast), I will now publish my definition of open EHR, and more importantly, open provider (note, Mr. H, that unlike Sittig and Wright, I don’t work for a provider, so it’s legit for me to do this one).

You Probably Already Have an Open EHR

If your EHR is MU2-compliant, it’s open enough for me. You just need to validate it is configured (as it should be, and most are) to send MU2-compatible C-CDA documents to any patient-authorized application using Direct Messaging.

Yes, I know CDA is ambiguous and has other issues. As long as the CDAs the EHR sends pass the MU2 certification validator (flawed as it is), that’s good enough.

To meet my self-appointed standards for open EHR, you need to make sure the freely downloadable NATE NBB4C trust-bundle is loaded. That means the EHR can easily and instantly send a patient clinical summary directly to any consumer/personal health product that is part of that NATE NBB4C trust bundle (which they all should be).

Nothing new to buy, no new standards or regulations needed. We’re done. Open EHR is here (and everywhere). Now comes the hard part … 

Open Provider

To save HIStalk PhD readers the work of defining it, let’s jump straight to the certification/testing process for open provider. I now officially declare every patient in America an “Open Provider Authorized Testing Body” (OPATB). Here’s what you do:

1. Sign up for a free Carebox at https://carebox.it.
2. Go to the “DIRECT Inbox” feature under “Import” and note your personal Direct Messaging address.
3. Go to any doctor or hospital that received at least one penny in Meaningful Use money and ask them to send you your clinical summary to that address using their EHR.

OK, you don’t really have to use my product for Steps 1 and 2. There are plenty of other applications that will give you a Direct Messaging address. But since I am making up the rules here, I get to self-promote a little. Plus, mine is free right now and there’s nothing to install, so you can just ignore it after you are done with your role as an OPATB.

Here’s how you score the provider. If in less than five minutes your clinical summary shows up in Carebox, you give them an open provider certificate, a sash they can wear at next year’s HIStalkapalooza, and a big hug from me.

If they ask you to pay anything, make you fill out forms, tell you it’s a “HIPAA issue” for them (it is, but in the sense that HIPAA says they have to do this, not the other way around), send you across town to their “records department,” ask you to provide them a self-addressed stamped envelope and expect some paper records within 30 days, or anything else, you can let Dr. Halamka know that he can stop working so hard to find an “Information Blocker,” at least by my definition.

Which Brings Me Back to Cerner

Mr. H started his initial open EHR challenge last year because he was upset with something that a reader reported was stated on a Cerner conference call about how they were open and others were not. So, Mr. H probably will not be happy to learn that I’m compiling a list of open EHR vendors who support open providers, and guess who is at the top of the list?

Why? Because I got an unsolicited call from two gentlemen at Cerner (I’d be thrilled to name them, but I don’t know if they want me to) who work on Direct Messaging. They wanted to be sure that bi-directional CCD exchange between Cerner and my no-name little startup product actually works. They showed me how easy it was for any PowerChart user — as well as users of many other Cerner apps, which all come pre-enabled to “Send Direct” and pre-configured to support the NBB4C trust bundle noted above – to send any patient’s record right into their Carebox. It worked flawlessly on the first try.

Hopefully other EHR vendors will call soon or someone can tell me who I should call so I can certify them as a great open EHR for open providers to use. Because my taxpayer-funded budget for this program is a bit limited (I’m not even tax-deductible), I’ll settle for self-certification to start. Just send me an e-mail and let me know that you sent a CCD from your EHR to Carebox and it worked. No reason it shouldn’t, if you claim MU2-compatibility. If you have any issues — since I’m told EHR vendors all want to work together to advance healthcare for everyone – I’m sure if you give Cerner a call, they’ll be happy to help you out.

Now all I need to do is convince Neal Patterson of Cerner to get his wife Jeanne to trade in the “bags and bags of records” that he speaks and wrote about her needing to carry around in exchange for a Carebox. Then, in parallel to him figuring out how to get every current or future source of our healthcare data to join CommonWell (good luck!), we can unleash thousands of startups who can help all of us transform US healthcare the CCHIT way.

Are We There Yet?

Freeing up patient data so that patients can authorize the use of that data in any clinical, research, analytics, or application context they want is — in my book — “The Real Thing” and “Changes the Game.” It doesn’t help you quench your thirst (with caffeine, a possible diuretic) or get Type II diabetes, but my CCHIT startup friends and I can try to get ONC or the White House to help us spin up some committees to work on those parts.

I think all of the constituents noted in the earlier quote above from Sittig and Wright will benefit — patients, clinicians, researchers, and software developers. I think we will get “there” a whole lot faster than by following Mr. H’s prescription for “putting the screws” to EHR vendors about what they have to prove to claim they are “open.” Of course, that is going to be lots of fun, too, so we can do that as well.

One Less Study for Mankind

What really compelled me to write this too-long article is that just a few weeks ago, Mr. H. wrote this about patient access to their own healthcare records: “Someone should perform a study to determine the level of demand and the reasons people aren’t requesting their information.”

I started writing a snarky article (do I write any other kind?) suggesting that we go back in time and commission a study in the 1970s about why nobody wants downloadable apps from Apple on their phone (both the rotary and the newer touch-tone kind).

But then along came Sittig and Wright and the associated consensus. It occurred to me that some really smart people might already be hard at work on Mr. H’s newer study request above and I probably missed the boat on my alternative recommendation.

So before it’s too late, I want to suggest that instead of spinning up another study – not to mention all the challenges associated with the time machine and the questionable value of going back to the 1970s, if we did mine – we might all be better served if we just get open providers (who are not information blockers) to free up electronic copies of our own health data that we are all entitled to get under HIPAA Right to Access. To do that, most can use their “already open” (at the “not ideal but good enough for now” MU2-level) EHRs. Then, instead of reading more studies and articles, we can all watch in amazement what happens in months and years from now, not decades.

Brian Weiss is founder of Carebox.

Morning Headlines 6/26/15

Supreme Court saves Obamacare

In a 6-3 decision, the Supreme Court rules in favor of preserving ACA subsidies for the six million users obtaining insurance through Healthcare.gov.

Arcadia Healthcare Solutions Acquires Leading Managed Care and ACO Implementation Provider Sage Technologies

Data aggregation and analytics firm Arcadia Healthcare Solutions acquires Sage Technologies, a company focused on helping provider groups transition from fee-for-service to value-based reimbursement models.

CVS Health Announces New Clinical Affiliations with Four Leading Health Care Organizations

CVS will use its Epic EHR to begin sharing visit and prescription information with four new clinical affiliates: Sutter Health (CA), Millennium Physician Group (FL) Bryan Health Connect (NE), and Mount Kisco Medical Group (NY).

HIStalk Practice Interviews Steven Stack, MD President, AMA

HIStalk’s own Jenn interview’s incoming AMA president Steven Stack, to discuss chronic disease management and prevention, improvements to medical education, and the impact EHRs and reimbursement reform is having on the provider community.

News 6/26/15

Top News

The Supreme Court upholds the legality of  federal medical insurance subsidies for consumers in all states — including those 34 that don’t run their own health insurance exchanges — in a 6-3 decision that preserves the Affordable Care Act.  Shares of publicly traded insurance companies and for-profit hospital operators jumped sharply on news of the decision.

Reader Comments

From Blue Eyes: “Re: 12 years of HIStalk. Seriously? I often think of what it would be like without HIStalk.” I calculate that since I started writing HIStalk in 2003, I’ve posted maybe 5,000 times and done around 500 interviews in writing many millions of words each year. I still can’t wait to start filling the blank screen every day.

From LaToya: “Re: [vendor name omitted.] Aren’t they HIStalk sponsors any more?” I sometimes get remarkably frank comments from company employees who explain why they aren’t continuing their sponsorship, most often: (a) we don’t have money in the budget since we’re cutting back all over the place; (b) we are thinking about pulling out of healthcare; (c) we have changed focus to work through resellers or partnerships instead of trying to sell directly to hospitals; and (d) the only person who knew anything about marketing quit, nobody’s really in charge, and we don’t know what HIStalk is. Some of the statements would make juicy gossip items were I inclined to kiss and tell, which I am not.

HIStalk Announcements and Requests

My latest annoyance: people who email me and then email again when I don’t respond quickly enough to suit them. Nothing is more vexing than a company’s PR person emailing everybody they can think of demanding to know why I haven’t run their news item when (a) they didn’t read HIStalk to see that I already mentioned the item since I’m perfectly capable of finding my own news, or (b) they’re unfamiliar with HIStalk and don’t know that I write news posts only on Tuesday and Thursday nights and over the weekend, so it stands to reason that their Monday announcement won’t have run here by Tuesday morning no matter how newsworthy. I’ll also observe that companies invariably think that all their announcements are stop-the-presses critical when 99 percent of them aren’t even close.

A note to the industry: “population health” isn’t the same as “population health management” which isn’t the same as “population health management technology.”

This week on HIStalk Practice: AMA President Steven Stack, MD shares his healthcare IT goals for the coming year. Physician willingness to offer telemedicine reflects an untapped market. Atlantic Dialysis Management Services goes with BridgeFront Web resources. Community Health Partnership joins the CORHIO HIE. CVS Health announces new clinical affiliations with emphasis on EHRs. Zen Charts zeroes in on addiction treatment centers.

This week on HIStalk Connect: Telehealth vendor MDLive continues the telehealth funding spree with a $50 million private equity investment. The FDA approves a new medical device that helps the blind "see" by delivering information about their surroundings through a vibrating array held in the mouth. Sano Intelligence raises a $10 million seed round to launch its non-invasive glucose monitoring wearable device. Engineering students at Johns Hopkins invent a tamper-proof pill bottle that it hopes will help curb the rise in prescription-related drug overdoses.

Webinars

June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.

Acquisitions, Funding, Business, and Stock

EHR data aggregation and analytics vendor Arcadia Healthcare Solutions acquires Sage Technologies, which offers services to providers transitioning to value-based care.

Mobile care coordination solutions vendor Cureatr raises $13 million in a Series B funding round, which the company will use to expand its Care Transition Notification network. 

Video visit provider MDLive raises $50 million, increasing its total to $74 million.

Non-profit Healtheway, which operates the eHealth Exchange and Carequality interoperability initiatives, renames itself The Sequoia Project. The announcement includes a convoluted, marketing-created rationale for the “rebranding process” and “new tagline” that were apparently vital for future success in choosing a name that sounds like a tree-hugging protest group instead of the perfectly good (and easier to spell) name it was already using. Founding members are AMA, Epic, ICA, Kaiser Permanente, MedVirginia, MiHIN, Mirth, New York eHealth Collaborative, Orion Health, and WEDI.

Castlight Health invests $3.1 million in new startup Lyra Health — which offers screening tools, patient-provider matching, and care navigators for behavioral health – and will sell its products with its own. 

Sales

OSS Health (PA) chooses Strata Decision’s StrataJazz for decision support and financial planning.

People

Alex Popowycz (Fidelity Investments) joins Health First (FL) as SVP/CIO. At least one site reported that he’s Health First’s first CIO, somehow forgetting Rich Rogers and then Lori DeLone, which takes us all the way back to 1995.

Huron Healthcare hires managing directors Linda Generotti (Siemens Healthcare) and Lynn Grennan (University of Arizona Health Network), focused respectively on clinical operations and physician organizations.

Greencastle Senior Management Consultant Troy Beane is promoted to Major in the Army National Guard. He earned the Bronze Star in 2009 as commander of Delta Company, 112th Infantry Division, while deployed in Iraq.

Announcements and Implementations

Philips announces a tablet-based, subscription-priced ultrasound solution called Lumify, although its transducer isn’t available in the US yet.

CVS announces affiliations with Sutter Health and three physician groups that will receive patient visit and prescription information from CVS’s Epic EHR.

In Scotland, three life sciences companies – including revenue cycle solutions vendor Craneware – sign the Scottish Business Pledge partnership between government and business.

Health-related companies making Computerworld’s “Best Places to Work in IT” for 2015 are Lafayette General Health, Sharp HealthCare, Nicklaus Children’s Hospital, CHG Healthcare Services, Halifax Health, Kaiser Permanente, Medtronic, Children’s Hospital of Philadelphia, Genesis HealthCare, Humana, Adventist Health System, Cerner, OhioHealth, Cancer Treatment Centers of America, Palmetto Health, Intermountain Healthcare, McKesson, Carolinas HealthCare, and Cook Children’s Health Care System.

Patient satisfaction scores at HealthAlliance of the Hudson Valley (NY) rose after its implementation of CipherHealth’s Orchid tablet-based nurse rounding application.

GetWellNetwork names the first two family engagement nurse scholar fellows supported by its O’Neil Center at the University of Pittsburgh School of Nursing.

Government and Politics

Florida’s Agency for Health Care Administration will host a half-day symposium on healthcare IT on Friday, June 26, at 8 a.m. in Tallahassee. Speakers include folks from Tallahassee Memorial Hospital, Baptist Healthcare, the Department of Health, and HIMSS. The organizers tell me that interest is good (90 registrations vs. the original 75 cap) so it may turn into a full HIT Summit later this year.

The Department of Justice sues four Michigan hospitals (Hillsdale, Branch, ProMedica, and Allegiance) for illegally agreeing not to compete in each other’s territories.

Privacy and Security

US healthcare organizations seem to be hardest hit by the password-stealing, difficult-to-detect Stegoloader trojan, which embeds much of its execution code inside photos. Security experts think hackers may be targeting healthcare, but my suspicion is that health systems just have a lot more people with limited technology skills using computers (and inadvertently launching malware) than do other industries.

Technology

The New York Times ponders the questionable business motivation behind precision medicine and gene testing, highlighting a company that paid doctors $75 for each patient they enrolled and took in $130 million in Medicare money before CMS launched a review of the company’s billing practices, effectively shutting down the 800-employee Renaissance RX. The founders ran an earlier company that also earned Medicare’s death penalty for fraud. Critics say “enthusiasm outpaces evidence” as Medicare was paying for experiments rather than proven treatments. Healthcare wouldn’t get such a bad fraud rap if Medicare was better at performing due diligence before mailing out big checks – couldn’t they have figured out that the people already accused of fraud were involved in the new company?

Other

Jenn interviewed newly installed AMA President Steven Stack, MD on HIStalk Practice. A snip:

Physicians are very frustrated with these systems, and then we’re very frustrated that the Meaningful Use program that we’re all subject to is overly prescriptive. It lacks flexibility where needed and has compelled us to purchase non-functioning tools to use them in ways that degrade our practice. Let’s not forget that more than half of Medicare physicians are being penalized by Medicare with a one-percent reduction in  compensation because the tools that we are given are so poor and the program the government created so rigid. Now we’re being punished for our inability to achieve what I think, if we really discuss it very openly, is a program that isn’t well designed and sets us up for failure. Needless to say, EHRs continue to be a challenge, and physicians are very frustrated that their input has been disregarded in ways that are injurious to the work we’re trying to do …  Health IT has been helpful and will be far more helpful when these records are actually interoperable. We’ve created digital silos that don’t share information any better than the old system where we had to have people send information via fax machine. If the federal government and software vendors would work much more attentively on making these things interoperable for those things that are of high use to us, I think that physicians would find a lot more joy from the tool than just the current reality where they contribute more misery than joy.

Radiologist Dr. Dalai says radiologist leadership shouldn’t be pushing them to get closer to patients “as part of the team” in order to prove their value, adding that he’s not comfortable in showing up out of the blue to explain his findings when the patient expects to receive that news from their own doctor. He also wonders whether radiologists will “be told we killed Grandma” in trying to serve as gatekeepers in restricting medically questionable exams. He adds,

When a study comes through on my PACS, I could come running out of the reading room; seek out the patient; act like I’m his or her new best friend, playing a warm, fuzzy Marcus Welby (a TV doc from way back, sort of the opposite of House); and discuss the results of the test. Instant gratification! If you knew me personally, you would realize that I really am a warm, fuzzy, caring kind of guy. But when those radiographs come though on my PACS screen, I don’t know anything about the patient other than the two- or three-word history the physician has lowered himself to give me. If I should happen to have a functioning electronic medical record (a contradiction in terms), I might be able to get some lab values and maybe some additional history. But … I still don’t know the patients like the clinical doctors do. I haven’t talked to them, I haven’t touched them, and I haven’t examined them. So would I be doing them a favor by indulging the itch for an immediate answer? … My solution probably comes too late: Avoid joining anything resembling an ACO. You see, we radiologists do add value — with every single exam. Even a normal chest radiograph adds value, but it isn’t "sexy" and doesn’t increase our self-aggrandizement.

Weird News Andy labels this widely reported story as “Smart Phone, Dumb Doctor.” A man hits “record” on his smart phone just before his colonoscopy begins so he can capture his doctor’s instructions. The playback reveals a “while you were sleeping” view of what anesthesiologist Tiffany Ingham, MD really thinks as she tells her sleeping patient, “I wanted to punch you in the face and man you up a little bit;” calls him a “retard;”makes fun of a rash on his penis; agrees to falsify the medical record in claiming the team provided post-procedure instructions; speculates whether the man is gay because he attended a previously all-women’s school; and tells staff she’s adding a diagnosis of hemorrhoids even though she saw no evidence of them. She suggests to the gastroenterologist that he pretend to receive an urgent page to avoid having to speak to the patient after the procedure, saying that she has done it before herself and adding, “Round and round we go, wheel of annoying patients we go, where it will land, nobody knows.” The man sued the anesthesiologist for defamation and malpractice and won, with the jury ordering her and her practice to pay $500,000. It wasn’t her lack of credentials – she is dual boarded (anesthesiology and internal medicine) and is a major in the Air Force Reserve, having been deployed short term to Afghanistan as a flight surgeon.

Sponsor Updates

• Medicity offers “New survey identifies the state of cost control in hospitals, health systems and physician organizations.”
• DocuSign offers “Yes, this crazy scribble is my signature. And I’m proud of it!”
• Extension Healthcare offers “Market Trends: Survey Examines Nurse Call Communication Preferences.”
• Galen Healthcare publishes “ICD-10 Clinical Documentation Improvement (CDI) – Now is the Time!”
• Greenway Health offers a transparent and collective approach to politics.
• Healthcare Data Solutions offers “Email Marketing Roundup: Which Metrics Should You Use?”
• Healthfinch posts “AMA STEPS Forward to Address Provider Burnout.”
• Impact Advisors offers “Healthcare CIOs Discuss Top Healthcare IT Optimization Strategies.”
• HealthMedx will exhibit at the New York State Health Facilities Association Conference June 28-July 1 in Saratoga Springs.
• EClinicalWorks will exhibit at the NATA 2015 66th Clinical Symposia & AT Expo June 24-26 in St. Louis.
• Healthwise offers “Helping our employees be ‘healthy, happy, and wise.’”
• Holon Solutions will exhibit at the TORCH Critical Access Hospital Conference & Tradeshow June 25-26 in San Antonio.
• Iatric Solutions offers “Making Your EMPI solution work for you.”
• MedData is named a 2015 Top Workplace by the Cleveland Plain Dealer.
• NextGen parent company Quality Systems Inc. is recognized in eight categories of the 13th Annual American Business Awards program.
• Navicure offers “How Can You Collect More From Your Patients?”
• New York eHealth Collaborative will exhibit at Wearable Tech + Digital Health NYC 2015 June 30 in New York City.
• Oneview Healthcare offers “Digital health revolution? Perhaps evolution better describes what’s actually going on.”
• Experian/Passport Health will exhibit at the HIMSS Privacy & Security Forum June 30-July 1 in Chicago.
• PDS IT offers “A Roles-Based Approach to Epic Security.”
• PeriGen offers slides and materials from its AWOHNN presentation on “A New Way to Handle Checklists.”
• PMD offers “Health Exchange Video: Style Boards.”
• Qpid Health posts “Is NLP-Enabled Data Mining the Digital Breakthrough We’ve Been Waiting For?”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

EPtalk by Dr. Jayne 6/25/15

I’ve been on the road fairly often over the last month. Most of my trips have been to work with small or mid-size provider groups for ICD-10 training. The sheer amount of misinformation floating around the physician lounges across the country appears to be staggering.

At the site I visited today, the physician leaders were actually cringing at some of the questions their providers were asking. I’m sure they thought they had already done a fairly good job educating their providers, but it just goes to show that you can never have enough training. It reminded me a bit of when our residents used to teach a sex education class at the local middle school and kids had the opportunity to ask anonymous (and often myth-laden) questions on slips of paper. We saw some doozies, but this was even more fun because very educated people were asking these wild questions out loud and in front of their peers.

Most of the questions revolved around creative ways to avoid ICD-10 or the lack of need to learn it since it has so many codes it might as well be impossible. It’s hard to convince people that it’s not going away when we’ve had unexpected delays before. It’s also hard to keep them from acting out of fear or panic because they haven’t done anything to prepare for the last several years despite plenty of advance warning. I’m hoping that the fact that their organizations paid good money to bring in an honest to goodness physician to deliver their training will help add a reality check.

Despite the fear and resistance, most of them have done just fine during our structured practice sessions. The fact that they’re using EHRs is going to make the transition pretty seamless, unlike having to use pocket reference cards or laminated cheat sheets.

One of my clients made me smile as their planning document kept going back and forth in email. They wanted me to train onsite at their clinics and were trying to figure out the best way to block schedules and ensure adequate time with the care teams as I crisscrossed the city. When the last document arrived, it was named “Copy of copy of copy of final schedule working copy version8.” I’m glad that explaining document versioning was out of scope for this engagement because I probably couldn’t have done it with a straight face. I give them full credit for trying, however.

Since I had six flights this week, I honed my personal ICD-10 skills:

• H91.23 – Sudden hearing loss of bilateral ears due to having your music playing so loud I could hear it through your headphones like I was wearing them myself.
• G47.62 – Sleep-related leg cramps for the passenger across the aisle.
• S37.20xA – Injury of bladder, initial encounter for the passengers consuming a mammoth cup of coffee prior to takeoff, then being foiled by a persistent “fasten seat belt” sign.
• R45.82 – Worry, for the kindly older woman next to me who kept waking me up to see if I wanted a drink, pretzels, or crackers

Unfortunately, I couldn’t find a code for “personal psychotic reaction due to child playing games on iPad without headphones.” so if anyone locates it, please let me know. I heard from a fellow road warrior that there is a restaurant that allows you to relive the glory days of flying as you dine aboard a replica Pan Am 747. I’m thinking it might be time to find a client in Los Angeles so I can check it out.

Mr. H mentioned earlier this week about his LinkedIn pet peeves. Although he focused on problems with user profile pictures, I wanted to throw in my two cents. If you’re going to try to connect with me, I am more likely to ignore you if you use the stock “I’d like to connect with you on LinkedIn” greeting. Even if we just met in passing or you’re a friend of a friend, at least add a personal comment that lets me know you’re not an anonymous “medical researcher” or a medical student from halfway around the world just looking to connect with MDs.

From Jimmy the Greek: “Re: patient recording colonoscopy. Please tell me this is at least as good as a Weird News Andy piece.” Yes, yes it is. A Virginia man receives $500K after recording his physician’s inappropriate comments during a colonoscopy. Although I don’t in any way condone the physician behavior, I wonder why the patient had his phone during the procedure. At most of the facilities where I’ve worked, patients who are being sedated have to put their personal belongings in a locker during procedures. Even if you’re not sedated, I doubt they’d let you take your phone to the GI lab. I’d hope that clinicians would be professional at all times, but this should be a lesson for our colleagues with borderline (or over the line) behavior.

My nephews like to play Mad Libs, the word game where you one player asks for a list of nouns, adverbs, and adjectives then reads back a funny story populated with the words. I received a spam email the other day that must have come from the creators of Mad Libs. Rather than parts of speech, though, it was populated with random, techy-sounding words strung together to form the name of the company and its services. Anyone asking for “thought leadership content” cracks me up, as did the suggestion that the sender had met me at a party at my home in a state where I’ve never lived. Nice try, but no go.

What’s your most entertaining variety of spam? Email me.

Email Dr. Jayne.

Morning Headlines 6/25/15

MDLIVE raises $50M from private equity firm

Telehealth vendor MDLive raises a $50 million investment round from private equity firm Bedford Funding.

Best Places to Work in IT 2015

Health IT was well represented on Computerworld’s “100 Best Places To Work In IT” list for 2015. The list included Cerner, Humana, Kaiser Permanente, Intermountain Healthcare,  HCA, and a number of other health systems.

Mobile app improves rates of CPR in cardiac arrest cases, studies find

A New England Journal of Medicine study investigates a mobile app that alerts CPR trained individuals when someone nearby needs help by pulling information from 911 dispatch systems. In the study, the app increased the likelihood of heart attack patients receiving CPR by almost 15 percent.

Welcome to our Newest CommonWell General Members

CommonWell Health Alliance welcomes T-Systems, Caremerge, and HIEs from Michigan and Texas to its health data exchange platform.