For the last several months, people have been asking me what I think is going to happen on October 1. Will vendors be completely ready? Will customers have time to take upgrades and patches? Will users have enough time to test and practice new workflows as well as learning new documentation standards? Will things come to a screeching halt? Or will it be like Y2K and turn out to largely be a non-event?
I’ve been telling them that I think the majority of systems are going to be ready, but I think that there will be some glitches. Although I don’t anticipate complete chaos and the breakdown of civilized medicine, I have been recommending to my small practice clients that they should prepare for delays in cash flow and consider having access to a line of credit to cover expenses if there are lags in payments. I’ve helped most of my clients develop business continuity plans so they’ve already thought through various scenarios and it’s just a question of applying ICD-10 problems to existing plans.
Larger practices, especially those owned by or affiliated with hospitals and health systems, appear to be pretty well prepared. Several that I’ve worked with have fleets of staffers dedicated to ICD-10 preparedness, from coders and compliance officers to EHR trainers. Nevertheless, most of them have increased the amount of cash they have on hand. They have also prepared to bring on extra staff to help them power through the glitches through a combination of manual data entry and brute force if it is needed.
All of the groups I’m working with have come to accept that the odds of a delay or reprieve are miniscule. I’m encouraging them to be cautiously optimistic but to continue preparing and drilling. There are so many moving pieces in the medical billing process and so many different systems and vendors involved. Although a practice might be prepared, what if their billing clearinghouse drops the ball? Or what about failures on the payer side? There are bound to be glitches.
Unfortunately, there will also be catastrophic failures. I came across one of those situations today when I received a frantic phone call from a prospective client. They’re using a specialty-specific EHR that started behaving erratically this week after turning on the ICD-10 dual-coding functionality. Apparently the system didn’t have the level of code mapping they anticipated, but it wasn’t discovered before it went live because they didn’t thoroughly test it.
They are unable to revert the feature and were told by the vendor that they need to very quickly do a code mapping and setup project. Due to the number of providers, the complexity of the build, and the skills of the IT support team, there is no way the practice can fix it in time for ICD-10, let alone fix the issues they’re currently facing.
Several of the problems are patient safety issues. On a pediatric chart, selecting a simple diagnosis of sore throat in ICD-9 is recording an ICD-10 diagnosis for Ludwig’s Angina, which is not only uncommon in children but also life-threatening. Needless to say, the physicians are struggling and the practice is in full freak-out mode. Although I’ve not worked with this specific system, I told them I was willing to take a look under the hood and see if I could help.
I had to wake up my database guy early on a Sunday morning, but luckily he’s always up for a challenge. After a couple of hours of massaging the data in their test system, we put together a plan and the client agreed to our proposal. We extracted the data from the relevant tables and I’ve spent most of the day comparing it to the CMS General Equivalency Mapping data. Our goal is to very quickly identify the data that is correct and stage it against their historical diagnosis patterns. We’ll validate their most frequently used diagnoses first and load it back into the system in batches every night. Then we’ll work our way through the rest of the data in order of frequency of use.
Although we can’t turn the dual coding feature off, we’ve completely wiped out the ICD-9 to ICD-10 crosswalk so that they can at least code without fear of adding incorrect data to their charts. Once we start adding data back in, if there isn’t a clean ICD-9 to ICD-10 map, they just won’t get an ICD-10 code. I was able to juggle some of my other commitments and hope to be ready to test the first batch of data later tonight. In the mean time, we’ll have a contract coder going through the charts where ICD-10 codes have already been applied, suggesting corrections as needed.
Due to the volume of codes that we need to examine and the premium they’re paying me to do it quickly, I’ve been chained to my laptop most of the day. I see code tables when I close my eyes and I’ve started to feel like an ICD-10 apocalypse might be on the horizon. I found some tips from AHIMA on how to survive such an event.
Do you have your medieval mace and leather armor ready? Email me.
CVS announces that it will partner with three national telehealth vendors, American Well, Teladoc, and Doctor on Demand to offer remote visits to patients and to connect its MinuteClinic providers with specialists available for real-time consults.
A JAMA article proposes that randomized control trials be fully embedded in EHRs, including functionality to support identifying trial participants, facilitating enrollment, and randomly assigning a treatment.
An FDA workgroup tasked with evaluating the agencies approach to post-market surveillance of medical devices publishes a final report recommending that a national, integrated network of registries be established, wherein each registry would be tasked with gathering post-market data about a certain device.
CMS publishes ACO performance data for 2014: total Shared Savings Program savings remained flat at $804 million, while Pioneer ACO savings climbed 24 percent to $120 million.
With Meaningful Use implementations winding down, ICD-10 almost done, and the Department of Defense EHR bid issued, is the industry poised to contract?
No. The reason would be — anticipating your follow-up question of “why is that” — I sense that healthcare pivoting to business needs now away from some of the forced march on regulation. That is a ripe opportunity.
Which of those business needs will create the most need for products and services, such as consulting?
On the provider side, you have legacy and very well-run organizations that are designed around fee-for-service and volume. They have been constructed in the way that the business is organized, the way people are trained, the way that their IT systems are designed and deployed, and have been around fee-for-service. Those systems are mostly passive. They’re mostly tabulation systems. They wake up when there’s an admission or a registration, then they count stuff or they move a little bit of information around.
Then you have this other tower over here on the payer’s side that is also set up just for fee-for-service. It says, "Gosh, you shouldn’t have done that service that you want a fee for or maybe you should have done another service." But again, those systems — pre-authorization and registration aside — wake up when there’s a claim, then they do their thing and try to process it.
When I talk to CEOs in this industry, on both the payer and provider sides — which as you know are coming together — I pose this question to them. I ask them how many employees they have. The last one told me he has 28,000. I say, “You have 28,000 people today coming to work who don’t really know it, but they’re doing fee-for-service medicine.” One hundred percent of the time, I get the nods. “Yes, that’s exactly what my problem is.”
You’re going to see very rapid change in the next few years. I’m very excited to be part of it at this stage.
Hospitals have performed poorly in doing what’s now expected of them, managing costs and health. Will they be able to change their direction and stay on top or will new competition overcome their money and influence?
This will sound like I’m avoiding the question, but I’m not. The answer is “and both.” When you think about what that healthcare enterprise of the future is going to look like, you’ve got to have hospitals and facilities to put the very sick and the very injured in. You need to have a well-developed physician network. You need to have some kind of risk-bearing entity.
Those components are going to come out of the traditional, hospital-centered health systems who have evolved their businesses a lot in the last couple decades. Some will come out of physician groups, some will come out of payers, and certainly there’s going to be new players. As you turn to IT and you think about the confluence of those factors along with the change in the payment methods and the availability of technology, there’s going to be new players out there on the frontier for both care delivery and technology.
I’m sure other folks have views on this, I look at it around that adage that IBM didn’t invent Google. They were the largest computer company in the world. Why didn’t they invent Google? It went against their old business model. You’re going to see some of that in care delivery, in risk management, and certainly with IT.
What factors determine which technology startups will have the best chance to succeed?
It’s always going to come down to scale. Scale is going to come from distribution. Distribution is going to come from dealing with that very specific business issue.
By way of example, you see some things on the periphery that I don’t think are going to work. Somebody made a little app for the Apple watch. You say, "How big can that market be?" Well, first of all, how many people are using an Apple product versus an Android product? How many people are going to buy the watch? How many people are technologically adept to do that? It getting smaller and smaller. You go, that’s going to be an interesting project, it’s going to contribute to the body of experience and body of knowledge that we have as an industry, but it’s not going to be something ubiquitous that’s going to move the needle.
The frontier is about true interoperability. Many people have said that we have mountains of data, but what we don’t have is interoperability. We have folks that have business models that aren’t built for that, both folks that are using those systems — the traditional healthcare industry participants — as well as the vendors. Both of those have been in a fee-for-service type of mentality, so it’s not in their business model to go to interoperability.
People want to talk about interoperability. They talk about bi-directional. Interoperability is omni-directional. It’s not planned interfacing. I’m Vendor A and I’m going to go communicate with Vendor B and vice versa. Interoperability is this: I use my systems, you use yours, and our information is translated seamlessly and it’s done in real time.
The operative question that I like to ask when it comes to interoperability is this. The person you love the most is in front of the doctor. What information do you want the doctor to have? What do you want the doctor to have to do to get that information?
That’s what we have to be driving toward as an industry. Long way around, when I think about things that are going to be very successful in the future, they’re going to address that question of making all that data interoperable and in a contextually relevant way and serving it up where it does the most good, which is at the point and the moment of care.
I asked Grahame Grieve what his one wish would be for interoperability and he said it’s that clinicians would consider it a clinical problem and apply the same level of enthusiasm as the IT people. I also asked him who creates the demand and incentive for sharing data and he didn’t have a clear answer.
First of all, I love the quote. I think he’s really on to something. That’s a terrific insight.
You’ve got two questions there. Looking at it as a clinical issue, I’m chairman of a company called Sandlot Solutions, arguably the best interoperability play in the industry today. One of our physicians, who’s been a pioneer in it and is a GI doctor, says this is the most important invention in the time that he’s been practicing medicine, and he’s well into his 60s. He goes through all the different medical devices. It comes down to, when he goes to treat a patient, he knows about them.
One of his many stories is a fellow coming into get polyps removed form his colon. He’s a Medicare patient, very well organized, and he hands the physician a list and says, “Here are all the meds I’m on.” The doctor, because he’s on Sandlot, looks in his own EMR, and he says, "Hmm, I’ve got something here that says you were put on Coumadin two weeks ago, the blood thinner." He says, "You’re right. I forgot to add that to my list." That is a medical disaster avoided because of interoperability. Even well-organized patients don’t do a great job of transferring that information. I’m above average at it and I don’t do a great job at it. I’m not an MD or a DO.
That’s where the demand can come from. From doctors saying, give me a full suite of information, a full payload, and give that to me at the point and moment of care. Give it to me in my workflow. Give it to me within my EMR. You guys quit fighting. I don’t care what enterprise it came from. I don’t care what brand of system sourced it. I want to be able to know where it came from, but I don’t want to go find it. I don’t want to have to go look in five or six places for it, which is what a lot of this first wave of so-called interoperability did.
Now to your second part of your question, which is how do you get people to participate? My experience in doing this now for almost four years is that everybody wants to be first to be last. Let me explain that. If you go to any provider in Memphis and you say to any provider, we want you to connect to a system that has all the other providers in town seamlessly moving information around. Right in your EMR you’ll get all of the data from the other folks within your enterprise, and within your affiliations, and with any public health data we have. It will be delivered into your EMR in the format you’re used to looking at it.
In exchange, as you treat this patient, within the consent laws, your information will be shared. One hundred percent of people would agree to do that. That’s the barrier right there.
It’s less about incentives and more about leadership. There are some good stories forming out there about leadership, so back to your first point, who creates the demand? It’s going to come down to leadership in our industry.
What did you think about the DoD contract and what are your thoughts on how Leidos will execute it with Cerner and the other partners that are involved?
It was a very thoroughly vetted process. They certainly had the right players that were going down the stretch drive.
Everybody in the industry wants to see them be successful. We don’t want some of the fits and starts like we’ve seen in the NHS experience. I just hope that they go about it in a methodical way and create value along the way.
I do hope that they have an open mindset and enough openness in the architecture to connect to the information systems stacks that are out there. I hope that we’re able to demonstrate better healthcare for our veterans and our service men and women.
What does the future hold for Allscripts, Cerner, Epic, and Meditech?
Individually, clearly Cerner, Epic, and Meditech are the three that we see in the market doing well. All are vigorously competitive. All three have very substantial customer bases. They all have their very loyal fans. They all have the ability to engineer and deliver product.
It’s going to be the ones that operate in conjunction with all the other technology out there are going to be the most successful. Again, I’d go back to the IBM-Google type of dynamic that is coming up in our industry.
This industry needs to start paying today’s price for IT. That’s not client server, that is cloud. Secure, private cloud, not just random cloud because of the privacy and security that we have. When those players — the major ambulatory and physician-based vendors — are truly operating in an interoperable world, open to the other data sources and places they need to provision data, especially down to the patient level, I think they’ll all be very successful.
All three of those companies are going to be part of the fabric of the next wave of healthcare. There will be other technologies that will leverage them and make them even more value, but all three of those are going to do rather well.
IBM is doing a lot with Watson. Will precision medicine have a significant impact on healthcare or is IBM just trying to find a lucrative market?
Time will tell on that. It’s a grand scheme and I’m wondering how they can bring it down to a granular level.
You asked at the top of our conversation if things were going to stall and I think not. Business requirements are going to drive IT. The question will be whose business requirement is going to bite off something that big, that complex, that far out on the edge, and that unproven?
I hope that they can move the needle and we get the best research driven to the point of care, but I see that there’s a gap between the demands of the market that I see arising today and the power of what may — but isn’t guaranteed — to come out of that collection of that technology. I think we have to wait and see.
Along those lines, NantHealth is investing a lot of money to nibble around the edges of healthcare IT. Do you think they are for real?
It’s an interesting collection of point solutions. Period.
Have you seen any startups that will be able to work their way into the enterprise?
Let me tell you what we haven’t seen. I don’t see anybody out there that is necessarily the silver bullet. I think what the industry is driving for right now is meaningful information in a contextually relevant way – both in the clinical setting and in the management of risk — and in dealing with the financial case. This is something that goes beyond the boundaries of the enterprise.
The way I look at it, there’s a continuum of that data capture. On the back end is analytic reporting. We have a number of analytic companies that are doing quite well, but they’re analyzing data that’s really bad. Healthcare has been accustomed to having data that is incomplete, developed for another purpose, and old. But now we have on one end of the spectrum analytic companies developing reports around that. Now we have better reports on really bad data.
I’ve been in the IT business 41 years and it’s still garbage-in, garbage-out. We see now the awakening for, "Let’s get to better sources of data." If one end of the spectrum is analytic reporting, the other end — the front end — is the interoperability, the capture, the curation, the collection, and the merging together of data, both at a patient level and at a population level. Between those two points, you have care coordination, referral management — both being done in very archaic ways — and care management for your chronically ill patients.
That’s the continuum that I see. I see a lot of work being done on the analytical reporting end, though I do see the folks that have been using those awakening and saying, "We’ve got better reports, but we still don’t have very good data." That’s what we have to do as an industry — connect from that source during that workflow of that actual patient encounter back through the big data analytics.
What should small companies know if they’re going to succeed in healthcare IT?
Innovation comes before standards. We have people that chase standards and regulation, and if standards ever did what they should do — which is make things cheaper and faster — it would work, but they rarely do.
I would encourage them to look more at innovation and look at a business reason for doing something versus trying to define a standard or drive a regulation and then answer that. That would be my advice to them — innovation before standards. Standards should fall out of innovation, not innovation being driven toward a standard, because we don’t know exactly how we’re going to get there.
Do you have any final thoughts?
We have a very important mission to do in healthcare. It’s not only demographic with the aging of the country, but it’s also very personal. Ultimately, this is the system that will take care of us and our loved ones. We need to make sure that we do a great job so that we have the best healthcare system possible.
The VA awards Lockheed Martin-owned contractor Systems Made Simple and its software supplier Epic a seven-year contract worth as much as $624 million if all contract options are exercised.
Banner Health will convert its newly acquired University of Arizona Health Network from its existing Epic systems to Banner’s Cerner platform. UAHN implemented Epic in 2013 at a cost of $115 million.
Five Cerner customers in the Pacific Northwest will begin exchanging health records with local AthenaHealth and Greenway practices through the CommonWell Health Alliance.
The VA awards its Medical Appointment Scheduling System (MASS) bid to one of its often-used contractors, Lockheed Martin-owned Systems Made Simple, which earns a seven-year, $624 million contract. The software supplier will be Epic, which gives the company a big win following the Leidos-Cerner-Accenture DoD selection. The VA issued its RFP for a commercial patient scheduling system in November 2014 following a nationwide patient wait time scandal. Lockheed Martin acquired the government healthcare IT contractor in October 2014 for an undisclosed price.
Reader Comments
From 4nER: “Re: Optum’s international push. It has dwindled – their UK-based CEO has left, Brazil acquisition Amil is struggling, and Virgin Care has beaten Optum in many NHS bids.” Unverified.
From You Don’t Need a Weatherman: “Re: Meditech. Opinion is they got into ambulatory and Web too late. As sites wait for MU Stage 3 and evaluate their vendors, Meditech is being evaluated by those sites. The timing may be perfect as Web EHR and Acute will be rolling out of 6.X as Stage 3 progresses.”
From Mark Pro: “Re: marketing people. You complain a lot about them. Don’t they do anything well?” As in most professions, the few incompetent, inexperienced, or overworked ones give the others an undeserved black eye. My favorite MBA topic by far was marketing (my second favorite was finance, strangely enough) and I really enjoyed learning about product positioning, channels, how marketing differs from advertising, etc. Marketing done right is education, collaboration, and orchestrating the intersection of product supply and customer demand. What puts a healthcare IT marketing person on my bad side:
Putting out incomprehensible announcements that are a BS buzzword tsunami clearly assembled by a roomful of people who are trying to advance their personal company stature rather than create clarity.
Expecting instant responses to their banal emails, always “circling back” because I’m too busy doing something important (like writing HIStalk) to respond immediately to their unsolicited questions. Just because you sent something I didn’t ask for doesn’t mean I’m obligated to acknowledge that I received it or to do anything more than hit “delete.”
Trying to do everything by committee, bugging Lorre to get on a call with a roomful of their people and then flooding her inbox with emails from each of them asking and re-asking questions she already answered. Usually that happens after they fail to read what she sent them earlier, preferring instead to waste everybody’s time in having it read to them over the phone.
Not following my rules, such as checking off the Readers Write submission box that says the article hasn’t appeared elsewhere, but then I find it posted on their company blog (I always Google before I run a guest post). That usually gets them banned.
Asking me to interview a brand new CEO (who doesn’t even know where the restrooms are yet) or an executive involved in a product launch (gee, wonder if they’ll say anything controversial?)
Not understanding the dynamic that I alone decide what I write, who I interview, or which products or news I consider worthy of reader time. I’m fine with companies suggesting that I interview their CEO, but I won’t allow marketing or PR people to participate. Lorre books most of the interviews for me and warns them upfront, “If he gets on the interview call and people other than the CEO are on the line, I guarantee you he’s going to hang up.” I like that nobody can whine over my head about my decisions – it’s just me, I have a long memory, and I won’t even pretend to like people who annoy me.
The marketing people I consider peers:
Are not new to healthcare IT, having paid their dues and learned the business, which probably means they have lost their youthful, chirpy innocence and can communicate as professionals.
Enjoy HIStalk and follow it even after they change jobs, often keeping in touch afterward.
Offer me what I need instead of what the company wants, perhaps offering to arrange an interview with a customer instead of a company executive who I’d turn down (I only interview CEOs except in rare occasions.)
Know not to waste my time with ghostwritten, worthless Readers Write articles that I’ll reject anyway.
Apologize when I call out an announcement, a newly rebranded product, or a company action as idiotic – sometimes they agree it’s bad, but explain that were overruled by the empty suits above them.
Request and accept my advice about how to improve an announcement, design and promote a webinar, or eliminate obvious mistakes or omissions in their web pages. I don’t volunteer to do that sort of thing, but if if someone asks and then ignores my input, I’m not going to jump at the chance to do them another favor.
HIStalk Announcements and Requests
Jenn covered Monday’s post for me since I needed a long weekend, so I told her I’d set up a new poll when I returned. Last week’s poll respondents forced to make a big company investment would choose Health Catalyst by far, followed by NantHealth and Evolent Health. Mobile Man says Nant shows how little even smart people know about healthcare, while JR commented that some of the companies have decent prospects but he isn’t sure you’d get your money back investing in any of them at this point in their trajectory. New poll to your right or here: what will happen following the scheduled October 1 switchover to ICD-10?
Welcome to new HIStalk Platinum Sponsor Stanson Health, which is also sponsoring HIStalk Practice at the Platinum level. The Los Angeles-based company provides easily implemented intelligent clinical decision support delivered at the point of care. Evidence-based content targets unnecessary tests and treatments while supporting Choosing Wisely and PQRS, while analytics helps organizations understand ordering patterns and identify opportunities. Of particular interest is the company’s advanced imaging content that works with any source of appropriate use criteria to reduce unnecessary imaging, inspecting 30 patient-specific data elements to minimize interruptions while tripling the inappropriate order cancellation rate compared to competitors. Cedars-Sinai Health System is saving $6 million per year after adding Stanson-powered Choosing Wisely recommendations into Epic (example: ordering an antibiotic for a patient with bronchitis issues a reminder that they don’t work for viral infections). The company also understands that patients may resist the “less medicine is sometimes better” message and has licensed content from Consumer Reports to provide them with friendly educational material. Stanson Health was co-founded by Scott Weingarten, MD, MPH (formerly co-founder and CEO of Zynx Health, now SVP/chief clinical transformation officer at Cedars-Sinai) and Darren Dworkin (SVP/CIO of Cedars-Sinai). I notice that Rick Adam is president and COO – he’s been in the industry forever as founder of Recondo Technology and New Era of Networks as well as being an executive in the early health IT days of Travenol (later Baxter). Thanks to Stanson Health for supporting HIStalk and HIStalk Practice.
Thinking about Rick Adam sent me to the online archives, where I turned up this exclamation-point filled 1986 THIS ad from Computerworld. I haven’t been able to track down Frank Russo, who took the company through a few more gasping iterations before turning the keys over to Jeff Goodman, who was axed after the company was sold to HBOC in 1994.
Mr. S wrote that his third grade class in Herminie, PA benefited from our contribution of STEM learning material (with matching funds from Chevron) just as the school year ended, giving his students new materials to master tricky topics that had come up through the year. He adds, “It is very important to give students every means possible of succeeding in life. Not every child learns the same way and not every child is interested in the same topics. These materials have allowed my students to succeed in my classroom in new ways and new topics. Thank you for caring about education and specifically caring about my classroom!” I still have matching money available from a generous vendor executive for companies that would like to contribute to other DonorsChoose projects via HIStalk now that the new school year is underway.
Also from my DonorsChoose project, Teach for America teacher Ms. S in Illinois, who offers an extracurricular programming class that tries to boost the numbers of female, black, and Hispanic students interested in technology, says her kids responded with “soooo cool!” to see the MacBook accessories we purchased (SuperDrive, external hard drive, case, and cables). Our funding of $264 paid for the entire setup plus the optional donation to DonorsChoose.
Webinars
September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.
Frank Poggio and Vince Ciotti delivered another brutally honest and opinionated HIStalk webinar on Tuesday, talking about the DoD EHR bid and how it will affect Cerner, Epic, and everybody else. I sponsored this one (meaning nobody paid anybody, in other words) and I’d be surprised if you don’t find it at least entertaining because people who’ve been in the business for a long time like Frank and Vince tend to have lost most of their muzzle and say whatever’s on their mind. If you have a non-commercial, informative, educational message that readers would enjoy, let me know and maybe you can do a webinar of your own.
Acquisitions, Funding, Business, and Stock
Cardinal Health will acquire 71 percent of Nashville-based post-acute care services and analytics vendor NaviHealth for $290 million in cash.
Zephyr Health, which offers drug companies analytics to predict new product success using public and private databases, raises $17.5 million in funding led by Google Ventures, increasing its total to $33.5 million.
Sales
The fire and ambulance services of Alameda, CA will use the Mediview patient care records, charting, and telemedicine pre-hospital application from Beyond Lucid Technologies.
Legacy Health (OR) chooses StrataJazz Continuous Cost Improvement as part of its five-year renewal for the full suite of Strata Decision’s products.
Missouri Delta Medical Center (MO) chooses PatientMatters for help with patient access, registration, and scheduling.
Vantage Oncology selects Wellcentive’s quality reporting and population health management solution for PQRS reporting.
Phynd Technologies recaps the six health systems that have recently signed for its Unified Provider Management Platform: Cone Health, Mount Sinai Medical Center, Kettering Health, Dayton Children’s Hospital, SCL Health System, and Presence Health.
Abington-Jefferson Health (PA) chooses the Paymode-X network from Bottomline Technologies to automate vendor payments.
Meridian Health (NJ) selects labor management solutions from Avantas.
People
WeiserMazars LLP brings on Todd Heckman (PwC) and Jonathan Stromberger as consulting principals.
Northern Inyo County Hospital (CA) hires Kevin Flanigan, MD, MBA (MaineCare) as chief medical officer/COO/CIO.
Lisa McVey (McKesson) is named EVP for technology and operations at the newly opened Atlanta office of health improvement technology vendor BioIQ .
Thomas Graf, MD (Geisinger Health System) joins The Chartis Group as national director of population health management.
Renowned Texas surgeon James H. “Red” Duke, MD died Tuesday at 86. He was an Army veteran, professor, trauma program developer, TV personality, and cowboy folk hero. He treated President John F. Kennedy and Governor John Connally at Dallas’s Parkland Memorial Hospital on November 22, 1963 while a surgical resident. Those of a certain age will remember him from a riveting episode of the groundbreaking 1978-1979 NBC reality medical program “Operation: Lifeline” and his 15-year stint as a nationally syndicated health reporter.
Announcements and Implementations
Cerner and Hospira will further integrate the former’s EHR with the latter’s smart IV pumps using Cerner’s CareAware iBus.
Imprivata launches PatientSecure, the palm vein scanning biometric patient ID system it acquired as part of its April 2015 acquisition of HT Systems.
Five Cerner clients in the Pacific Northwest will use CommonWell to exchange information with practices using Greenway, Athenahealth, and other systems connected to CommonWell.
Modern Healthcare names its 2015 Best Places to Work, which like every healthcare magazine’s “list” has as its primary objective selling advertising rather than conducting useful, scientifically valid research. Still, I’ll mention those HIStalk sponsor companies so named since (a) they like the recognition; (b) the awards really are driven by employee surveys; and (c) they’re good companies in multiple ways at least from the folks I know from each one: Burwood Group, CoverMyMeds, CTG Health Solutions, Cumberland Consulting Group, Divurgent, Galen Healthcare Solutions, Hayes Management Consulting, Health Catalyst, Impact Advisors, Imprivata, Park Place International, Santa Rosa Consulting, The Advisory Board Company, and The Chartis Group.
Practice Fusion will connect to Theranos for labs and RadNet for imaging in two states, collecting fees from those companies in return for connecting them with its users (that and selling supposedly de-identified patient data and pushing ads at doctors are its main revenue sources). We’ll see some interesting figures if the 10-year-old company ever does an IPO given its suggested market value of $700 million. All of that revenue requires keeping its free EHR users happy, so perhaps the incentives are well aligned for everyone.
Medical kiosk vendor HealthSpot will roll out a new Samsung blood chemistry analyzer that will give patients their results for certain blood tests in seven minutes. It’s fascinating how quickly the tedious lab draw and results reporting process is disintermediating, just as dramatically as when lab techs were mostly replaced with sophisticated high-volume instruments, which in return came about because of regulations and when big reference labs convinced individual medical practices to stop running their own labs. With Theranos already doing tests without a doctor’s order in Arizona, the whole process may soon be in the hands of consumers.
Government and Politics
A US appeals court says hotel operator Wyndham Worldwide can be sued by the Federal Trade Commission for allowing hackers to breach its systems in stealing the credit card information of 619,000 customers. Wyndham argued that the FTC had exceeded its powers similar to being allowed to “regulate the locks on hotel room doors,” while the court responded, “Were Wyndham a supermarket, leaving so many banana peels all over the place that 619,000 customers fall hardly suggests it should be immune from liability.”
Privacy and Security
An interesting article (with healthcare consumer implications) says future currency will be data, not money, and everybody’s personal data is being taken by social networking companies whose terms of service allow them to steal photos and files under the pretense of improving their product. The interesting conclusion: perhaps individuals (and patients) should create their personal API that puts the ownership and control of the information back into the hands of the person to which it pertains. The discussion was triggered by new terms of service from streaming music Spotify, which requires users to give the company access to their photos, contacts, and device locations.
Technology
A web ad piqued my curiosity about PillPack, a Boston-based online consumer pharmacy that just raised $50 million to expand its reach in offering individual prescription dose packs broken out into time due. The company manages all aspects of the prescription, from packaging and shipping to insurance, and will use its new funding to open brick-and-mortar storefronts and to roll out an app that will connect patients to pharmacists. The founder-pharmacist, described as looking like “the guy who you might buy pot from at a Dead concert,” says, “We should probably hire a finance guy.”
Other
A Tennessee company that runs skilled nursing and rehab facilities is forced into restructuring after implementing an EHR that caused billing delays and cash flow problems that led to its defaulting on a loan. The acting CEO, a partner with the company hired to turn the company around, says he’s seen paper-to-digital conversions cause financial problems across the country.
This is an unusual Craigslist ad.
BIDMC CIO John Halamka, MD says that in planning for FY16, clinicians spend too much time documenting in poorly designed EHR tools that were designed for capturing information, not managing customer relationships. He adds that consumer apps have raised user expectations and those will have to be bolted on to EHR transaction capabilities because “the difference between the $2 app and the $2 billion EHR is that the $2 app is easier to use, more convenient, and possibly even more useful.”
Phoenix-based Banner Health, which bought Tucson’s University of Arizona Health Network in February and isn’t happy with that organization’s losses, will convert UAHN from Epic to its own Cerner system as everybody expected and will cut $100 million of UAHN’s overhead over the next three years. UAHN spent at least $115 million implementing Epic with a November 2013 go-live, which may be the only case where an over budget EHR implementation caused such significant financial woes that an academic medical center had to sell out to a competitor.
Texas physicians will be paid for school-based telemedicine consultations with Medicaid-enrolled students whose parents have signed consent forms starting September 1. Proponents say it will keep kids in school and parents at work instead of sending them both home, while opponents question why non-Medicaid students are excluded and whether remote physicians will have enough information about the students to treat them properly.
Google shuts down its Flu Trends tracker, which got people excited for some reason back in 2008 even though its premise was ridiculous – that it could detect worldwide flu outbreaks by looking at search term patterns in a crude form of big data analysis. Not too shockingly, it didn’t work, and even if it had been able to identify outbreaks, the information would have done little to stop their spread.
Stanford University offers its online-delivered, $3,500 Genetics and Genomics Certificate. Just added to the curriculum is the elective course “Personal Genomics and Your Health,” which can be taken for $495.
A bookkeeper of Buffalo, MN-based mammography informatics vendor PenRad Technologies is charged with stealing $700,000 from the company and using it to pay personal expenses and to buy silver bullion bars she stored in her house.
LA County’s second-highest-paid employee made $790,000 in 2014 without working a single day. The former chief medical officer of Harbor-UCLA Medical Center earned the money as a partial settlement after he was fired for unstated reasons (rumored to be related to his medical credentials), sued the county for defamation, then turned down its job offer and retired.
New York’s Beth Israel Medical Center wiggles out of a $95 million lawsuit brought by the family of a wealthy heiress who claimed she was detained in a private room for several years solely to extract money from her when the statute of limitations runs out. The lawsuit charged the hospital with keeping the perfectly healthy woman in a $1,200 per day private room while hitting her up constantly for donations, including a $3 million painting the family said she donated under pressure.
A state health department in Malaysia is investigating a doctor who posted a photo of herself flashing the peace sign along with a patient in labor whose genitals were fully exposed. The doctor had a reputation for taking perioperative selfies.
It’s not HIT-related, but if you need your spirits raised, check out this video sent over by The PACS Designer of the United States Navy Band performing hits by Frankie Valli and the Four Seasons.
Sponsor Updates
ZirMed Chief Data Scientist Paul Bradley, PhD will present at two upcoming big data conferences.
PatientSafe Solutions posts “Medication Reconciliation Safety Concerns Linger Even with EHRs.”
KLAS’s 2015 mid-year report ranks MModal’s Fluency for Imaging as the highest-ranking front-end speech recognition solution for diagnostic imaging.
Black Book Rankings names the Looking Glass enterprise content management system from Streamline Health Solutions as number one in financial management and content management solutions.
AdvancedMD offers “PRM Software Capabilities, part 2 of 2.”
Awarepoint offers a video on caregiver enablement via healthcare technology.
Besler Consulting offers “IPPS Advisor: In-depth review of the FY 2016 IPPS Final Rule.”
Bottomline Technologies will exhibit at the California Association of Healthcare Admissions Management event August 30-September 2 in Sonoma.
CoverMyMeds Director Julie Hessick is named a finalist for Technology Innovator of the Year at the Next-Generation Pharmacist awards.
Stanson Health will exhibit at UHC’s annual conference in Orlando and will participate in its Member Innovation Expo and Reception on October 1.
Culbert Healthcare Solutions offers “The Defining Moments Leading Up to ICD-10.”
MedCPU takes home the 2015 Interactive Media Award for Best Website in Healthcare from the Interactive Media Council.
Inovalon, a healthcare-focused data analytics vendor, will acquire Avalere Health, a data-focused consulting firm, for $140 million in cash and restricted stocks.
Modern Healthcare unveils 2015’s Most Influential People in Healthcare list, which includes: Epic’s Judy Faulkner (#31), ONC’s Karen DeSalvo, MD (#35), McKesson’s John Hammergren (#73), and Cerner’s Neal Patterson (#99).
CMS publishes the July 2015 Meaningful Use update: 306,000 EPs and 4,400 EHs have attested to MU Stage 1, while 56,000 EPs and 1,500 EHs have attested for Stage 2. $31.3 billion has been paid out to date.
What Do National Patient Identifiers and Donald Trump Have in Common? By Catherine Schulten
Over the past several years (decades?), the call for a national patient ID has moved beyond discontented grumblings by hospital CIOs to a hot button topic that has garnered national attention from the likes of CHIME, HIMSS, the US Congress, and practically everyone with an opinion who is involved in healthcare data exchange.
A HIStalk poll conducted 2/8/15 asked, “Should the federal government issue a national patient identifier?” The overwhelming response was yes, as 79 percent said yes while 21 percent said no.
Interestingly, a poll done by the Wall Street Journal asking, “Should patients have unique electronic identification numbers for their medical records?” revealed that 44 percent said yes while 56 percent said no.
Industry leaders who support the use of a national patient identifier point to the use of universal patient identifiers (UPIs) in the UK, Ireland, Canada, and elsewhere. They tout efficiencies gained, increased patient safety, the ability to easily pull together a longitudinal record across disparate systems, lower administrative costs, accelerated medical discovery, and the ability to preserve patient privacy. They also cite patient privacy advocates and the existing ban on any federal funding to study or promulgate a national patient identifier as the reason why no forward momentum on this issue has occurred.
Those opposed to the national patient identifier typically cite two primary deterrents: patient privacy and the role of the federal government in establishing an agency that has the ultimate authority to create, distribute, and manage these identifiers.
But before we get into the pros and cons of each side in this debate, let’s first agree on a few items that seem to be overlooked when we talk about a national patient ID.
First of all, let’s quit calling it a national patient identifier. In practicality, it is actually a national ID. From the moment we are born until the day we die, we all have the potential to be a patient. In all countries that have adopted this type of system, the ID is assigned to the patient by the government at birth. In some cases, not only is this ID used to identify an individual for healthcare purposes, but it is also used when securing other government benefits.
Secondly, healthcare is a service that applies not only to US citizens born in this country, but others who may be here legally or not. Nationalized citizens, foreign visitors, individuals with work or student visas, and even illegal immigrants would need to use the ID. Otherwise, how does one know for sure whether Jean-Luc Picard with an ID and the one without an ID are the same or different individuals? For this design to work, an ID process must be supported for non-US citizens as well.
Back to the question at hand: what do national patient identifiers and Donald Trump have in common?
Both are light on details and heavy on promises. We hear what we want to hear when told that a national patient identifier is the only option that solves for true data interoperability, that privacy advocates and their concerns stand in the way of this enlightened future, and that an ID, once introduced, will be used consistently and accurately.
We seem to forget that HIT systems, no matter how well they claim to be protected, are vulnerable to sophisticated security hacks and low-tech identity theft schemes. We forget that healthcare is a service that anyone can secure even if you purposefully choose to anonymize yourself or — in the case of an emergent care situation — are simply unable to provide identity credentials.
But here’s another way that a national patient ID is like Donald Trump. We are fed up with the status quo. We struggle for a way to achieve the promise of unencumbered health information exchange. We’ve invested millions, more likely billions of dollars into the systems and exchanges that are supposed to support data liquidity and yet we still stumble over the seemingly simple matter of accurate patient identification and record matching. We are fed up and we aren’t going to take it any more! We demand action!
As a result, the promise of a national patient ID takes the spotlight and many cycles are spent touting this concept as the deliverance we need. If only the federal government would get its act together and those pesky privacy advocates would quit proclaiming doom and gloom.
However, the truth – as is typically the case – lies somewhere in between.
A national strategy and design for health information exchange that considers the unique challenges of patient identity and record matching is required. The ability for a patient to manage his or her own credentials if they wish to promote or even prevent exchange is necessary. Ultimately, we need a design that doesn’t rely solely on a set of individual attributes to properly identify or match the patient (I refer to the oft-cited “Maria Garcia in Harris County, TX” study.)
We need visionaries at the table who understand the nuances and challenges and can chart a new path forward. We need to be looking at the role of existing forms of patient identification such as insurance cards, driver licenses, passports, smart cards, and biometrics to assist in the process. National identity standards and concepts such as OpenID and NIST’s Levels of Assurance are paramount to the design. Finally, peer-reviewed pilot studies that reveal the strengths and weaknesses of different approaches will help ensure the best ideas rise to the top.
Catherine Schulten is director of product management with LifeMedID of Citrus Heights, CA.
August 24, 2015Readers WriteComments Off on Readers Write: Connecting Mobile Health and Alarm Safety Strategies
Connecting Mobile Health and Alarm Safety Strategies: A Guide for Hospitals Managing Mobile Alarms and Alerts By Mary Jahrsdoerfer, PhD, RN
As The Joint Commission’s National Patient Safety Goal on alarm safety inches closer to the January 1, 2016 compliance deadline, hospitals are discovering that long-term, meaningful reductions in alarm-related patient safety risks extend beyond medical device alarms. Although hospitals can satisfy TJC’s alarm safety deadline by presenting a solid strategy for reducing medical device alarms alone, there is an implicit understanding that managing patient monitors and ventilators are only part of a much larger problem related to clinical interruption fatigue.
In addition to medical devices, a comprehensive clinical communications strategy also includes managing the alerts (nurse call, EHR, labs), text messages, and mobile phones/devices that care team members use to facilitate collaboration around any of these patient events. A hospital should certainly follow guidelines that advise changing monitoring leads more often, implementing patient-specific monitoring thresholds, and configuring alarm delays, but these clinical interruptions only target a subset of the overall problem.
Clinical interruptions occur when a nurse continues to receive alarms and alerts while performing a patient-related task that could have escalated to another available caregiver with an integrated platform. The interruption may be an actionable, or even a critical event, but it’s still an interruption if the recipient is unable to respond with the sense of urgency required. Nurses have described frightening scenarios where they were engaged in administering life-saving treatment for one patient while an urgent alarm for another patient blared in the background. This situation could have been easily avoided with automatic escalation of that alarm to the next available nurse.
Preventing alarm collisions requires a holistic approach to managing clinical communications that must necessarily include the full spectrum of patient events. The challenge is integrating each system in each unit without overwhelming clinical users. Assimilation requires collecting input from affected users, measuring alarm and alert activity, and ensuring the right workflow.
The Joint Commission has provided a starting point for hospitals that are serious about reducing alarm-related patient safety risks. Middleware is the foundation upon which medical device alarm management is built — hospitals must utilize an FDA-cleared platform to deliver alarms to recipients on mobile phones. A long-term alarm safety strategy includes integrating all of a hospital’s clinical systems, which will require planning beyond TJC’s NPSG deadline.
The overall goal of TJC’s alarm safety goal is to reduce medical errors as it relates to medical device alarms, but nurses realize that the broader issue of interruption fatigue is a consequence of many workflow and communication inefficiencies. My admonishment for hospitals grappling with the alarm safety mandate, HIPAA compliance through text messaging, nurse call and EHR alert management, and smartphone and mobile phone deployment is to view them as subsets of the same communication architecture that require a common foundation to solve.
23-hospital health system Mercy Health (OH) announces that it will implement Premier’s integrated pharmacy and care management program in an effort to further improve its population health management initiative.
The Federation of State Medical Boards launches an online search tool that presents consumers with licensure and disciplinary information on providers.
John Halamka, MD and CIO of Beth Israel Deaconess Medical Center posts a blog outlining the strategic objectives facing health IT in 2016. On BYOD and the use of apps in care delivery, he says “The difference between the $2 app and the $2 billion dollar EHR is that the $2 app is easier to use, more convenient and possibly even more useful.”
Google co-founder Sergy Brin announces that the life sciences team within Google’s X Lab will spin off to form its own stand-alone business unit within Google’s newly created parent company, Alphabet. The new company will be led by renowned biologist and now CEO Andrew Conrad, PhD.
August 23, 2015NewsComments Off on Monday Morning Update 8/24/15
Top News
Mercy Health (OH) implements Premier’s integrated pharmacy and care management program to advance population health management initiatives at its 23 hospitals across Ohio and Kentucky.
Last Week’s Most Interesting News
Practice Fusion promotes Tom Langan to interim CEO, replacing founder Ryan Howard, who will move to board chair.
The executive exodus continues at NYC Health & Hospitals Corporation, with Paul Contino departing following an investigation of its $764 million Epic implementation.
Gene-sequencing company Illumina forms Helix, a business that will offer free genome sequencing to consumers and then monetize the data by selling portions of it back to patients as they need it.
ZocDoc raises a $130 million funding round on a $1.8 billion valuation, making it one of the most highly valued venture-backed companies in New York.
Leidos wins a $900 million contract to support R&D efforts within the US Army’s Medical Research and Materiel Command.
Epic is selected as the replacement EHR vendor for Finland’s Hospital District of Helsinki and Uusimaa, in a $424 million contract budgeted to grow to $635 million over 10 years.
Webinars
August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience.
September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.
Acquisitions, Funding, Business, and Stock
San Francisco-based Zephyr Health lands $17.5 million in a funding round led by Google Ventures, with help from existing investors Icon Ventures and Kleiner Perkins Caufield Byers. The med device and biopharma analytics firm has raised $33.5 million since its founding in 2011.
Dawn Van Dyke (The Advisory Board) joins The Sequoia Project (fka Healtheway) as marketing director.
Dean Schorno (Adaptive Biotechnologies) joins 23andMe as CFO and head of operations.
Sales
Cone Health (NC), Mount Sinai Medical Center (FL), Kettering Health (OH), Dayton Children’s Hospital (OH), SCL Health System (CO), and Chicago-based Presence Health sign on to the Unified Provider Management Platform from Kearney, NE-based Phynd Technologies.
Announcements and Implementations
Cerner shop EvergreenHealth becomes the only hospital in Washington to avoid paying a hospital readmissions penalty for the fourth year in a row. The two-hospital provider achieved HIMSS Stage 6 recognition last month.
NHS facilities in Wye Valley and Salisbury announce plans to move from decades-old patient administration systems to “electronic patient record systems” over the next two years. Wye Valley will spend over $23 million on a system from IMS MSXIMS, while Salisbury NHS will continue spending money with CSC on its Lorenzo platform. CSC has earned a tainted reputation as part of the boondoggle that was the National Programme for IT (NPfIT), which imploded in 2011 due to project overruns, mismanagement,and resultant budget-busting.
Technology
ZeOmega releases an annual clinical content update for its Jiva population health platform.
Validic adds RxRevu prescription intelligence software, including prescription drug delivery options and a price transparency tool, to its digital health platform.
Government and Politics
A 68-page report from the President’s Council of Advisors on Science and Technology determines that more work is needed from federal agencies such as HHS, NIH, NIST, and the National Science Foundation to promote and utilize open standards and interfaces to leverage data analyses for healthcare delivery and biomedical research. The report recommends without a hint of irony that “NIH and HHS should create funding mechanisms that will encourage accelerated deployment, testing, and evolution of translational IT systems for clinical use.”
The White House issues a fairly broad call to stakeholders for ideas on how to move its Precision Medicine Initiative forward, outlining 10 potential categories of ways to treat disease and improve health that have precision medicine potential. Feedback is due September 21.
The American Red Cross honors female community leaders and volunteers who contributed significantly to the recovery of New Orleans and Louisiana after Hurricane Katrina at its inaugural Power of Women luncheon. National Coordinator and Acting Assistant HHS Secretary Karen DeSalvo, MD was among the honorees for her work as city health commissioner and senior health policy advisor to New Orleans Mayor Mitchell Landrieu from 2011-14.
Research and Innovation
Oregon Health & Science University’s Knight Cancer Institute partners with Intel to launch the Collaborative Cancer Cloud, a network that will enable providers to securely share genomic data for more personalized medicine and tailored cancer research. OSHU plans to go live in the first quarter of next year with two additional cancer centers to pilot the new technology, plus make open source its Trusted Execution Technology to ensure patient privacy.
Other
Nancy Snyderman, MD will make her first public appearance since leaving NBC earlier this year when she hosts a discussion next month with New Jersey hospital CEOs during the Princeton Regional Chamber of Commerce Healthcare Symposium. Snyderman left the network after facing criticism for violating a voluntary agreement with the CDC to stay out of public areas after reporting from Liberia during the Ebola epidemic. Keyspeakers.com notes that her speaking fees are nothing to sneeze at.
Sponsor Updates
Huron Consulting offers “A Modern Commentary on Medicare at 50.”
The SSI Group will exhibit at the 2015 MidAmerica Summer Institute Region 8 August 26-28 in Minneapolis.
Streamline Health rings the Nasdaq opening bell in New York City.
T-System offers “ICD-10 Leniency from CMS: What You Need to Know.”
TeleTracking offers “One Team … Unlimited Success.”
Verisk Health offers “Talking Cost Drivers: How Employers Can Stop Rising Medical Costs.”
VitalHealth Software offers “Healthcare Outcomes: Our First Executive Forum.”
Illumina, the worlds largest gene sequencing company, forms Helix, a company that will offer free genome sequencing to consumers, and then will monetize that data by selling portions of the genetic information back to patients incrementally over time as they need it.
The Kansas City Star discusses the nations interoperability problems, asking “Why, then, does a windowless office in Truman Medical Center need to scan 2.9 million pages of paper medical records that started out as electronic ones?”
Investors and genome sequencing company Illumina form Helix, an app store-like service that will sequence and store a user’s DNA for free, but then offer the user pay-as-you-go apps to access it in the future. A customer might pay $20 to see if they have a specific genetic variant, then Helix will additionally sequence all of their medically relevant variants at their own cost of $500, hoping to sell the customer other information they need later without requiring a second round of sequencing. Partners such as LabCorp and Mayo Clinic will be paid a royalty-type fee, both for getting customers to submit their initial DNA sample and for each app they sell.
San Diego-based Illumina sold $1.8 billion of DNA equipment and tests last year and is hoping to penetrate the market for consumers, who so far have shown little interest in having their DNA sequenced. The FDA may weigh in with regulatory requirements. As the excellent MIT Technology Review concludes, “With Helix, says Flatley, companies won’t have to invest in starting a laboratory any more. Instead, he says, any developer with a computer will be able to start a genomics company.”
Reader Comments
From Gotham Growler: “Re: NYHHC. Glen Tullman was right in the Allscripts lawsuit.” The 2012 Allscripts lawsuit had nothing to do with the current investigation into HHC’s payments to consultants or how it has managed (or mismanaged, depending on who you believe) its Epic project. Allscripts claimed that HHC’s choice of Epic over Allscripts was unfair because HHC incorrectly calculated the total cost of ownership of Allscripts, which the company says was $500 million less than the number HHC used to choose Epic. The Allscripts analysis from its lawsuit (above) shows that HHC pegged the cost of all three options (Epic, Allscripts, or doing nothing) at around $1.4 billion, which is where the project estimate stands today. The lawsuit backfired, with Allscripts earning negative publicity from an industry generally puzzled at what the company hoped to gain by suing a prospect after losing a selection — HHC responded publicly in stating that the Allscripts TCO claims were “absurd,” that Allscripts was getting beaten soundly in the market by Epic because it “lacks a truly integrated solution,” and that the lawsuit was “an ill-fated attempt to reassure investors and inflate its sagging stock price.” Allscripts filed the lawsuit on December 13, 2012. Six days later, the company announced that it had failed to find a buyer for itself and had instead hired Paul Black as CEO and fired its executive team of CEO Glen Tullman, President Lee Shapiro, Chief Client Officer Laurie McGraw, and EVP of Culture and Talent Diane Adams. Allscripts dropped the HHC lawsuit three months later. MDRX shares are up 30 percent since Black took over, although they significantly trail the Nasdaq’s 64 percent overall rise over that time.
I went back to my October 2012 post about HHC’s original Epic decision, where I now recall that the $1.4 billion project cost was clearly spelled out to documents prepared for HHC’s board. That suggests that newspaper reports that the project is running double the expected costs of $700 million are incorrect – HHC estimated $1.4 billion from the beginning. The most interesting aspect of the lawsuit is that it disclosed that Epic’s software license fees represented $303 million of the $1.4 billion project, which is pure profit to Epic since the software carries no incremental costs. People always observe that Epic gets only a small portion of a total project cost of $500 million or $1 billion as license fees, but the lawsuit indicates that it’s around 25 percent. The Epic financial magic is high license fees, billing out freshly graduated liberal arts majors at multiples of their $50 hourly salary, and charging a significant portion of the license fees as annual maintenance with rebates for behaving in ways that Epic likes (applying updates, not bad-mouthing the company, and following Epic’s consultant hiring processes, for example.) Not too much different than any other vendor except for using newbies and putting lots of restrictive clauses in the contracts.
From Quality is Job Open: “Re: Quality Systems/NextGen. They let CTO Steve Puckett go, but are also swapping out all of their development leadership to create an Office of the CTO with an SVP of engineering, chief architect, and chief product officer.” Unverified, but the recruiter’s email I ran across seems to confirm that newly appointed CEO Rusty Frantz is retooling the whole product development group.
From Fly on the Wall: “Re: MediGain. The CEO and chairman are gone after a series of lawsuits claiming financial improprieties. As reported on HIStalk on 10/29/14, MediGain received an investment of $38 million from Prudential Capital Group. The latest lawsuit was filed by MedVision in January 2015, claiming that MediGain failed to pay the founders the monies due them.” Unverified, but the bios of Greg Hackney and Dinesh Butani have been removed from the executive page of the coding and revenue cycle vendor’s site.
From Don: “Re: Theranos shout-out. I’ve used the service for nine months in Phoenix. No DMV type experience – draw stations are at Walgreens and have weekend hours. Great for people without insurance coverage, with PT/INR at $2.70 vs. $99.50 hospital bills Medicare, who pays $4.98. Fast turnaround and results are available via web, smartphone, app, and PDF download. Tests drawn at PCP are available in four hours and are available on his eClinicalWorks system and patient portal. No lab order required in Arizona. As long as Theranos meets CLIA-88, CAP, JCAHO, and other regulatory requirements, we will use them whenever possible. My only concern is that convenience and pricing could deteriorate as the company expands to meet financial viability.”
HIStalk Announcements and Requests
This week on HIStalk Practice: Circle Health launches new practice business model in San Francisco. Telemedicine comes to a pet near you. Urgent Clinics Medical Care implements DocuTap tech at Houston facilities. Millenials may not be as averse to primary care office visits as their addictions to devices would have you believe. HHS encourages health IT-savvy practices to submit nominations for the 2015 Million Hearts Hypertension Control Challenge. Palliative care via telemedicine makes a difference in rural California. Large group practices weigh in with favored vendors based on customer satisfaction.
This week on HIStalk Connect: Doctors working at Al-Shifa Hospital in the Gaza Strip have developed a 3D-printed stethoscope that can be produced for 30 cents and performs as well as modern commercial alternatives. Nutritional supplement startup WellPath announces new integration points with both Fitbit and 23andMe in an effort to enhance its ability to personalize nutritional supplements. Finnish designers have launched a Kickstarter campaign to fund the Oura Ring, a ring that tracks activity levels, caloric burn, heart rate, respiration rate, and sleep cycles.
Webinars
August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience.
September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.
Acquisitions, Funding, Business, and Stock
Physician-patient matching service Grand Rounds raises another $55 million in financing, increasing its total to $106 million. Companies provide the service to their employees, who can seek second opinions, find insurance-covered doctors and have appointments made for them, and ask for medical help while hospitalized. The company digitizes and stores the medical records of its users within its app. The co-founders are Owen Tripp (co-founder of Reputation.com) and Rusty Hoffman, MD (chief of interventional radiology at Stanford Hospital).
Doctor appointment booking app ZocDoc is valued at $1.8 billion from its most recent funding round, earning them the already-overused and annoying “unicorn” label by people whose lips are too busy to say “billion-dollar valuation.”
Sales
NeuroPsychiatric Hospitals (IN) chooses Medhost’s clinical and financial solutions.
People
Kennedy Health (NJ) promotes Tom Balcavage from VP/CIO to SVP of technology and program services, where he will oversee ambulatory, product line, dialysis, patient experience, and imaging as well as IT.
Consumer healthcare expense management system vendor CoPatient names Tom Torre (Alegeus Technologies) as CEO.
William Tierney, MD (Regenstrief Institute) is named inaugural chair of population health for Dell Medical School at the University of Texas at Austin.
Healthcare software vendor Ability Network names board chair Mark Pulido (BenefitPoint) as CEO. He was CEO of McKesson until the company fired him along most of the executives involved in its 1999 acquisition of book-cooking HBO & Company for $14 billion, with the June 1999 hit list including Pulido, Chairman Charlie McCall, CFO Richard Hawkins, Al Bergonzi, David Held, Jay Lapine, and Mike Smeraski.
Announcements and Implementations
Allscripts will use CoverMyMeds as its prescription electronic prior authorization (ePA) solution. That’s how I read this somewhat vague announcement, anyway – Allscripts announced in December 2014 that it had developed its eAuth product for Express Scripts patients, so perhaps this agreement expands its reach.
Cerner will integrate the CoverMyMeds ePA solution with Millennium.
Cancer diagnostic vendor Guardant Health and oncology IT vendor Flatiron Health will develop a cloud-based platform to integrate liquid biopsy-based genetic testing results from Guardant’s equipment with clinical treatments and outcomes information to improve the targeting of cancer therapies.
Privacy and Security
The health minister of the Netherlands will propose that doctors be forced to turn over the medical records of patients to disability fraud investigators, although planned European Union privacy legislation may override that requirement by giving individuals more control over information about them, especially their health records. That new EU regulation will impact England’s NHS, which is making the data of non-opt-out patients available to researchers, drug chains, and private companies.
Carilion Clinic (VA) reprimands or fires 14 employees in unspecified roles for accessing patient records without legitimate need.
A former Florida TV news anchor sues his former employer, claiming he was fired for covering a story about paper medical records found in an abandoned storage unit whose contents were auctioned off. Matthew Dougherty says the station’s news director ordered him to “kill the story” when he found that the owner of the records was his own family physician, threatening him with statements that he had violated HIPAA.
Other
The Kansas City paper writes a surprisingly insightful article on the lack of EHR interoperability, opening with a brilliant question: “Why, then, does a windowless office in Truman Medical Center need to scan 2.9 million pages of paper medical records that started out as electronic ones?” That’s pretty eloquent for a site that co-features the usual eyeball-pandering cute dog video right next to it. I like its term of “digital dead ends,” which it summarizes as, “All that scanning springs from institutional rivalries over control of your medical data. Records emerging from all that scanning give your doctor the digital age version of something pieced together with duct tape — and rendered less valuable in the process.”
It isn’t just a US problem that nobody likes taking a pay cut: China passes a law prohibiting doctors from selling drugs to patients at a markup, so to offset their loss of income, the doctors doubled the rate of inpatient care. As the abstract concludes, “The reform had an unintended consequence: China’s healthcare providers have sought new, potentially inappropriate forms of revenue.”
Cleveland Clinic kicks McDonald’s out of its food court after years of trying to cancel the company’s lease, apparently convinced that the people who eat there (many of whom its own clinical employees) can’t be trusted to choose their food wisely during the very few hours each lifetime they’re inside the hallowed Clinic’s food court walls rather than everywhere else in Cleveland, which has 25 surviving McDonald’s. They should have instead used their copy of the franchise as a living laboratory to learn how to shift consumption to the healthier options that McDonald’s offers and that nobody buys, like salads, apple slices, and non-sugary drinks. McDonald’s, like Walmart and drug dealers, meets consumer demand that won’t go away no matter how much finger-waggers try unsuccessfully to legislate away the supply.
Sponsor Updates
MedData offers “The ABCs of ICD-10: Background and New Features.”
Navicure will exhibit at the 2015 Community Health Institute & Expo August 23-25 in Orlando.
ICD-10 is roughly six weeks away and CMS is launching an ICD-10 Clinical Concepts Series for specialties. Each guide contains specialty-specific information that can be shared with providers, including common ICD-10 codes and their counterparts. It also includes clinical scenarios for practice and links to case studies and other resources. If you’re looking for supplemental materials for your physicians, it’s worth a look. Specialties already released include Internal Medicine, Cardiology, Pediatrics, OB/GYN, Orthopedics, and Family Practice. They seem to be all on the website, but CMS is still sending out separate emails announcing their availability.
As a side note to CMS (rant alert) can we please come into the 21st century and start calling my specialty Family Medicine? There are still plenty of EHR vendors who can’t get the name of the specialty correct, either. The American Academy of General Practice was founded in 1947 and in 1971 became known as the American Academy of Family Physicians. We’ve never referred to ourselves as Family Practice. The MD certification board was originally called the American Board of Family Practice, but changed its name to Family Medicine in 2005. The DO board was originally the American Osteopathic Board of General Practitioners and changed its name to the American Osteopathic Board of Family Physicians in 1993.
CMS continues to use taxonomy codes that have not been updated to reflect the changes in specialty certification nomenclature that occurred up to two decades ago. CMS specialty code 08 (associated with provider taxonomy code 207Q00000X) still refers to us as “Family Practice.” With the increasing number of Nurse Practitioners (across many specialties), continuing to use outdated terminology is confusing. Physicians generally want to be referred to as such – for example, Internal Medicine physicians should not be referred to as “General Practitioners.” Physicians who care for children are Pediatricians rather than pediatric practitioners.
Thanks for putting up with my brief history lesson. It’s good information for those of you in the implementation trenches who may wind up on the receiving end of a physician’s unhappiness at finding the name of his or her specialty butchered in the EHR. It may seem like a small issue, but physician psychology is often complex. I’ve lost physicians at the beginning of a training session because they’re fixated on the idea that if the system can’t even get their specialty right, it can’t be that great of a system. It’s hard to overcome that kind of negativity if you run into one of those providers.
CMS isn’t the only governmental body that might be inadvertently offending physicians and other clinicians. I registered today for a meeting on laboratory data interoperability sponsored by FDA, CDC, and the National Library of Medicine. Although the registration form had checkboxes for MDs and PhDs, apparently DOs need not apply. I guess they don’t realize there literally dozens of disciplines that take part in the care and feeding of laboratory systems and interfaces. If they couldn’t provide a more comprehensive list, they should have just made it a free text field and let users enter whatever credential they feel is appropriate.
I had a near-miss in the office today as a result of another unexpected downtime. Usually the labs that are performed in-office are transcribed from the little analyzer printout slips to the EHR by the staff, which does a peer review to make sure there are no transcription errors. The EHR flags the results in different colors and bold type if they are out of range. I missed a significantly abnormal lab result at the time I reviewed it, only seeing it at the end of day after it had been loaded into the EHR and I was catching up on charts. Fortunately the patient had been admitted to the hospital for other reasons and the abnormality was addressed there, but that doesn’t make the experience any less horrifying for a physician.
In thinking through the event there were several potential causes:
General chaos in the office due to the downtime.
Trying to see a number of patients quickly to catch up from our initial delays.
Reviewing the data in an unfamiliar format.
Having the little cash register-type tape use color or having it in a more standard format that made the result stand out would certainly have helped, but it wouldn’t have countered the impact of general chaos or the fact that I was moving fast. I’m exceedingly thankful that the patient didn’t have any negative consequences. It’s a lesson learned for my next downtime experience, which based on the odds this week could happen at any minute.
This is the first time I’ve experienced system outages on a vendor-hosted system. In my past life, we’ve always been self-hosted and have been able to provide regular updates to the users. This week the practice’s owners have struggled with the vendor and it feels like the communication is not very good. In addition to system outages, the vendor’s telephone system went out today. I don’t know if it was related to the customer downtimes, but it’s adding up to be a perfect storm.
Speaking of outages, my former employer had to take down the EHR today at several hospitals for “urgent maintenance” at 9:30 in the morning. Despite my resignation, they haven’t removed me from the distribution lists, so I get all the notifications. The announcement came at 9:15 after the system apparently became so sluggish it was unusable. That’s not a lot of notice to give people in the swing of a busy hospital morning when you have hundreds of patients receiving procedures and treatments. It’s one of the peak times on the operating room schedules, so I can only imagine the magnified chaos going on there compared to my own downtime experience.
Do you agree that downtime is the gift that keeps on giving? Email me.
CIO.com covers the renewed public interest in establishing a national patient identifier, detailing several non-government efforts to establish an NPI infrastructure, including CHIME’s partnership with HeroX to back its National Patient ID Challenge with a $1 million prize.
MeriTalk publishes a study estimating that $342 billion is lost each year due to poor integration between the benefits eligibility systems used by different HHS agencies.
The CDC and HHS launch a competition among providers focused on improving hypertension control by recognizing organizations that demonstrate exceptional hypertension control rates achieved through the use of health IT, integrated team-based care delivery, and effective community outreach programs.
August 19, 2015InterviewsComments Off on HIStalk Interviews Seth Blackley, President, Evolent Health
Seth Blackley is president and co-founder of Evolent Health of Arlington, VA.
Tell me about yourself and the company.
Evolent partners with health systems and providers to support their acceleration of value-based care, which we define as providers receiving some form of prepaid healthcare or other incentives that manage the total cost of care. Our customers are generally providers, like Indiana University Health; WakeMed in Raleigh, NC; Premier in Dayton, OH; and other organizations like that. Typically they’re pursuing prepaid healthcare because they think it’s the best way to meet their mission for their patients, but they also feel like it’s the best way to steward their finances.
We generally are either supporting them with a value or risk contract with a payer, CMS, or their own health plan. Evolent is providing our customers with both technology and services in an integrated way that helps them ensure they’re hitting their cost and quality targets.
Frank Williams, Tom Peterson, and I founded the company back in 2011 along with the Advisory Board and UPMC, which is the biggest provider-owned health plan in the country after Kaiser. We looked all around the country and saw lots of software companies, consulting companies, and health plans, but nobody providing an integrated solution to help providers accelerate in this direction. We’re about 1,000 people today, working in 25 organizations. We’re an independent company listed on the New York Stock Exchange.
Surveys suggest that even those providers who participate in an ACO aren’t sure if ACOs improve quality or cost. Will the model will work?
What is definitely proven is that integrated medicine does work. If you look at things that UPMC has done over the years, or that Kaiser has done, or many other systems where you have aligned incentives, it absolutely drives healthcare value — cost down and quality up. The issue that’s an open question is what ACO models will drive the right incentives to make those sorts of outcomes work.
There’s a spectrum of ACOs. There are ACOs that have more full upside and downside incentives for providers, where they make the full investments that they need to provide integrated medicine. There are ACOs in name only. They’ve got the C and the O right, but they don’t have the A — the accountable part. Lots of those want to migrate towards a type of ACO that really does drive value.
I think it proven that integrated care works and you can drive incredible value. That’s why the markets are pushing that way. Some people are on Phase One of that and haven’t yet migrated to an ACO model that is sustainable over time.
We’ve created a health system based on the premise that provider competition is good, but many of the hot issues such as interoperability and integrated care try to force those competitors to work together. Will the competitive pressure go away and allow those things to happen?
The direction that CMS and the buyers of healthcare are pushing for is to have healthy competition that will create alternatives for consumers and buyers to purchase networks and products that are higher value. That kind of competition is healthy. What it will cause at is providers and payers to look at each other differently and find out the right way to configure those networks.
The organizations that may have been competitive in the past may become partners and vice versa, but we have to continue letting that evolve such that we do have healthy competition of selection choices of different provider networks and different tiered networks. The buyers of healthcare will have options and the volume in healthcare flows to those payers and providers who are creating value. We’ll have more collaboration areas than we’ve had it in the past, but we still want the competition over time that’s set up around the right issue, which is the total cost and quality of healthcare.
You mentioned UPMC, which is a key player in the western Pennsylvania market where health systems bought insurance companies and vice versa trying to control the market. That may have been a preview of what we can expect as health systems and insurers try to maintain their business. Is it constructive for the big to get bigger?
Without speaking to Pittsburgh specifically, what will be constructive is if the buyers of healthcare — and CMS is really leading the way here with this 50 percent target by 2018 under true value-based care, but then also their value-based purchasing bundles, the doc fix — all lining up the structure where you really on the provider side will only get paid well if you’re creating value over time. If the market continues to move that way, whether you’re big or small, you’re going to have to create value in order to have a viable financial structure as a health system. That’s the biggest force that we see happen.
I do think that FTC and the DOJ and whatever markets will continue doing their work, both on the payer side and the provider side, which they need to do, but generally, the structure of value-based reimbursement is probably the most healthy thing we have to kind of make sure we end up with a cost and quality outcome that’s attractive to people who are buying healthcare.
What will hospitals look like in five to 10 years?
Our view, from an Evolent standpoint, is that there’s going to be some winners and some losers over the coming years in the health system space. We feel that progressive health systems will increasingly become entities that provide a very broad set of services and that ultimately take accountability for the total premium dollar all the way back to the buyer of healthcare. That includes acute inpatient, outpatient, and probably more primary care and more care management and population health services than they’ve had in the past.
We see a lot of those systems investing more heavily in those types of services that help manage the total cost of care then they do in new bricks and mortar. As an example, the things that are part of the premium, like pharmaceutical costs that we see health systems investing more around, “How do I manage the total cost of pharmaceuticals?" which traditionally hasn’t been part of their purview.
We think those many systems that are going to be the winners will continue to invest in that broad spectrum in ability to take all that, coordinate it, and offer something back to a buyer of healthcare that is attractive. We think that there will be a swath of systems that move that way. There are some systems that, if they don’t move as fast, may be boxed in a little bit more in terms of the spectrum of services they offer. Those will have a harder time financially than those that attempt to move upstream and take on a Triple Aim approach to healthcare.
Health systems haven’t had much interest in managing consumer health and haven’t done a good job holding down costs, and yet now they’re being appointed as the best hope for doing both. Will it be a challenge for health systems to move quickly away from transactions and filled beds to managing health and costs?
We do think it’s a big shift. It requires a lot of new competency and new capability. It’s the reason we created Evolent as an acceleration partner for those health systems as they build up their own talent and their own infrastructure around this. We think they can benefit from a partner like Evolent to provide the expertise in these areas where they’ve had less of it in the past. Things like our Identifi technology platform that is purpose built to help optimize their EMR investment in order to do this work and take an EMR investment which historically was more focused on the areas you asked about and make sure it’s optimized to do things that are going to be critical in this new world.
There are all kinds of issues. One example is risk adjustment, which is a really important issue for the exchanges or for Medicare Advantage that traditional health systems haven’t had as much exposure to. Or managing pharmaceutical costs. Just generally coordinating care and prioritizing outreach to a patient who may not be in their hospital or in their physician practice on any given day. Our Identifi platform is one example of what we bring to the table to help them make that pivot.
Your description is very accurate. It’s a big leap to go from here to there. That’s where we’re focused in supporting them.
The EMR is becoming less he center of the universe and is getting walled off by other technologies that are just as essential, just in different ways. Is there a market outside the core EMR business and are people paying enough attention to using them optimally rather than just buying them?
We’ve seen most of our health system partners betting deeply on the EMR as a critical part of their future. We’re spending a lot of time helping them make sure they’re getting the most out of that platform and leverage and identify to do that in concert with the EMR.
That said, most of our partners have networks that may be very broad. We have one partner that working with that has about 40 different EMRs that are relevant across their network. Being able to integrate and optimize population help across all those is critical. Having all the clinical content and knowledge about how to do population health is another thing that we’re bringing to the table through Identifi. We see other companies doing similar work.
In answer to your question, people are betting on the EMR but also realizing that they need to supplement it to be proficient at population health. We are trying to help them in both of those ways.
What are the most important characteristics of a provider that is well positioned to succeed under value-based care?
The things that we see that are critical are that the health system leadership has a vision that, over time, having a value-based structure is the best answer from a mission standpoint for their patients and is the best way to steward their financials. Those that get that and believe that or feel like the world’s headed that way is probably the most important thing.
After all, you can develop additional assets. You can develop your brand. You can develop more physician relationships if you start with that and you’re committed to do it. That’s probably the first and most important thing.
Obviously having a physician network, particularly primary care physicians, is, also a critical asset, so we look a lot at that. Many of the things that go beyond the leadership and the physician base can be developed over time.
One thing that we see a lot is that health systems, at times, need support in helping understand the full array of capabilities and competencies that they need to be successful. We do a lot of that in the Blueprint process. It’s not just about technology. It’s not just a consulting project. There’s a broad set of services and technologies that they need to make the pivot, as you articulated. It’s a new frontier for many of them. We try to bring that depth and understanding during the Blueprint as well.
Where do you want the company and the health system to be in five to 10 years?
Like many of the systems we’re working with today, I hope that there are systems in every market across the country that have a vision and a plan to execute on an approach to take the value-based model and make it a core part of their business. Not a pilot or initiative, but a core part of the business. That’s certainly where CMS and the payers are pushing.
We hope they have that in place. We hope that they’re the ones that do it and are the market leaders, able to gain market share and have a stronger financial position than they have today based on that strategy. You can see that happening today and a number of our partners are getting great outcomes out of the gate. We’re hopeful that that spreads and scales nationally and that they’re successful as part of it. As a result, the patients they’re taking care of are getting better care at a lower cost. That’s where our mission lies and where the missions of our customers lie as well.
Do you have any final thoughts?
We increasingly see that the future direction for payers and providers is pretty clear. CMS and the other payers are speaking clearly about where they want the market to head. We feel like that creates a huge opportunity or risk for the provider. If you can move and be a market leader, it’s a huge opportunity, and if not, it’s a risk.
Our experience with IU Health, WakeMed, Premier, and MedStar is showing, already over the last few years, that they can both do better financially and do better for their patients if they’ve got the right support. Evolent is uniquely set up, based on our heritage, to help them do that.
Comments Off on HIStalk Interviews Seth Blackley, President, Evolent Health
NYC Health & Hospitals Corporation CTO Paul Contino becomes the fourth high-ranking IT official to leave since HHC started its now over budget and behind schedule Epic rollout.
In Finland, Epic has been selected as the replacement EHR vendor for the Hospital District of Helsinki and Uusimaa, in a $424 million contract that is budgeted to grow to $635 million in total project costs over 10-years.
The New York Times dissects medical research studies, explaining in plain terms how to evaluate often confusing research methodologies and what characteristics to look for in a trustworthy study. The study also weighs the pros and cons of RCTs versus retrospective data analytics studies based on national datasets.
CTO Paul Contino leaves NYC Health & Hospitals Corporation, the fourth high-ranking IT HHC official to depart following an investigation of its $764 million Epic implementation. HHC previously fired CIO Bert Robles, two other employees, and seven consultants. Several of the project’s top positions being filled in interim by Clinovations (acquired by The Advisory Board Company in February 2015), which was given a $4 million, 15-month contract to manage the project. HHC is investigating reports of consultant overbilling on the project that is 18 months behind schedule. Internal documents suggest an actual project cost of $1.4 billion, nearly double the announced cost. HHC chose Epic in January 2013 at an announced contract price of $302 million. It hopes to bring it live system-wide by 2018.
Reader Comments
From Former PF Employee: “Re: Practice Fusion’s interim CEO. Ryan Howard was never going to make it as CEO through an IPO. He had too many issues and wasn’t able to temper them enough. An IPO may happen but isn’t as imminent as the PR team says — that was a tactic to distract people from the need to change CEOs. It wasn’t supposed to be this sudden, but that’s how Ryan is and part of why this is a good decision overall. Side note: why does everyone think PF only generates revenue from ads and selling data? Ads are maybe 30 percent and data actually isn’t sold (while ‘insights’ from the data are sold, that’s less than five percent too).” Unverified.
From Duluth Dilettante: “Re: Practice Fusion’s interim CEO. I agree, you don’t put in an interim CEO to prepare for an IPO. A lot of venture money was poured into both Practice Fusion and CareCloud, both of which changed CEOs. The ‘broken’ healthcare space offers opportunities but is complicated, especially when competing with incumbent vendors like Epic and Cerner. Once you take VC money, the game changes to achieving lofty financial goals or getting kicked out by impatient investors.” I can’t imagine the learning that’s required of a startup CEO who faces a tough investor grade card at each revenue milestone. Think about Neal Patterson guiding Cerner from a picnic table conversation to a huge corporation and what he had to learn along the way. CEOs who are afraid of losing their job let boards convince them to maximize short-term profits even at the expense of long-term potential, so risky innovation isn’t encouraged, like Cerner spending a fortune developing Millennium in the late 1990s. One might postulate that every publicly traded company would have been better, but not necessarily bigger, if it had stayed private and stuck with a non-quarterly mindset like Epic, InterSystems, Meditech, and quite a few other health IT companies that are still run by their very successful founders after decades.
From Hospital Money Man: “Re: CMS. Cutting it awfully close for the 2015 MU modification / alignment rule. Reporting periods need to start no later than October 2 assuming the provision sticks. There’s no time for vendors to respond and QA is the first to get cut. Some vendors will hedge in assuming NPRM will pass as written, but there’s obvious risk. Just in case anyone wonders why we’re in the position we’re in with consensus that EHR functionality is in shambles and calls for program postponement.”
HIStalk Announcements and Requests
My latest gripe: referring to provider payments as noble-sounding “reimbursement,” an especially embarrassing euphemism when the reimbursee books an annual “surplus” of hundreds of millions of dollars. Also, publications that say Congress prohibits use of a National Patient Identifier, which isn’t exactly true – it only prohibits HHS spending government money to implement it.
Webinars
August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.
Acquisitions, Funding, Business, and Stock
Wolters Kluwer will acquire physician CME provider Learners’ Digest International for $150 million in cash.
Denver-based predictive analytics vendor NextHealth Technologies raises $1 million in funding from investors that include Nuance Healthcare President Trace Devanny.
Medical coding services vendor Aviacode receives a $16 million investment to further develop its marketing and technology. David Jensen founded the company in 2000.
Rehab therapy software vendor WebPT acquires Therabill, which offers a Web-based practice management system for therapists.
Bold, insightful investment firms set a consensus target share price of $7.05 for Merge Healthcare, no doubt acting independently of the news that IBM will acquire the company for $7.13 per share.
Sales
Hospital District of Helsinki and Uusimaa in Finland chooses Epic’s $424 million bid to replace its patient care system. Epic outscored CGI based on price, functionality, usability, and interoperability. HUS has 21,000 employees and nearly 3,000 beds.
People
St. Jude Children’s Research Hospital (TN) names Keith Perry (University of Texas MD Anderson Cancer Center) as CIO.
Froedtert & the Medical College of Wisconsin hires William Showalter (Wellmont Health System) as SVP/CIO.
Steve Puckett, EVP/CTO of Quality Systems (NextGen), resigns “by mutual agreement with the company.” His duties will transition to COO Daniel Morefield.
Meg Aranow (The Advisory Board Company) joins SRG Technology as SVP of technology.
CareTech Solutions President and CEO Jim Giordano is appointed vice chairman of Ascension Michigan’s board.
RightCare Solutions names Jeff Edgin (Siemens Medical Solutions) as SVP of business development.
Announcements and Implementations
Peer60 publishes “IT Infrastructure Trends in Medical Imaging 2015.” It’s interesting that hospitals are nearly equally split between wanting to buy PACS or VNA hardware on their own vs. choosing a turnkey solution. Preferred hardware vendors were Dell and HP.
Clinical Architecture announces Content Cloud, a cloud-based terminology update service.
Novant Health (NC), which has the highest Epic MyChart engagement in the US with 50 percent of its users logging into the portal at least monthly, will integrate user wearable data into MyChart using Apple HealthKit.
Capital BlueCross (PA) announces that enrollees can start using its American Well-powered physician video visits on January 1, 2016.
Government and Politics
Leidos wins another big military medical contract, earning a 10-year, $900 million bid to support US Army medical research.
FDA, CDC, and NLM will convene a free public workshop on promoting semantic interoperability between diagnostic devices and EHRs/LISs on September 28, 2015 at the FDA’s Silver Spring, MD campus.
Privacy and Security
The State of Colorado apologizes for sending 1,600 PHI-containing letters intended for Medicaid recipients to the mailing addresses of other people due to a vendor’s programming error.
Innovation and Research
MIT researchers develop a cognitive assessment in which smart pens analyze the way a person draws a clock, automating a manually interpreted test and potentially allowing earlier detection of dementia.
Technology
An article about the Internet of Things says consumer and other light uses (some of them absurd, like refrigerator and trash can sensors) can’t be profitable since they communicate via expensive cellular networks.
Other
In England, local media get worked up after their Freedom of Information requests reveal that a hospital paid a cardiologist $17,000 to cover three, eight-hour holiday shifts, or compensation of $708 per hour.
UK investors complain that digital health innovation is stifled there by NHS, whose bureaucracy controls nearly all health-related spending even as NHS says its future success depends on innovative technology. A frustrated English startup CEO who moved his company to the US despite being named a NHS Innovation Accelerator Fellow says, “The NHS is optimized for people with large sales organizations and/or specific knowledge about how the system works. Although US healthcare has its problems and there are some messed-up incentives, at least there are incentives.” You can imagine a similar situation here if the federal government ran healthcare even more than it already does.
A study of 96 medical specialists in Massachusetts finds that most are unaware of the state’s 2012 medical transparency law that requires them to provide consumers with self-pay prices within two business days. Dentists were the most accommodating, presumably because they have many patients without insurance. One ophthalmology practice quoted $140 for an eyeglass exam, but raised the price to $327 when told the patient would be paying cash. Price estimates for a colonoscopy that includes facility and anesthesiology charges ranged from $1,300 to $10,000. Some practices told the surveyor that they weren’t allowed to give prices by phone, while others were “downright rude.” The president of the state medical society blames “the complexity of the payment system.”
The Kansas City paper digs back into Cerner history in comparing Amazon’s “brutal” workplace to Neal Patterson’s infamous 2001 threatening employee email that sent CERN shares down 20 percent after it went public. I’ve changed my opinion about the email over the years as several then-Cerner employees have said Neal was right – employees were taking advantage of the company’s management sloppiness and he had to skip those layers to get his point across directly and unequivocally. It must have worked since shares have increase somewhere around eightfold since then vs. the Nasdaq’s doubling. Still, it’s fun to run his spitting nails email every couple of years.
The New York Times publishes a great article called “How to Know Whether to Believe a Health Study.” It says the problem with randomized trials is that they focus on narrow populations of people who are most likely to benefit from the particular treatment, often also excluding older patients and children. However, it fails to mention what I see as the biggest problem – studies are often sponsored by companies that suppress publication of the negative or even inconclusive ones. The author likes observational studies in which large, existing databases are mined for new insights as long as they cover broad populations and not just people who chose to receive a particular treatment.
Lenny Robinson, who sold his cleaning business and made a full-time job of visiting hospitalized children in Maryland costumed as Batman, was killed Sunday when his stalled Batmobile was struck by another car on Interstate 70. He was 51.
Sponsor Updates
Aprima announces attendance of 800 at its user conference earlier this month.
Caradigm and iHT2 publish “12 Things You Need to Know About Value-Based Reimbursement.”
AdvancedMD offers a look at its new ICD-10 website.
AirWatch becomes a founding sponsor of the new Center for the Development and Application of Internet-of-Things Technologies at Georgia Tech.
Strata Decision Technology participates along with Costs of Care in a national story contest called “The Best Care, The Lowest Cost: One Idea at a Time.”
Aventura offers “A Nurse’s Perspective: Shifting the Focus from the Computer to the Patient.”
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