Morning Headlines 6/11/15

Walgreens and MDLIVE Expand Telehealth Platform to Three New States, Add Desktop and Tablet Functionality

Walgreens expands its telehealth service to users in Colorado, Illinois and Washington, and promises to make the service available to 25 states by the end of the year.

Kentucky Physician Named AMA President-elect

AMA announces that its next president will be Steven Stack, MD, an emergency medicine physician from Kentucky. Stack served as the chair of the AMA’s Health Information Technology Advisory Group from 2007 to 2013 and has served on multiple ONC advisory groups.

Reducing Alert Fatigue Prevents Pharmacy Medication Errors

Hospital Sisters Health System (IL) reduces the number of alerts being presented to physicians by 40 percent, while improving its rate of catching preventable medication errors by analyzing and optimizing its alerts.

Growth Of New York Physician Participation In Meaningful Use Of Electronic Health Records Was Variable, 2011–12

Health Affairs publishes an analysis of the Meaningful Use program, finding that providers that had adopted EHR systems prior to MU were more likely to be “early and consistent participants” in the program.

Readers Write: The Learning Healthcare System Starts with the Vendor-Neutral Archive

The Learning Healthcare System Starts with the Vendor-Neutral Archive
By Larry Sitka

The Office of the National Coordinator for Health Information Technology, commonly referred to as ONC, recently released “Connecting Health and Care for the Nation, A Shared Nationwide Interoperability Roadmap (DRAFT Version 1.0).” Inside the 166-page framework description, ONC introduces the need for a platform called a Learning Health System, which it defines as “an environment that links the care delivery system with communities and societal supports in ‘closed loops’ of electronic health information flow, at many different levels, to enable continuous learning and improved health.”

The ONC document is designed to be a 10-year roadmap that describes barriers to interoperability across the current health IT landscape, including a description and proposal for a desired future state of healthcare IT. It introduces an architecture overview for a learning healthcare system and what is required of such a system.

In the report, ONC states that “by 2024, individuals, care providers, communities and researchers should have an array of interoperable health IT products and services that support continuous learning and improved health. This ‘learning health system’ should also result in lower health care costs (by identifying and reducing waste and preventable events), improved population health, empowered consumers and ongoing technological innovation” through coordinated care plans.

The report states that in the future, “all individuals, their families and health care providers should be able to send, receive, find and use electronic health information in a manner that is appropriate, secure, timely and reliable. Individuals should be able to securely share electronic health information with care providers and make use of the electronic health information to support their own health and wellness through informed, shared decision-making.”

While the vision and future state put forth by the ONC is sound, as healthcare professionals, we must ask ourselves, “Where do we begin?” and, “What can we do today to begin reaping some of the benefits of interoperability and providing the foundation for the next 10 years?”

As with any technology revolution, certain technologies mature faster than others and begin to provide a glimpse of the future landscape. In the case of interoperability, the vendor-neutral archive (VNA) is a mature technology that is already playing a leading role in evolving the current healthcare ecosystem toward a learning healthcare system and providing a means for real-time healthcare delivery.

The foundation for a learning healthcare system is the basis of what a VNA provides today. Leveraging and thinking of a VNA as merely an imaging storage tool is shortsighted. Why not envision the VNA as providing the pathway and functionality for a patient-centered healthcare discovery tool? The VNA already has the capability to provide an IT interoperability framework that enables many applications to work in unison to learn the context of a patient, inside or outside the current healthcare organization. By leveraging a VNA in this context, suggestive results can be provided to the healthcare organization’s clinicians, physicians, and, most importantly, the patient in a passive or real-time manner.

The VNA is an effective means for improving patient outcomes through interoperability and for moving healthcare organizations beyond the traditional product sell. The ONC report states, “Consumers are increasingly expecting their electronic health data to be available when and where it matters to them, just as their data is in other sectors. New technology is allowing for a more accessible, affordable and innovative approach. However, barriers remain remain to the seamless sharing and use of electronic health information.” The VNA has all the elements necessary to establish a learning health system foundation.

In the construction of a building, every project begins with the foundation. A solid and stable foundation is critical and must be carefully planned. It is the most difficult structural element to change. The foundation of a learning healthcare system is built around two key components—patient context and the healthcare delivery organization (HDO) context. Taking ownership of the data and focusing on HDO interoperability through standards are essential pillars that must be cemented into this foundation.

From an HDO perspective, ownership of clinical content on behalf of the patient is a mandatory requirement. An assumed role of the HDO, on behalf of the patient, is the holding of collected patient content for future use in the continuum of care. The HDO must define and build a foundation by which secure sharing of patient content is inherent. This environment must be capable of not just storing content but also dynamically finding, moving, and distributing content in real time.

This content is linked and possibly moved into a learning healthcare system independent of the organization’s affiliation. The content is either linked on demand or covertly as information is discovered, further extending the patient longitudinal record. The goal of content aggregation is to provide suggestive access to patient information for the healthcare worker who is responsible for delivering a better patient outcome. The patient outcome is the evidence by which the HDO shall be paid.

From the patient perspective, ownership of the data by the patient is now something we vendors must enable and that HDOs are legally bound to steward. HIPAA, for example, can appear to vendors as restricting and controlling. It attempts to define who and what content can be accessed along with the purpose of accessing that content. However, it is actually HIPAA that finally gives ownership of the content back to the patient. It is the first piece of legislation specifying to the HDO and its vendors that true ownership of results and supporting documentation belongs to the patient and not the healthcare organization, the insurance company, or the product vendors.

Once the foundation of a learning healthcare system is created, the framing comes next. Framing requires exact measurements and sizing using standards-based products. With the cutting and coercion of the materials comes a custom fit per the requirements in a blueprint. Such is the case of a learning healthcare system, where the HDO must begin by demanding standardization of not only structured content but also unstructured content. Standardization assures interoperability and a canonical data model that is based on industry standards and site-specific requirements, not proprietary vendor specifics. Standardization or canonicalization of the metadata to be used and exchanged in a learning healthcare system is exactly what a true VNA platform provides.

Simple problems come with very complex solutions in these cases. For example, patient names, IDs, and study descriptions have become as complex to the HDO as the Y2K problem. Can you imagine the chaos that would ensue from an IT infrastructure not based on wireless or Ethernet standards for physical connectivity? Simply put, what if we all drove on an Interstate without painted lines? What if the map we used for guidance did not include a legend?

Such is the case for the HDO when it comes to delivering a standards-based form of patient content. Of course, there are DICOM standards, HL7 standards, and the XDS framework, but HDOs must demand that vendors actually support and utilize these standards, participating in annual Connectathons to validate their ability to interoperate. More importantly, HDOs must contractually demand interoperability following those exact standards. In short, an HDO must stop purchasing solutions that are unique to its own internal, proprietary standards.

The deployment of the electronic medical record (EMR) to capture and attempt to hold unstructured content, at least inside a data warehouse application, is a step in the right direction. Unfortunately, the EMR only solves half of the problem by providing a collection point. To test this, try and share the unstructured content between EMRs and between organizations. This has become a next-to-impossible task. EMR providers that claim to be able to share unstructured content typically come up far short of expectations.

The idea of sharing an electronic record is what initially drove EMR adoption. But now we have a large volume of unstructured content that must feed the learning healthcare system. The VNA is a capable platform for achieving this goal. The chart above indicates where the VNA is already meeting three-year and six-year interoperability objectives set forth in the ONC report.

The final steps in a construction process are completed by selecting the best products, with the best look and feel, to meet the needs of the owner. Such is the case in creating a learning healthcare system, which demands the ability to select the best products and functionality to deliver the best patient outcomes. Different departments and healthcare settings, much like physicians, have different needs and requirements. Why be limited to only one selection? More importantly, don’t be forced into “one size fits all” in the selection of applications. Give HDO users the flexibility to select the applications that best suit their workflow and objectives. For example, a radiology-centric viewer will not work very efficiently for wound care or treatment planning.

When connecting the building to the outside world, each location typically has its own utility providers that are part of a grid. The same is true for a learning healthcare system, where existing healthcare information exchanges (HIEs) are the on-ramps. The HIE and image or content exchange, which are typically not profitable today, are expected to evolve into much more in the future. Difficulties often arise when seeking cooperation among different, unaffiliated organizations for patient informational access. Vendors, of course, find it difficult to build any product today around something that is not profitable, not to mention being a very difficult sell to HDO executive teams. Tomorrow’s HIE technology inside the learning healthcare system, however, will not only be a necessity but will be integral in making sure image and content exchange is included in the VNA as an embedded feature. Sharing patient content across the private sector, HIEs and government organizations will become commonplace within the next decade, all driven by patient outcomes.

But, more importantly, the business and legal perspective. The VNA selected should support an HIE inherently. An image/content exchange is a mandatory requirement of a VNA and is the basis of a learning healthcare system for moving released content in a secure manner. It is also critical that an image/content exchange within a learning healthcare system provide the business process and verification steps, including automation of steps that include BAA approval and appropriate patient release form access and approval.

The data demands of a learning healthcare system will far exceed anything an HDO has seen to date. Typically, the sizing of a VNA is done by traffic volumes requested by concurrent users, or study volumes. However, the oncoming big data analytics applications (a necessity inside a learning healthcare system) will far exceed any current traffic volumes requested by humans. A learning healthcare system will be in a continuous mode of finding, aggregating, and coercing information relevant to the patient in context. This is also a necessity to building out the patient record.

Once found, the information is persisted in the learning healthcare system whereby the analytics and other applications, including natural language processing (NLP), will access the information. NLP will give the data better context and perception around the patient, allowing the healthcare worker to have better informational access and decision processing through new clinical support applications. Support for these demanding applications will require an infrastructure that can scale on-demand, both horizontally and vertically. These applications will leverage your VNA for more than just “basement storage,” where content becomes cluttered and inefficient while never being used again.

The learning healthcare system will be an integral part of improving the way the healthcare ecosystem works and how patients, providers, and payers interact within that ecosystem. Achieving the complete vision of the learning healthcare system will be a gradual process and lessons will be learned throughout the journey. There are important actions we can initiate today, however, to begin building the necessary foundation for this vision. VNA technology is the foundational cornerstone mature enough to begin solving some of the greatest challenges and to remove some of the obstacles to a fully interoperable healthcare system.

Larry Sitka is principal solution architect with Lexmark Healthcare of Lexington, KY.

HIStalk Interviews Tony Schueth, CEO, Point-of-Care Partners

Tony Schueth is CEO and managing partner of Point-of-Care Partners of Coral Springs, FL.

Tell me about yourself and the company.

Point-of-Care Partners is a health IT strategy and management consulting firm that I started 12 years ago when I left Merck-Medco, which is a pharmacy benefit management company that was owned by the pharmaceutical manufacturer Merck. We are unique because we focus on a subject matter and then work across stakeholders. For example, health plans, PBMs, integrated delivery networks, EHR vendors, and other technology companies and pharmaceutical manufacturers are all our clients.

The first subject matter that we focused on was electronic prescribing. Then we consulted and worked with all the different stakeholders in prescribing. The subject matter that we focus on now are some variations of e-prescribing, including e-prescribing of controlled substances, specialty e-prescribing, but also electronic prior authorization, population health, clinical decision support, clinical messaging, real-world evidence and outcomes, health information exchange, and patient engagement. We also have three new solutions and services built primarily for EHRs, a 50-state regulatory analysis of e-prescribing and e-prior authorization laws as well as a database of NPIs-to-EHR, including version numbers.

I got my start in electronic prescribing in the mid 1990s when I was a product manager for an early-generation e-prescribing solution and have been working in electronic prescribing ever since then. We have created a transaction standard that supports the process. We also have intermediaries that specialize in e-prescribing. Prescriptions are flowing electronically. It’s a true success story, in my opinion. It’s also gratifying.

Recently I was listening to a panel of physicians talk about and complain their electronic health records. I asked them, "OK, I’ve heard all these negative things, but what do you like most about your EHR?" To a person, they said electronic prescribing.

For someone who has been in this business for nearly 20 years, that made me feel proud. But it didn’t happen overnight and we’re not finished yet. The areas where we still need to address are e-prescribing of controlled substances and e-prescribing of specialty medications. We still have some challenges around data quality, such as formulary files, as well as unintended consequences of e-prescribing or data issues where maybe inadvertently the wrong dosage was chosen or something like that.

Companies like Surescripts have built networks and seem to have ambitions that go beyond just pushing transactions around. How do those networks fit in the big picture of interoperability?

I also have a great deal of experience in health information exchange arena. I worked in the mid 1990s for the largest Community Health Information Network or CHIN vendor of that era. It was pre-Internet and only a small portion of the data was digitized. What we learned is that once a pipe is established, it can be used for more than just what it was originally intended for.

But sometimes it’s not so easy. For example, we have worked with companies focused on administrative and financial transactions who aspired to exchange clinical information. The challenge is that the user of the administrative and financial information is not necessarily the user of the clinical data. As always, we need to really think about workflow, especially in the physicians’ office.

The other advantage the national networks have over public HIEs is that it’s not just local competitors glaring at each other across a small room. Providers don’t seem to worry about connecting to a network that has a big competitor as just one of many national members. Will the balance shift towards proprietary networks?

About 10 years ago when RHIOs were first forming,  eHealth Initiative retained me to bring forward some lessons learned from the CHIN era to the RHIO – and subsequently HIE – era. I was uniquely positioned to seek out and speak with some of the founding fathers of the previous era and asked them if they thought it would work this time around.

There were mixed reactions. All pointed out the advantages we have today, including the Internet, digitized data, and federal and state governments that have passed supportive laws and regulations. About half were optimistic, but the others thought the biggest challenge that still remains is that of the competition you just mentioned.

It’s nearly universally agreed that healthcare is local. You get local competitors in the same room and to decide how to exchange information and they all say the right things. But when it comes to prioritization, investment, and those kinds of things, they’re not always stepping forward and supporting in the way that’s needed for a successful initiative.

To answer your question directly, yes, some of these larger, more national exchanges don’t have the competitive issues, but they have other issues. You really need to look at every situation differently and adjust to the different situations.

How do pharma and medical device companies see provider EHRs and the information they contain?

Pharma is waking up to EHRs. They’ve always been part of my consulting equation, having previously been employed by companies owned partially by Merck and Lilly. In the early days of my consulting — especially around electronic prescribing — they would say, "Come back to me when all of my doctors are prescribing electronically," A Surescripts report just came out that said that 56 percent of doctors are prescribing electronically, but I had a side conversation with a Surescripts executive who said that 80 percent of specialists who practice in the ambulatory environment are prescribing electronically. 

We may not have all, but we’re pretty much there. Pharma gets that electronic health records are the center of the healthcare universe at the moment and want to understand how it’s impacting them, both positively and negatively.

Several years ago, we had an engagement with a company that was concerned that patients with COPD were being misdiagnosed with asthma. With that diagnosis, the prescriber could choose from several medications that were optimal for asthma, not COPD. That situation was not only sub-optimal for the manufacturer, but for the patient as well. They wanted to understand how to get guidelines – a series of five simple questions – included in the EHR that would help diagnose patients as having COPD. Then, yes, the prescriber might write a prescription for their drug. But this company didn’t even have the largest market share in that category. They were satisfied with the patient being properly diagnosed. Wouldn’t that be good for us all?

Do you have any final thoughts?

I just got back from Health Datapalooza and there was a lot of talk there about the future. A lot of excitement and enthusiasm for being able to use data more effectively in healthcare. I believe we have a lot of challenges with healthcare data, but we’re making progress. Like health information exchange; like e-prescribing. We have to start somewhere and it’s not going to happen overnight.

Eventually I believe I will be at a conference with a panel of physicians talking about how they practice medicine. When I ask them what tool they like the best, I expect they’ll say their EHR. I know we have a ways to go to get there, but I believe we’re on the way. It won’t happen overnight, but it will happen. I’m extremely excited to be leading a firm that is helping to make that a reality.

Morning Headlines 6/10/15

American Well Corp v Teladoc, Inc

Telehealth vendor American Well sues rival Teladoc for patent infringement, alleging that Teladoc is using American Well’s patent-protected technology to match patients with doctors. The lawsuit comes just as Teladoc prepares for its IPO.

NHS details released against patients’ wishes, admits data body

In England, the Health and Social Care Information Centre reports that 700,000 patients have had their medical information shared against their wishes. The organization, which is responsible for processing patient requests to prevent data sharing, reports that it does not have the staff to keep up with the volume of requests it is receiving.

Charities struggle to share care data

In England, the CIO of Combat Stress, a charity dedicated to providing mental health services to  veterans, reports that a lack of interoperability with NHS health IT systems is hindering care delivery. He is calling for a standards-based approach to document sharing between the organizations.

Veterans Adding Life Story to Medical Records

The Madison, WI VA Medical Center is piloting an initiative aimed at capturing the life story, as told by the patient, for every patient’s medical record. The initiative is designed to permanently record the traumatic events behind many of the veteran’s injuries so that they do not need to retell the story every time they see a new doctor.

News 6/10/15

Top News

Video visit provider American Well sues competitor Teladoc for patent infringement, claiming that Teladoc continues to use American Well’s patented doctor-patient visit matching and queuing technology even after American Well turned down its request for a license.

Reader Comments

From Stickler: “Re: Epic. It is NOT an acronym. MEDITECH is an acronym. I have personally heard a CIO say he automatically deletes any vendor email that spells Epic as EPIC. Anyone who does it immediately loses any credibility they might have otherwise had – it shows they don’t know or don’t care and neither does a positive impression make.” Vendors let their marketing people run amok in peppering company names with bizarre extra capitalization, non-capitalization, conjoined words with capitalization in the middle, extraneous symbols, and other heinous and overly attention-seeking insults to the English language in trying to create a memorable company brand. The important distinction in Epic’s case is that they spell their own name correctly – it is clueless others who spell it EPIC. I agree with your CIO friend that I would hesitate to do business with a company claiming Epic expertise that doesn’t include knowing how to spell the company’s name. MEDITECH, by the way, is not an acronym, which is defined as an abbreviation made up of the first letters of several words that can be pronounced as a single word (IBM is not an acronym since it can’t be pronounced – it is instead an initialism, while NASA is an acronym). For that reason, Meditech’s name should not be capitalized even though the company does it – it’s an artificially, informally shortened version of the company’s real name, Medical Information Technology, Inc. The AP Stylebook for publications is clear that all-caps company names are not to be used unless the letters are individually pronounced, such as IBM or BMW, no matter how the company registered its legal name or trademarks.

From Richard Head: “Re: Leidos tweet. Is there a possible interpretation that could make this true?” I’ll challenge the Leidos and/or Cerner folks to provide details, especially since “healthcare facilities” seems like a pretty broad group given the large number of “healthcare facilities” in non-Cerner parts of the world such as China and Russia, for example.

From Bud Fox: “Re: DoD EHR bid. A private recruiting firm contracted by the DoD has been contacting my health system’s Epic analysts to recruit them for its EHR project, with starting salaries of over $100,000. Perhaps the DoD has already quietly selected Epic?” My sources say that no decision has been made and won’t be for at least another month. If there’s a frontrunner, DoD is keeping quiet about it even among the bidders.

From Dusty Wind: “Re: DoD EHR bid. Leidos will say or do anything to keep the business, which is supposedly contributes 20 percent of their revenue in maintaining CHCS.” Unverified, but Leidos wins under two scenarios – (a) DoD chooses Cerner, or (b) DoD decides to do nothing. Either way Leidos gets the lucrative operations and change orders business for many years. They will take significant revenue a hit if DoD chooses Epic or Allscripts.

From Point Taker: “Re: grammatical errors. And you worry about the small ones!” The Twitterverse loves this gaffe by a headline writer who confused “ambidextrous” with “amphibious,” with wags adding comments as “Faces Aquaman in next outing” and “He loves rain delays.”

Webinars

None scheduled soon. Contact Lorre for information about webinar services.

We had a great turnout for Tuesday’s Medicity-sponsored webinar titled “Successful HIEs DO Exist: Best Practices for Care Coordination.” Participation was so extensive that we ran out of Q&A time, but we’ve sent the remaining questions to speakers Brian Ahier of Medicity and Dan Paoletti of Ohio Health Information Partnership and will provide their answers by email.

Acquisitions, Funding, Business, and Stock

Cardiac biomarker lab company Health Diagnostic Laboratory files Chapter 11 bankruptcy two months after agreeing to pay $50 million to settle Department of Justice charges of giving kickbacks to doctors to order its tests.

Medsphere closes a $7.5 million venture-backed loan that the company will use for working capital.

Sales

Accountable Care Medical Group (FL) chooses HealthEC’s population health management solution.

People

Pratik Chakraborty (Wipro) joins home care data collection platform vendor CellTrak as VP of R&D.

Announcements and Implementations

Orion Health incorporates the image exchange system of eHealth Technologies into its HIE platform for the North Dakota Health Information Network.

EClinicalWorks will offer its users electronic prior authorization services from Surescripts.

Ochsner Health System (LA) launches Healthgrades-powered appointment scheduling that updates its Epic EHR.

Apple’s always-in-June developers’ conference announcements: (a) the Apple Music streaming service that will even eventually run on Android devices; (b) iOS 9; (c) OS X 10.11 El Capitan; (d) support for native Apple Watch apps; (e) a smarter Siri; and (f) public transit directions in Maps. 

Government and Politics

The Senate’s HELP committee will review AMIA’s just-published “EHR 2020” report in a Wednesday morning session available as a live video stream. Witnesses include incoming AMIA chair Tom Payne, MD, Carolinas HealthCare SVP/CIO Craig Richardville, Christine Bechtel, and Cerner CEO Neal Patterson.

The Madison, WI VA hospital encourages patients to spend an hour telling a trained volunteer their life story, which is written up, edited by the patient, and then added to their electronic chart. Army veteran Jennifer Sluga (above), who served in Kosovo, describes the “My Life, My Story” program, which is expanding to other VA hospitals but unfortunately not to hospitals in general:

“Even if you do get asked about your story, you get tired of telling it over and over. You hold back information. With this interview, I get it out and it’s in the record. I don’t have to talk about the hard stuff if I don’t want to. I don’t have to be strong and put on the soldier face. I know it’s there for the provider to read. There are a lot of younger providers who don’t have the life experience to know what it means. You might be sitting across from an 89-year-old veteran but you don’t know what experiences he has under his belt. If you have his story in the record, you might realize that he isn’t just an old man, but a hero. Anything you can do to make a veteran feel special is worth it. Interviewing them and writing their stories does that.”

Privacy and Security

In England, the NHS’s information center admits that the information of 700,000 patients may have been shared without their permission because technical and workload requirements left the department unable to record opt-out preferences.

Innovation and Research

The 28 members of the Greater Dayton Area Hospital Association (OH) launch Ascend Innovations, a business to commercialize healthcare technology from hospitals, the Air Force Research Laboratory, and other sources that combine “Dayton’s biggest industries – defense and healthcare.” 

Other

In England, the CIO of a veterans’ support organization says it could provide better service to its clients if it had access to their NHS healthcare records, but it can’t afford the integration and auditing costs involved. He also notes the barrier of outside groups like his being unable to update the NHS records.

Independence Blue Cross applies algorithms to its databases to assign health coaches to coordinate services for high-risk patients, reporting a 40-50 percent reduction in expected CHF admissions. A Harvard law professor questions whether patients should have the right to opt out, but the insurer says their information is used only in its role of improving their care and that should be perfectly fine.

A study finds that long-term care hospitals seem to time patient discharges for maximum Medicare payment rather than clinical needs.

Industry groups want pathologists to follow standard case review protocols before sending results to referring doctors, hoping to reduce the 10 to 25 percent of cases where experts don’t agree that a growth is either benign or malignant. A possible solution is digital pathology that allows pathologists to share scanned images and to apply biomarker algorithms, although FDA won’t approve it for primary or secondary diagnosis until it’s convinced that the quality of the digital image is as good as that of the original tissue slide.

A study finds that 50 US hospitals are charging uninsured patients more than 10 times the actual cost of their care vs. the 3.4 times national hospital average, with all but one of those 50 being for-profit hospitals. Researchers say it isn’t just uninsured patients who are getting gouged – it’s also those being treated out of network, using workers’ compensation, and being reimbursed by their auto insurance carrier, adding, “They are price-gouging because they can. They are marking up the prices because no one is telling them they can’t.” Community Health Systems owns 25 of the hospitals, while HCA has 14. The hospital owners predictably disagree with the findings, saying they offer discounts and charity care and need the money to keep their safety net hospitals open.

Weird News Andy says of this patient who performed “Yesterday” by the Beatles during his brain tumor removal surgery, “All his troubles seemed so far away.”

Sponsor Updates

• PeriGen will introduce its PeriCALM CheckList OB solution at the AWHONN conference June 13-17 in Long Beach, CA.
• A Forward Health Group video features the use of its PopulationManager by ARC Community Services to address substance abuse in women.
• Wellsoft will exhibit at the National Freestanding Emergency Center Conference June 17-18 in Dallas.
• Health Catalyst’s Dan Burton, Steve Barlow, and Tom Burton are named “EY Entrepreneur of the Year” in the technology category of the Utah region.
• Accreon client OntarioMD is recognized with the CHIA Innovation Award at the eHealth 15 conference.
• AirWatch shares its reaction to the Apple Worldwide Developers Conference announcements in a new blog.
• CareSync highlights National Cancer Survivors Day.
• ChartMaxx exhibits at NYHIMA through June 10 in Syracuse, NY.
• E-MDs customer Orlando Heart Specialists (FL) is chosen as one of five sites to pilot the American College of Cardiology SMARTCare ischemic heart disease treatment options program.
• CommVault advances to preferred solution partner with Cisco.
• Aventura is named as a 2015 Red Herring Top 100 North America Tech Startup.
• CoverMyMeds will exhibit at the Next Generation Payers Summit June 10-12 in Miami.
• Richard Helppie of Santa Rosa Holdings and Sandlot Solutions is interviewed for an article titled “The missing link in interopability: what patients want.”
• CTG posts a new podcast featuring patient advocates in its #TalkHITwithCTG series.
• Bottomline Technologies will exhibit at ACE June 17-19 in Austin, TX.
• Divurgent receives the Small Business Award from the US Chamber of Commerce.
• Burwood Group is named to the 2015 CRN Solution Provider 500 list.
• CitiusTech will exhibit at DIA 2015 June 14-18 in Washington, DC.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/9/15

Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

CMS publishes its final rule addressing changes to the Medicare Shared Savings Program. The final rule introduces a new program, called Track 3, based on the successful aspects of the Pioneer ACO Model. The rule also beings to address performance benchmarking concerns, and promises additional performance benchmarking regulations later this year.

Back to the Future

Outgoing AMA president Robert Wah, MD, rails against the Meaningful Use program and ICD-10 implementation at the AMA Annual Conference this weekend in Chicago, saying “the Meaningful Use requirements for electronic records are a heavy burden and a prison for innovation,” and “We believe ICD-10 will further disrupt physician practices when we’re already facing headaches like Meaningful Use.”

ICD-10 ‘Grace Period’ Bill Introduced in US House

Representative Gary Palmer (R-AL) introduces HR 2652, titled Protecting Patients and Physicians Against Coding Act of 2015, which if passed would establish a two-year grace period during which both ICD-9 and ICD-10 codes would be accepted. It is the third bill introduced in the last two months that attempts to delay the upcoming ICD-10 switchover.

Curbside Consult with Dr. Jayne 6/8/15

I was visiting some friends this weekend and we drove past a niche primary care clinic. It advertised “Healthcare for Guys!” which certainly caught my eye. Although the location I saw was next to Costco, a quick Web search revealed that they apparently also have a location next to a home improvement store. I’m always interested in new models of care and thought I’d find out a little bit more. Unfortunately, their website was pretty sparse without even a listing of their physicians or the fact that they now have multiple locations. Their Facebook page had multiple posts with grammar errors and typos. Not exactly a vote of confidence, but a great example of why physicians need to pay attention to their social media presence and webpages.

On the flight home, I noticed that the ever-present SkyMall catalog was missing — apparently it’s gone digital-only. After some procrastination (check out the automated pill dispenser above), I was forced to read journals instead. An article in the Annals of Family Medicine caught my eye: “Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians.” The study set out to assess “the feasibility and acceptability” of some of the care coordination objectives in the proposed Meaningful Use rule for Stage 3. Specifically, they looked at referrals, transfer of care, clinical summaries, and patient dashboards.

Researchers surveyed primary care practices that had been recognized as patient-centered medical homes (by the National Committee for Quality Assurance) in addition to participating in Meaningful Use. They also surveyed community health centers with patient-centered medical home recognition. The survey looked not only whether the sites had implemented the proposed objectives, but also at whether the practice thought those objectives were important. The results were similar to anecdotal comments I’ve heard in the field. While 78 percent of the physicians thought it was important to be notified of hospital discharges, only 48 percent were using IT systems. Conversely, while 77 percent of practices were providing clinical summaries to patients, only 48 percent of them considered providing summaries to be “very important.”

Similar to what we know about vaccine delivery (namely that non-physicians do a better job of following protocols and ensuring vaccination), the study found that care coordination was more often done using IT systems when a non-physician was responsible. The practice’s “capacity for systemic change” was also positively associated with using health IT for care coordination as was being in a non-urban area. The study concludes that “health IT capabilities are not currently aligned with clinicians’ priorities” and that “many practices will need financial and technical assistance for health IT to enhance care coordination.”

Those aren’t earth-shaking conclusions for anyone who has been in the trenches during the Meaningful Use era. While those practices that had already transformed care coordination prior to MU will continue to do so, those arriving later to the dance are struggling. It’s hard to identify dedicated resources to manage patient panels without negatively impacting the bottom line of practices already on thin margins. Although there is the promise of future money for demonstrable outcomes, you have to demonstrate quality to get the money. It’s a somewhat perverse chicken-egg-chicken loop.

I also wasn’t surprised by the fact that the survey only had a 35 percent response rate. Additionally, the study found that the most commonly implemented care coordination processes were not those with the most IT involvement. Respondents cited the top barriers as time, money, and IT systems. There were several other interesting data points from the practice demographic data: approximately one-third of clinicians were concerned about practice financial health; more than three-quarters of practices received help improving care coordination; and referral tracking was less than 100 percent. My former risk/compliance department would have a field day with the latter statistic since everyone was expected to track 100 percent of referrals 100 percent of the time.

Now that we’re getting a critical mass of providers involved using IT systems, we need more surveys such as this to determine where physician priorities really are and whether we can align systems to support those clinical priorities rather than trying to drive clinicians based on what systems will support. Interestingly, the next article I read discussed the idea that payment reform isn’t the only factor turning medicine on its ear. The NPR headline caught my eye: “A Top Medical School Revamps Requirements To Lure English Majors.”

Having been a non-science major myself, I support approaches like this aimed at bringing more diversity into the field. Some of the problems we’re trying to solve are extremely complex with a high number of psychosocial factors. It’s going to take more than biochemists and fruit fly-counting biology majors to help solve them. There were a decent number of non-traditional majors in my entering medical school class, but it certainly wasn’t the norm.

What was your undergraduate major? Would you do it again or is it just good for cocktail party discussions? Email me.

Email Dr. Jayne.

HIStalk Interviews David Lee, CEO, Huntington Medical Foundation

David Lee is CEO of Huntington Medical Foundation of Pasadena, CA.

Tell me about yourself and the medical group.

I’ve been in the medical group practice for over 20-plus years. To a community clinic, from an FQHC, to a private practice, to a mid-sized medical group like we are here,  I have a vast experience in healthcare over a long period of time. Most of it’s been from an operational standpoint, so it gives me some good background of knowing the different lines of healthcare business. Not just in the commercial world, but also in the community side of it.

We’re a multi-specialty group, about 75 physicians, eight locations, and with a handful of subspecialties in the group. We are spread out primarily in Pasadena, but east is Arcadia and also north is La Canada.

What are your primary systems?

Our EHR system is the Allscripts Enterprise system.

What do you think about the Meaningful Use program?

The ambition is the right ambition. There’s no perfect EHR system. A lot of times, it’s how it gets mapped and capturing the right information. There are times of trying to capture the information in a meaningful way is not always the most meaningful way to capture the information, to be quite frank with you. It’s just trying to navigate into some of the complexities of an EHR system. 

I don’t think there’s a perfect system out there that does it all. Having a strong IT team and a clinical team to be able to make sure that the execution takes place is a critical piece for us and what we do. That’s how we’ve been successful in Meaningful Use.

What is your real-world experience in exchanging information with other providers?

My end goal is to get to the predictive analytics side of it and create an ecosystem that has self-reporting data to be able to aggregate the data. As you’re well aware, today it’s all disparate. 

On our end, what we’re doing is not relying on our EHR system to pull out data. We have someone who’s dedicated on the analytics side who will dive in deeper into the data. But we’re also being innovative and thinking outside of healthcare. 

We’re engaged today in working outside of the healthcare industry to have some of these solutions to creating, for example, a master patient index, so that the disparate systems are being connected and to be able to exchange information. Not so much in an HIE, but similar to an HIE. As simply as getting an order to a specialist that’s outside of our organization. It’s always been a challenge, but I’m very optimistic – we are very close on our end to making this connection happen in the near term.

Are physicians are pushing back against the idea that everything that they do should be summarized by clicking a box or choosing a dropdown and in doing so losing the ability to quickly determine afterward what’s wrong with the patient or what they need to do?

Absolutely. Part of the challenge is completing a form online. A lot of those forms are converted in a PDF and it’s not discrete. Once it comes into our system, it’s still fragmented. Part of what we’re trying to do is getting this form that’s filled in discretely completed and moving that discrete information into that patient’s profile in the EHR system. 

There’s been a lot of work on our end of creating that type of system so that it becomes seamless and it tells the right story at the right time for our physicians. If it’s a scanned document, it gets filed away and then scanned. The frequency of those being viewed is probably not as good if it was on a dashboard created on the screen as a summary of what’s currently in our system. That would be much more effective than as a scanned document.

How are you doing with exchanging information with hospitals?

We’re fortunate that with our partnership through Huntington Hospital, Huntington Hospital has an HIE. We’re able to get the information from an inpatient standpoint. Obviously it’s not perfect and I think there’s some challenges with that, but half of the battle is that there’s an HIE already established to be able to get ED visits, inpatient information, lab information, anything that resides in their system that involves one of our patients. We can get that information today and we are fortunate in that sense.

Have you started the move toward value-based care in a way that has increased the need for that same kind of connectivity to outside organizations?

Absolutely. The culture has definitely changed for our organization in moving to a value-based. A lot of things, even from the physician standpoint, are changing some of our compensation model for our physicians to incentivize in the right away, a lot of it based on the value. But not just the segmentation of that. Our entire population is all based on this value-based, taking the baby steps incrementally to get that in place.

But the importance of it is the data. We also have an ACO that is very critical in how we hand off care, especially with the high risk and trying to look at readmission rate. We leverage resources from the hospital, but also with that leverage of not just resources, but the data. Trying to get that aggregated is an important piece that we’re working through, too.

In terms of population health management, who drives the initiative and what information is collected and aggregated to allow you to manage a population outside your own encounters?

Today we are taking just a segment of the population. It’s a Medicare population with the ACO. That is a start. That also includes independent physicians in the community that are into some ACO. Obviously there’s different challenges in that sense, but we have just embarked with a segment of that population. 

On our end, from an ambulatory standpoint, we look at it as the entire population. But when we’re looking at it from an enterprise and a value-based with the hospital, we’re just taking the Medicare population and specifically the ACO population.

Are you learning anything in those steps of  trying to understand more about the patient outside their visits and trying engage with them even when they don’t initiate the conversation?

Overall, patients are very receptive. We collected data and looked at our readmissions. We took a segment in that ACO population and took some of the high-risk patients to reduce readmission rate. When we first started, our readmission rate was 16 percent. By leveraging, for example, resources from the nurse navigators that then come into one of our three primary care offices, internal medicine offices, to be able to go into our EHR system to look at the data. We reduced it to eight percent readmission rate, a substantial amount of percent reduction. Leveraging some of the resources, and those are resources being able to tap into our information to be able to then manage the patients. Obviously the outcomes have been successful in what we’re trying to do.

What is that patient’s recourse if they have a problem at nine at night other than to go to the ED?

We have an urgent care. That’s something positive on our end. It closes at 10, and when you’re in one system, the navigation internally makes it more seamless. We’re able to leverage that instead of them going to the ED. 

The nurse navigators, for example, are always connected. If they’re in the skilled nursing facility, they are always informing the primary care physician about keeping them in the loop if there’s any activity that needs to be contacted. Again, it’s not perfect. We just started this program about eight months ago. But it’s been a good work in progress of looking at where those gaps are, and the ones we identify, we’re able to put some solutions together.

For-profit retail clinics can be either competitors or partners, and in some cases, they are offering community outreach services and off-hours coverage. Do you have any relationships with them?

We currently don’t have any partnerships with these retail businesses, but I am looking into creating this. A lot of our patients want care right now. Creating access is always a challenge in healthcare. 

What I’m looking to do is create a platform that not only engages the patient when they need it from a telemedicine standpoint, but the whole patient experience along with the whole continuum. Create a platform from a technology standpoint so that I’m not relying on a retail business … not knowing if they got services in that sense, but when the services are performed that we have that information.

As I mentioned early on, the end goal of what I’m trying to achieve is getting to the predictive analytics side of it. Why am I interested? Because for us, we need to transform and focus on the prevention and the wellness side of it. For so long, healthcare has not put any emphasis on that. We’re really driven on this outcome-based. We need to focus a lot of our efforts on the prevention side. From the prevention side, we’ve got to dive in deep to look at the analytics to be predictive before they get sick and we’re managing patients at that point, before they enter into the hospital. There’s no follow-up from an ambulatory standpoint. We just need to have much more effective systems in place to be able to do that.

Retail clinics have a lot of locations, extended hours, and short wait times. Are you feeling market pressure to change your practice for patient convenience?

No, I haven’t felt it yet. In our area, it’s probably slower on that retail business side of it. But as it grows, we just then need to figure out from an access standpoint how to get that information back. As the world moves into this value-based and more outcome-driven, it’s more about getting that information, that data, back into our system. If we’re not informed or in the loop of that even though the care was taking place, those outcomes won’t go anywhere. They’re getting the care somewhere else.

What are you doing or considering to let patients be more involved in the information that you have or to collect information from them?

Patients have access to a portal that gives information. What I hope in the near future is that we get much more push notification in creating that experience, as simply informing patients as they walk into our office to be able to say, “Welcome to your 10:00 appointment” or if our physician is behind. They’re using their own personal device of getting information that we’re helping to provide them so they’re much more informed and much more engaged about their own health. Those are some of the pieces that from a technology standpoint of what we’re looking to do. 

I personally feel that we haven’t leveraged technology and healthcare in general the way we should have. As a lot of good solutions in the healthcare space have been entered,  we need to take advantage of some of these opportunities to create a better experience for our patients and better care. It doesn’t have to be a traditional way of coming to the office to be treated –it can be done with us sending someone into the home or using telemedicine, especially from a technology standpoint. We need to start exploring and creating some of that delivery model in a different way.

What are the technologies you need that someone could build?

The interoperability, the connection, the integration to outside systems that are outside of our organization. That’s one of our biggest challenges. When you have the disparate systems out there, it’s hard to get that connection. That would be our number one problem and issue.

That’s where duplications often are created. Primary care sends a referral to a specialist outside of our network or our organization. If the subspecialty is referring to another subspecialty, or a subspecialty wants to see that patient again for a follow-up, primary care is unaware of that 90 percent of the time. That’s the part of the system — how do we get that connection, so at least everyone who’s part of this patient’s care is in the loop of the care that’s being taken care of? That’s a big challenge for healthcare, to  connect all these fragmented systems into a much more seamless and aggregated way.

What will be the group’s greatest opportunities and the greatest threats in the next five years?

Healthcare in general is rapidly changing, but I think one of our greatest opportunities will be the technology side. Healthcare in general has not done a good job in collecting that data or even using technology in a meaningful way. But the obstacle and challenge that healthcare faces is culture. A long-time fee-for-service world and mentality changing into a value-based and a focus on prevention and wellness — that’s a culture shift. When you’re doing that, it doesn’t happen overnight. I see that as the biggest challenge for the healthcare in general and the industry — changing culture. It will be a big undertaking.

Morning Headlines 6/8/15

CSC to pay $190 million to settle SEC charges

CSC will pay a $190 million to settle fraud allegations after the SEC charged the company with manipulating financial results and hiding problems with its largest contract, the UK’s now defunct NPfIT program, from investors. CSC signed a $4.5 billion contract with the NHS to deploy its Lorenzo EHR across 166 hospitals, but a poor implementation track record led to the program being shut down.

Evolent Health Stock Closed at $18.86 in IPO Debut

Evolent Health finishes its first day of trading on the NYSE at $18.86, up 11 percent from the start of the day.

Hawaii Pulls The Plug On Embattled Health Insurance Exchange

Hawaii will shut down its $130 million, state-run health insurance exchange and migrate to Healthcare.gov after a series of technical failures kept it from meeting key ACA requirements. With one of the lowest uninsured rates in the country, administrators acknowledged that the sites 40,000 users would no generate enough revenue to continue operations after federal subsidies ran out.

Data hacked from U.S. government dates back to 1985: U.S. official

Chinese hackers breach the severs of the US Office of Personnel Management, stealing security clearance and background check data going back to 1985 and affecting nearly four million current and former government employees.  

Monday Morning Update 6/8/15

Top News

CSC will pay $190 million to settle SEC charges of accounting fraud related to its money-losing NPfIT contracts with the UK’s National Health Service. Five of eight former CSC executives have settled SEC charges of manipulating financial results, with former CEO Michael Laphen agreeing to return more than $4 million in compensation under the clawback provision of the Sarbanes-Oxley Act. The SEC’s investigation found that CSC lied about earnings after falling short of revenue due to missed NPfIT deadlines and also took out high-interest loans from NHS to hide cash flow problems from investors. A Bloomberg report says HP was close to acquiring CSC last month for $9.3 billion but backed out, with CSC’s new plan being to split itself into two publicly traded companies.

Reader Comments

From ICDelightful: “Re: ICD-10. Why didn’t CMS just do ICD-9 to ICD-10 mapping itself to provide a single standard? Even if 20 percent of the codes don’t directly it seems like CMS is in the best position to determine which are the closest match.” I’ll leave it to more HIM-savvy readers to respond, with my guess being that ICD-10 codes have a mandatory additional level of specificity that can’t be automatically and accurately derived from a given ICD-9 code.

From The PACS Designer: “Re: coining a new term. With the advent of cloud-based solutions, it’s becoming apparent that data stored in the cloud and other database solutions need a better term than big data. With transparency being key to move data more efficiently, it would be better to use the term ‘dataware’ to describe the transparent data sources.”

From Mountain High: “Re: Boulder Community Hospital. Goes down again, this time for only about a day (eight days of downtime in 2013).” It sounds to me like they were experiencing some kind of denial-of-service or malware attack given that the forwarded internal email suggests that its network was overloaded and the IT security director was assigned to investigate.

HIStalk Announcements and Requests

Poll respondents are equally split as to whether lack of patient data-sharing should be blamed on health systems or their EHR vendors. Will says the correct answer is none of the above – the fee-for-service system treats interoperability as an unreimbursed cost and data will be shared when there’s a business reason to do so, while Frank blames lack of customer (patient) demand and Mobile Man says the biggest payor (Uncle Sam) could change interoperability overnight by changing reimbursement. New poll to your right or here: how will overall health IT vendor revenue change over the next five years?

My latest grammar peeve: capitalizing relationship names when the word isn’t used as a title, as in, “I visited my Dad” (wrong) vs. “I visited Dad” (right). Sometimes people mysteriously do the same in referring to an occupation, such as “I am a Teacher.” Not new but increasing in frequency is the practice of combining words not used as adjectives, such as, “I brush my teeth everyday” (wrong) vs. “My everyday practice is brushing my teeth” (right). I acknowledge that rampantly incorrect word usage will eventually find its way into dictionaries that see their role as observational rather than authoritative, which would make one fine mess in nearly every other discipline where things are either right or they aren’t despite what the questionably knowledgeable masses believe.

Mrs. H says the two Chromebooks we bought for her Oregon elementary students via the DonorsChoose project (with matching funds from the Bill & Melinda Gates Foundation) have boosted morale and improved reading scores. I have $10,000 in matching money available (courtesy of an anonymous vendor executive’s personal pledge) for companies donating $1,000 or more, who also get a mention right here on HIStalk for their involvement.

Last Week’s Most Interesting News

• Quality Systems President and CEO Steven Plochoki resigns.
• BIDMC CIO John Halamka, MD urges CMS to shut down the Meaningful Use program and instead hold providers accountable for patient outcomes and letting the market determine which technologies they need.
• A M&A publication states that health IT firms Netsmart, Precyse Solutions, Mediware, Edifecs, Caradigm, and Altegra Health are being shopped for sale.
• A cybersecurity firm warns that unsecured medical devices provide hackers with a nearly undetectable back door into health system networks.
• Partners HealthCare (MA) goes live on Epic at a total project cost of $1.2 billion, double its original budget.
• An insurance company demands that Cottage Healthcare System (CA) repay its $4.1 million breach settlement, saying the hospital lied on its insurance application by claiming it was performing IT security maintenance steps when it really wasn’t.
• A Texas judge issues an injunction requested by telemedicine vendor Teladoc against the Texas Medical Board for its requirement that physicians conduct an initial face-to-face patient visit before prescribing drugs.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Acquisitions, Funding, Business, and Stock

Shares of Evolent Health closed Friday up 11 percent to $18.86, valuing the newly NYSE-listed company at $950 million. UPMC’s stake is worth $278 million, while CEO Frank Williams holds $22 million in shares. 

Sales

Glytec announces that 13 health systems have chosen its eGlycemic Management System for managing glucose levels using evidence-based insulin dosing recommendations. Among the new clients are Kaweah Delta Health Care District (CA), Edward-Elmhurst Healthcare (IL), Mary Hitchcock Memorial Hospital (NH), and Mission Health System (NC).

Government and Politics

Hawaii will shut down its $130 million health insurance exchange and move to Healthcare.gov. Hawaii’s high percentage of insured citizens, driven by a mandatory state employer insurance law, gave it too few users and too little revenue to sustain itself once it spent all of its federal grant money.

Privacy and Security

China-based hackers breach the US federal government’s personnel system and steal the information of up to 4 million current and former federal employees in a just-announced December 2014 incident. Investigators say the cybercriminals, who may be working for the Chinese government, are likely the same ones who recently breached health insurers Anthem and Premera Blue Cross. The message is clear – in-depth information about people is more desirable to hackers (or “actors,” as the security people inexplicably say) than credit card files, and the fact that the Anthem and Premera data hasn’t hit the black market would suggest that a bigger and more organized plan is in place that goes beyond simply making a quick buck. Credit cards can be cancelled after a breach, but in-depth personal information can’t.

Other

St. Louis Children’s Hospital (MO) says CNN misled readers by including it in an article titled “Is your pediatric heart hospital keeping secrets? We have answers.” The hospital says the CardioAccess software it uses doesn’t collect all of the information, leaving the hospital unable to report it.

Reno, MV pediatrician Ron Aryel, MD says syndicated columnist and non-practicing physician Charles Krauthammer is wrong in blaming physician dissatisfaction on EHRs. “My electronic medical record is my most powerful tool in the office. It helps to organize my thinking, prevents mistakes, and helps me spot important trends within my practice. My time ‘entering data’ rewards both me and my patients with better outcomes and more effective medicine. But doctors should focus on what they do best. I am good at getting patients healthy, and Krauthammer is good at being paid to write opinion pieces. I think he should keep doing that.” Krauthammer might not even be all that good at writing opinion pieces – he doesn’t offer one shred of proof to back up his assertion that an “EHR mandate” is causing physicians to quit. Nobody “mandates” that physicians accept insurance, deal with Medicare, sell their practices to health systems, or use EHRs – they voluntarily did all of those things for the money and now have seller’s remorse, leaving them with three basic choices: (a) deal with it while complaining to anyone who will listen; (b) start over in a cash-only concierge practice; or (c) quit and do something else. The problem with (c) is that doctors nearly always find the market value of their non-medical capabilities to be much less than they themselves believe, with the threatened loss of income and status steering them back to (a) in most cases. Actually I don’t have any more data than Krauthammer cites, but I suspect there’s a (d) choice in which doctors take purely transactional 9 to 5 physician jobs, such as working for insurance companies, telemedicine providers, consulting companies, and contracted physician staffing firms, accepting the notion that doctors rarely hang out their own shingles these days and that means becoming a begrudgingly obedient time-selling corporate widget like most everybody else who doesn’t drape a stethoscope around their neck as a status symbol.

Here’s yet another questionably useful gadget for quantified selfers to embrace: The Lovely, a wearable sex tracker / sex toy (already tagged as the “Fitbit for your penis”) whose app tracks intensity and calories burned and provides suggestions for improvement and experimentation. I’m fearful of a future in which lust-crazed users flood Facebook with their Lovely-generated updates and boastful historical dashboards.

Weird News Andy says this spine transplant wasn’t about politicians, but rather a 35-year-old woman who faked romance with an 86-year-old man and then scammed him into giving her $1.2 million to pay for her “spinal transplant.” WNA’s rim shot conclusion is that “her story really struck a chord with the victim.”

Sponsor Updates

• Zynx Health offers “Restricting Low-Volume Hobbyists: Translating the Volume-Outcome Relationship Into Health Policy.”
• Streamline Health will exhibit at the 2015 CHIA Convention & Exhibit June 8-10 in Palm Springs, CA.
• Sunquest releases the agenda for its 2015 Executive Summit July 13 in Scottsdale, AZ.
• Xerox Healthcare offers “Healthcare C-Suite Sets Sights on Population Health Management.”
• SIS COO Doug Rempfer pens an article for HFMA’s magazine entitled, “Using Perioperative Analytics to Reduce Costs and Optimize Performance in the OR.”
• T-System offers “Leading with Passion: Checking in on Your People.”
• TeleTracking will exhibit at the Digital Health and Care Congress 2015 June 16-17 in London.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/5/15

Quality Systems, Inc. Announces Retirement of President and Chief Executive Officer Steven T. Plochocki; Names Rusty Frantz Successor

Quality Systems announces that President and CEO Steven T. Plochocki will retire from the Company, effective June 30, 2015. He will be replaced by Rusty Frantz, former Carefusion SVP/GM.

So What is Interoperability Anyway?

John Halamka, MD and CIO at Beth Israel Deaconess Medical Center, calls for the end of the Meaningful Use program, proposing instead that Congress hold providers accountable for outcomes and let the free market dictate which technologies will work best to pursue those goals.

How hospitals hope to boost ratings on Yelp, HealthGrades, ZocDoc and Vitals

The Washington Post covers the impact patient satisfaction scores are having on clinical economics and the various efforts being undertaken by hospitals and practices to monitor and improve their online reputations.

Former Facebook CFO Ebersman Launches New Health Tech Startup Lyra Health

Former Facebook CFO David Ebersman launches a new business, backed by a seed investment from Venrock, focused on improving population health efforts in the behavioral health space.

EPtalk by Dr. Jayne 6/4/15

Pharmaceutical companies are major users of direct-to-consumer advertising. Although we see a lot of EHR vendors advertising in medical journals and at conferences, I haven’t seen a lot of direct mailings to non-administrative physicians. This week at my clinical office, I received a direct-to-physician mailing from Imprivata regarding electronic prescribing of controlled substances (EPCS). It was actually a nice piece – educational with respect to Meaningful Use requirements and the current status of EPCS.

Rather than relying on MU-related scare tactics, it appealed to the concepts of streamlining physician workflow and reducing prescription fraud and abuse. Enclosures explained the DEA ruling in detail and laid out strategies for planning a successful implementation. They did, of course, market their solution, but it was tastefully done. I also appreciated the fact that the entire packet was devoid of flashy marketing distractions. Maybe I’m getting more boring with age, but it’s nice to see something straightforward.

Health Datapalooza took place this week in Washington, DC. The agenda listed sessions on personalized medicine, patient-reported outcomes as quality indicators, data privacy and security, and advancing technology. I’d be interested in hearing from readers who attended. What were the best sessions? Anything earth-shaking?

The May-June issue of the Journal of the American Board of Family Medicine surprised me with a special issue including multiple healthcare IT articles. One reviewed existing studies on physician use of scribes, concluding that scribes may improve clinician satisfaction and productivity. The researchers were only able to find five studies done between 2000 and 2014, so the validity of the results is limited. Another discussed the notion that “primary care researchers are uniquely positioned to inform the evidence-based design and use of technology.” It suggests leveraging existing research programs and methodologies from human factors engineering, which sounds like a great idea. A third examined how physicians use previous visit notes to prepare for an upcoming visit, suggesting that the note output of EHRs needs an overhaul to reduce cognitive load.

A friend shared Atul Gawande’s recent piece titled “Overkill,” which discusses continued recommendations for unnecessary tests and treatments. These not only drive up the cost of healthcare, but can lead to additional testing, which often leads to a spiral of waste. It also leads to overdiagnosis, which creates stress for patients and can also lead to additional unnecessary treatment. Theoretically our EHR systems should help us avoid these pitfalls through the use of clinical decision support and better availability of patient data at the point of care. However, until we spend time educating the populace that there are risks to “doing too much,” we won’t be able to take action on the information before us.

Gawande cites specific examples, stating, “We’ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven’t reduced the death rate at all.” It’s not just the United States facing this issue – South Korea is seeing similar problems. I often hear patients talking about the nation having the most advanced technology in the world and the best procedures, so it’s challenging to help them understand that often less is indeed more.

We’re putting steps in place to encourage physicians to proceed thoughtfully and avoid unnecessary expenditures, but I haven’t seen the level of national programming needed to bring patients around to this new way of thinking. Choosing Wisely presents evidence-based lists of tests and procedures to reconsider, but I don’t see them being used on the front lines of care. Patients often don’t want to rely on a physician’s education and clinical judgment; they want hard proof and this leads to testing. The relentless pursuit of higher patient satisfaction scores doesn’t make it easy to say no to patients, either.

It will be interesting to see how the healthcare landscape shifts over the next five to 10 years. Billions of dollars in Meaningful Use funds haven’t shifted the needle as much as we’d hoped, so it might be time to try new strategies.

How can we make the most of the next decade? Email me.

Email Dr. Jayne.

News 6/5/15

Top News

 

Quality Systems (NextGen) announces the retirement of President and CEO Steven Plochoki. He will be replaced by Carefusion SVP/GM Rusty Frantz. QSII share price dropped 14.5 percent in Plochoki’s seven-year tenure vs. the Nasdaq’s 111 percent gain. 

Reader Comments

From LearnHealthTech: “Re: Florida Governor Rick Scott. Thanks for the new article on the stunningly corrupt and hypocritical governor. After defrauding taxpayers as a hospital CEO, he wants to go after non-profit hospitals for turning a profit.” Both for-profit and non-profit hospitals have plenty to be ashamed about, but Columbia/HCA’s felony fraud guilty pleas and $2 billion in settlement costs top the list. I suppose I shouldn’t be so critical because: (a) our healthcare system rewards aggressive business tactics, as evidenced by the stock market success of for-profit hospital operators and big healthcare-focused companies like McKesson and any number of insurers; (b) CMS’s “pay and chase” payment methods encourage health systems and companies to interpret its rules favorably in asking forgiveness rather than permission, no different than companies dealing with the IRS; and (c) Scott is right about the non-profit hospitals that still manage to have hundreds of millions of dollars in “excess revenue” that never seems to result in their overpaid CEOs offering to return the money, which usually means they just spend it on outcomes-indifferent activities such as buying up physician practices or erecting fancier buildings.

From Marshall: “Re: Connecticut hospital CEO salaries. Boosted handsomely.” Ten non-profit hospital executives made between $1 million to $3.52 million, with one CEO’s compensation increased 133 percent from $1 million to $2.3 million in just one year, while a second CEO saw his pay bumped by 85 percent to $3.1 million in the same year. The health systems didn’t provide a response to the newspaper’s inquiries, but it’s always the same anyway: (a) we have to pay that to keep him and we’re lucky he hasn’t left for greener pastures; (b) it’s not our fault that the market commands such high salaries and it’s a really hard job; or (c) we’re not really paying that much – it just looks that way because of one-time benefits such as payout of accrued retirement or severance benefits.

HIStalk Announcements and Requests

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

This week on HIStalk Connect: Dallas-based telehealth provider Teladoc enjoys its first victory in its antitrust lawsuit against the Texas Medical Board. The National Cancer Institute announces the start of a multi-arm cancer research project that will attempt to match cancer drugs with cancer-related genetic mutations. Google’s artificial intelligence research team is working on an app that will calculate the total calories in a plate of food by analyzing a picture of it. Rockwood City, CA-based digital health startup BaseHealth launches a genome API that will enable developers to integrate personalized care plans and risk reports into wellness applications.

This week on HIStalk Practice: Persivia CEO Mansoor Khan gives Jenn the scoop on starting up a new population health management company. Northwestern Counseling & Support Services connects to the Vermont HIE. Dr. Gregg describes the “bastardization” of HIT. CVS Health partners with HHS. Hughston Clinic rolls out TrainerRx software. TMA PracticeEdge COO Dave Spalding lays out the vision for ACOs in Texas. CMS opens up data for further research and development, and gives physicians an easy way to rat out information blockers. Solutions Recovery Center goes with ZenCharts. Gastro Health launches virtual support community.

I was thinking about the plethora (and increasing number) of proprietary body sensors tied to specific apps or services. That sensor-app connection is mandatory at the moment, particularly with FDA-approved systems, but at some point the sensor overlap and need for economy of scale would seem to make it desirable for a single universal sensor that all health and fitness apps can talk to. It seems inefficient for every app vendor to develop and maintain yet another heart rate or calories-burned gadget, especially when consumers need or want information that requires more than one of them.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Acquisitions, Funding, Business, and Stock

Genstar, owner of behavioral EHR vendor Netsmart, has reportedly retained an investment bank to either take the company public or sell it, with a potential price of $750 million. Also on the block, according to insiders, are health IT firms Precyse Solutions, Mediware, Edifecs, Caradigm, and Altegra Health.

Telemedicine provider Carena receives $13.3 million in funding from Cambia Health Solutions and McKesson Ventures to continue development of its virtual clinic solutions, which it says can be brought live 90 days after signing as a branded virtual clinic.

GE is rumored to be shopping its GE Capital Healthcare Financial Services unit for up to $11 billion as it dismantles GE Capital.

Shares of value-based care consulting firm Evolent Health begin trading on the New York Stock Exchange Friday at $17, which values the company — formed in 2011 by UPMC Health Plan and The Advisory Board Company — at $800 million.

Sales

East Jefferson General Hospital (LA) signs up for MedCPU’s clinical decision support system. I interviewed EJGH CMIO Beau Raymond, MD a couple of weeks ago.

Penn State Hershey Medical Center chooses PeraHealth’s clinical surveillance system.

People

Patient engagement solutions vendor TeleHealth Services names Gary Kolbeck (GK Consulting Services) as VP of business development.

Ted Reynolds (CTG Health Solutions) joins Impact Advisors as VP.

Announcements and Implementations

Provide Medical Park (WA) goes live on the Advantages RTLS patient flow system from Versus Technology, which allows patients to skip the waiting room and proceed directly to an available exam room.

CitiusTech launches CQ-IQ, a cloud-hosted quality analytics platform for CQM reporting that includes 250 pre-built quality measures across several care settings. I interviewed CEO Rizwan Koita in January.  

Former Facebook CFO David Ebersman launches Lyra Health, which offers behavioral health screening tools and care coordination. His co-founder and chief medical officer is Dena Bravata, MD, who left Castlight Health in December 2014 after five years as chief medical officer and head of products.

Two public relations firms, one of which focuses on sensitive federal government issues, form ATDigitalHealth, which will promote interoperability and telehealth services to lawmakers.

Government and Politics

The opening of the Topeka, KS VA hospital’s ED – closed for almost a year and a half due to staffing shortages — is delayed for at least six more weeks as the VA’s central office requires it to upgrade its EDIS.

Privacy and Security

A report by cyberdefense vendor TrapX finds that most healthcare organizations are vulnerable to Medjack (medical device hijack), where hackers locate unpatched, Internet-connected medical devices and use them as a back door to penetrate the health system’s network. The attacks, which are made easier by FDA restrictions on keeping devices it has approved updated, are hard to detect since security teams can’t view a device console and can’t just disconnect them for maintenance.

Plans by the Federal Employees Health Benefits Program to launch a claims database of federal employees for third-party cost analysis are criticized by privacy advocates, unions, and consumer groups who question the potential privacy exposure.

Technology

A Harvard-developed blood test that costs as little as $25 can detect nearly every virus to which a person has been exposed, potentially allowing epidemiologists to track diseases and to determine optimal vaccination ages.

Other

East Texas Medical Center sues Blue Cross, Aetna, and Cigna for excluding the hospital from their PPO networks in what it says is a violation of Texas insurance code.

I’m not surprised by Will Weider’s tweet. What we think patients want, as often is the case, isn’t what they really want. It’s smug paternalism to presume either way without actually asking them or letting their actions speak for themselves.

Clint Eastwood will direct a movie version of  US Air pilot Sully Sullenberger’s biography, most likely dramatizing the “Miracle on the Hudson” story of his saving his own life (and in doing so, the lives of his passengers) rather than his later, less-dramatic safety efforts.

A Washington Post article says hospitals struggle to meet unrealistic consumer expectations as they try to manage their social media reputations, with patients rating doctors and nurses on bedside manner and convenience while providers are focused instead on delivering clinical outcomes. It mentions HealthLoop’s tailored follow-up messages and responses that help doctors know when to intervene after an encounter, citing an unnamed hospital whose satisfaction scores jumped 11 percent after implementing HealthLoop.

BIDMC CIO John Halamka, MD says the Meaningful Use program should be shut down and replaced with outcomes-based CMS incentives, with ONC refocusing its work to create a national provider messaging directory, encourage the use of a voluntary national patient identifier, work to streamline state-specific privacy laws, coordinate federal health IT priorities, and support private sector initiatives. He says interoperability demands have changed in a value-based care world and that the private sector is best equipped to meet market needs, urging that the industry “help providers do their job and improve satisfaction to the point that Congress no longer wants to legislate the solution to the problem.”

Several high-profile health IT bloggers who are patients of One Medical Group call out the supposedly tech-savvy concierge medicine company on Twitter for not providing online bill payments and for being unable to give patients digital copies of their records.  

British Medical Journal reorganizes its software development teams as it moves from publisher to a vendor of point-of-care clinical guidance.

An anesthesiologist says it’s not just OR personnel who are distracted by screwing around with their phones instead of doing their jobs. He provides a first-hand example of a teen struck by a car and awaiting surgery who was taking selfies from his hospital bed while one parent was texting and the other was posting to Facebook, all of them scolding the anesthesiologist for interrupting them as he tried to take a pre-op history. He urges health professionals to educate the public about addiction to texting and social media.

Sponsor Updates

• Patientco CFO Kurt Lovell is recognized by the Atlanta Business Chronicle as a CFO of the Year finalist.
• Anthelio’s Engage mobile patient engagement app earns ONC’s 2014 Edition Modular Certification.
• Impact Advisors is named to Crain’s Chicago “Fast 50 List” as the #21 fastest-growing Chicago company.
• Healthloop is featured in an Economist article titled “Small data from patients at home will mean big cost savings.”
• Nordic profiles practice director and cheese carver Joey Vosters, who says he’ll carve the company’s logo for the next work party if Nordic will get him a 45-pound block of cheese.
• Patientkeeper offers “About Nurses, Patience, and EHRs.”
• Iatric Systems announces successful integration of Welch Allyn and Nihon Kohden medical devices with the EHR of Halifax Regional Medical Center (NC) using its Accelero Connect solution.
• MedData will exhibit at the Coastal Emergency Medicine Conference June 5-6 in Kiawah Island, SC.
• Navicure offers “Setting Goals to Improve Patient Collections and Total RCM.”
• Nordic hosts a meetup for Houston-area consultants and candidates on June 5.
• Oneview Healthcare Head of Solutions Niall O’Neill talks to NewJobRadio.
• Orion Health offers “Why you should be an engaged patient.”
• Passport Health will hold a Northeast User Group Meeting June 11-12.
• PatientSafe Solutions offers “Patient Centered Care: Is It Really That New?”
• PDS publishes “Technology and the Group Purchasing Organization Business Model.”
• Phynd Technologies offers “My Time at the More Disruption Please Hill Day.”
• New York eHealth Collaborative will exhibit at NYHIMA’s 2015 Annual Conference June 7-10 in Syracuse, NY.
• PMD posts “Purpose Build: EHR Mobile Apps vs. PMD Charge Capture.”
• Qpid Health offers “’Human-Digestible’ Documentation Tops AMIA EHR 2020 Task Force Recommendations.”
• Extension Healthcare offers “Bridging the Gap Between Clinical Users and Health Tech Managers.”
• Galen Healthcare Solutions recaps its experience at the 2015 MUSE conference.
• Beth Israel Deaconess Medical Center CIO John Halamka, MD contributes to the debut of Hayes Management Consulting’s new Healthcare Leaders series.
• HDS posts “The High Price of Health IT Security Breaches: $6B.”
• The Atlanta Journal-Constitution profiles entrepreneur Greg Foster’s battle with brain cancer while starting Brightwhistle, which was recently acquired by Influence Health.
• InstaMed publishes a new white paper entitled, “New Expectations: The Payment Experience Members Want from US Health Plans.”
• Intellect Resources offers “Healthcare IT Jobs: Carpe Diem.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/4/15

ICD-10 Medicare FFS End-to-End Testing: April 27 through May 1, 2015

CMS reports the results of its latest end-to-end ICD-10 testing period: 88 percent of the test claims were accepted, up from the 81 percent in February. Two percent were rejected due to invalid ICD-10 codes, while the remaining rejections were due to errors unrelated to ICD-10.

Why CMS should stop Stage 3 of meaningful use

AMA joins the growing list of industry organizations calling on ONC to delay MU3. AMA proposes a one-year pause in the program in 2017, giving providers and vendors a much needed break, before moving forward with MU3 in 2018.

We the people want easy, electronic access to our health information

Farzad Mostashari, MD and former National Coordinator for Health IT, unveils a new petition called Get My Health Data that is soliciting signatures from people that are passionate about patient’s access to medical data. He also encourages patients to test the current environment by requesting their medical records from local health facilities and then reporting issues they run into under the Twitter hashtag #tracer.

HIStalk Interviews Asif Ahmad, CEO, Anthelio Healthcare Solutions

Asif Ahmad is CEO of Anthelio Healthcare Solutions of Dallas, TX.

 

Tell me about yourself and the company. 

I was in academic medicine for 18 years. I was a CIO and head of globalization at Duke University Health System and prior to that at Ohio State. About five years ago, I moved onto the corporate side. I had done a lot of startup companies out of academics. I was at McKesson for three years. Now I’m CEO of Anthelio. I come from 23 years in healthcare, specifically in technology, with a big focus on clinical optimization and driving efficient and effective utilization of health IT.

Anthelio is the only independent, vendor-agnostic, full-breadth IT services and technology company. I thought it would be a great marriage of my background and a company with the footprint to start defining some interesting new models of service delivery and service management with what is happening since Meaningful Use.

We are privately held and the largest technology company in the pure healthcare space. We have about 2,000 employees and close to $250 million in revenue, which makes us a pretty big, mid-cap privately held company.

We provide three product lines. One is pure IT services all the way from full IT outsourcing to prioritized IT services, including EHR implementation and optimization. Then we have a second line, which is revenue cycle and health information management, from coding to revenue optimization to clinical documentation improvement. Then we have our products portfolio, which is a vendor-agnostic patient engagement product, data solution products like data warehousing and operational data store, and our analytics products. That’s what defines the company — a IT solutions group, an HIM revenue cycle solutions group, and vendor-agnostic across the board products.

Your background as an academic medical center CIO and a biomedical engineer makes you unusual among large-company CEOs. What was the transition like and how would you advise CIOs with similar interests?

The transition for me was really easy, because even in the academic medical center, I was really the one who was going against the norm. Things can be done faster, quicker, more efficient. Cost should be an issue, revenue, opportunity losses should be an issue, and also making a bigger footprint for your academics. When I was at Duke, for example, the three hospitals weren’t integrated a lot at all, so I was brought in to bring that together. Nobody was even thinking about outpatient care — this was pre-population health — and I, working with the chancellor, put that big footprint together. In two to three years, we had full adoption of CPOE. This was all pre-Meaningful Use. We had integrated physician-hospital billing as a single CBO. We spun a lot of companies out of there like Sentillion, a company that Microsoft bought, which was out of my department at Duke. I was always working to optimize whatever the opportunity was for the parent organization.

What I would advise for a CIO is to get yourself organized to learn the operations of healthcare. I think there’s a big movement there. The CIOs don’t really get involved in learning and being held accountable for driving the operations of healthcare. At both Duke and Ohio State, I had P&L responsibility. I was running almost a billion-dollar business for Duke. I had volunteered to run the lab and radiology business, which is a very technology-based business, and my biomedical background was in imaging. I’ve always utilized my technology background to drive operations.

You are right, you don’t see too many people like me in business. There should be more of my kind because part of the problem is that CIOs are always on one end of the board room and the CEO is on the other end calling up Deloitte or Accenture or somebody else to advise them how to use technology. There’s not really that much of a connection between the two groups. 

I have always prided myself in being that bridge, somebody who understands technology, but who wants to grow, drive, and be held accountable for managing the operations of healthcare. I always have had physicians reporting to me from a P&L perspective. At Ohio State, I was building the heart hospital with the doctors there. I was doing a lot of things that were eventually very strongly technology enabled, but we started first with, what’s wrong with the process? What’s wrong with the current way of delivering care? Then technology got introduced. But I was the one who drove both the clinical side and the technology side.

What is the trend for health systems to outsource infrastructure, security, or application management?

I think it’s going to start moving. There’s going to be a huge tailwind towards that. Everyone has invested a lot of money in big systems. A lot of people have bought the Epics and the Cerners and now they’re sitting with huge amounts of cost which is depreciating.

Previously most hospital CIOs were a little afraid of outsourcing because the whole idea was that you have to manage, maintain, and contain it. With cloud services and the advent of cybersecurity issues, you cannot have enough competency within your own portfolio to do it. You have to take chance of things where you think scale matters. When I look back on my days at Duke, I would never manage IT security on my own with what I know now being on the commercial side. Similarly, I built a $30 million data center. Why should you be building data centers in academic medical centers or hospitals when that’s just a huge cost sink? You should be working with somebody else to outsource.

Similarly, application management and application hosting. Why would you want to put an Epic and a Cerner or whatever else out there with the SaaS model? Take it out of your portfolio. I have to manage everything close to my chest because the whole technology evolution has told us that that’s not the way to manage in the most cost-effective or effective way because you’ll have a lot more downtime. You put all your eggs in one basket in one building and one server.

Everybody invested a lot of money, and yet the cost of IT has not borne the benefits that one was to see in how the impact of these EMRs were to be had from an outcomes perspective or what needed to happen from patient safety or better financial outcomes. People are not seeing it used for that. You’re seeing post some of these big implementations hospitals taking a hit on their credit ratings. So I think you’re going to see a lot of trends towards outsourcing. I’m able to relate to it because I was also on the other side and we work with our clients now.

But the plan is not to fully outsource everything you have. Take the pain points, take where the scale matters, and let’s take that. That’s where the idea of productized  services solutions comes in. It used to be that everything needed to be outsourced, that you would give me everything because I can’t do just parts of this business. Now we’re in an ecosystem that CIOs of the health systems can work with companies like Anthelio and we can take the headaches off you because we have the scale. Then you should focus on clinical optimization, driving changes with your physician behaviors and the patient engagement. We talk about population health, but yet a patient portfolio itself doesn’t give you that. You have to have the patients engaged in some kind of mobility solution. So focus your interests there and then companies like ours handle the back-end infrastructure. Historically, everything had to be very close to you, but now because of the cost structure and evolution of technology, people are easing up on that. I think it’s the right thing to do.

Is offshoring increasing or decreasing?

I’m glad you asked. Almost 30 percent of our workforce at Anthelio is based out of India. The whole trend for offshoring is different. Ours is growing because we don’t think of it as an offshore. I always tell my team that Mumbai is no different than Michigan. By the way, we have a huge delivery center in Michigan, so that’s why I use that analogy. If you align operations tightly, you don’t think of India or Philippines or wherever else you’re offshoring as some destination or location where there is a buffer and a black box. If you tie every community working from home and diffuse services, big vendors have already shown that it can be done. You don’t have to be in one location. The fact that you could have a remote workforce really changed offshoring. That’s one thing that is helping offshoring at the moment. If you align your accountability, it doesn’t matter where the employee is with the right confines in place.

The number two thing that helped us is that it’s not just a cost arbitrage to us. You look at where the best talent is, where the best access to talent is to scale, and how to drive growth from there. People used to send just the back-office jobs to India or somewhere else like that. I’m going to send my billing clerks to India, for example, with ICD-10 coming. I think that has changed. India has some really good talent. I have turned India into an innovation hub for us. We do combined product development. We do combined software delivery as well as service delivery there, not just cost arbitrage.

Offshoring done right should have never been an issue, but the problem is that it wasn’t done right. People took chunks of cost — the quarter end is coming, so let’s just thrown this out to India or wherever else and let’s drive the cost. But it’s not a cost equation. It should be a value equation. Where do you drive the most value? The way we have done offshoring is to balance that out. You can have access to some lower-cost talent in India, but what should that be, and how do you mix that talent then with the talent pool in US so it’s one combined talent pool and not just this bifurcated or trifurcated talent pool who never see each other? 

In our case, the people at all levels between our teams in India — in two locations in Mumbai and Hyderabad — and our locations here Dallas, Tennessee, Michigan, Chicago — they keep going back and forth. There’s a true sense of one combined team. Offshoring is going to continue, but in the context of where the value is driven. It’s not just a cost arbitrage, which is  bound to fail. It needs to be seen as value arbitrage.

What will the most important healthcare IT implications be over the next five years?

There’s been this big push to buy new integrated EMRs, and yet you don’t see an impact of it to the outcomes. I think there’s going to be a litmus test. Patients are going to push to ask for more access to their information. The traditional EMR systems can’t provide it, so I think there’s going to be a disruption.

I see in the next five years there should be a disruption in how we manage health technology in the US, which is done in vacuums and silos still. It’s gotten somewhat better, but you’re not going to get your value-based reimbursement. There’s going to be more consolidation, but at the same time, I think the patients themselves are going to push for a much more holistic kind of view. More mobility solutions are going to come forward, not just the enterprise systems that are out there.

In five years you should see a lot of non-profit and for-profit collaborations in a very meaningful way, and hopefully more transition of roles going back and forth. There’s a big vacuum in what the actual understanding of healthcare delivery is versus what the vendors perceive, both on the service and the product side. Hence, many products don’t work. The ones that do work are the ones who understand.

EHR Design Talk with Dr. Rick 6/3/15

The Story of My Leukemia

Dear Friends and Readers,

I can’t begin to tell you how happy I am to resume writing about EHR user interface design and to share my ideas with the HIStalk community. I am grateful for this opportunity. By all odds, in the long view of human history, I should not be alive.

In the fall of 2013, while jogging I noticed that my exercise tolerance had decreased – I couldn’t run up a hill which a few months earlier had presented only a slight challenge. At the time, I attributed the change to just getting older. A little later, however, after climbing a single flight of stairs at work, I found that couldn’t utter a sentence without first stopping to catch my breath. Although I was still in denial, I reluctantly took time off from work to see a colleague of my PCP who was available that afternoon.

Although I had minimal findings on physical exam and my ECG was negative, by this time it was clear even to me that something was wrong. My labs were drawn and sent off. A little later that evening I got a call from my primary care doctor and friend. She advised me to go to the hospital to be admitted via the emergency department, as my hematocrit was 18 and I had other hematologic abnormalities as well.

When I asked if I could delay admission until the next morning, the answer was a tactful but emphatic ‘no.’ So with my wife Karen’s help, I packed a toothbrush and a few other things, drove to Mount Auburn Hospital (where I had done my internship 30 years before), and was admitted.

A bone marrow biopsy performed the next day revealed acute myelogenous leukemia (AML). That evening I was transferred by ambulance (although I insisted on walking and carrying my own bag) to Feldberg 7, the inpatient Bone Marrow Transplant (BMT) Unit of Beth Israel Deaconess Medical Center (BIDMC), where I received extraordinary, life-saving care over the next three months.

Quite frankly, when I was told I had AML, I thought it was more or less a death sentence. My last training in AML had been more than 30 years ago when I was a medical student. At that time, the likelihood of successful treatment was very low. My mind went to practical issues such as whether I would have enough time to organize important family documents. It was easier to focus on these kinds of things than wonder how I would say goodbye to my family and friends.

The attending physician on call that week for Feldberg 7, who has since become my trusted primary oncologist, came in from home to see me. By then it was nearly midnight. We had a long talk. Although she did not minimize any of the very real risks of the disease, the induction chemotherapy, or the eventual stem cell transplant if I should get to that point, I regained hope. I learned that my chances not just for life-prolonging treatment but for a cure were approximately 50 percent.

After two courses of induction chemotherapy complicated by several medical issues, I received a stem cell transplant on December 9, 2013. I am now a year and a half out from my transplant. Although my recovery has been complicated by mild chronic Graft versus Host Disease, I am doing very well. My most recent bone marrow biopsy showed no evidence of relapse, and at this point, there is a good chance that I am cured.

I have been transformed by my journey through illness and back to health. I am grateful beyond words to my doctors, including the fellows and house officers who took care of me; to my nurses, who in addition to providing extraordinary care, were also the main emotional support for me and my family; and to all the other members of my BIDMC health care team whose contributions often go unacknowledged.

My experience has also made me keenly aware that, day after day, at hospitals and clinics across the country (and the world), healthcare teams like mine put in the same kind of long, hard hours and devote the same kind of demanding cognitive effort in order to take care of their patients.

Even before my illness I had a strong interest in applying what we know about human perception and cognition in order to create simple, powerful, elegant EHR user interface designs – designs that make it easier for doctors and nurses to care for their patients. Now that I have experienced a life-threatening illness first hand, this interest has taken on an added personal dimension.

As a patient, I could not of course (and was far too sick to) sit next to my doctors and nurses and observe them as they entered, reviewed, and interpreted my data in BIDMC’s EHR (WebOMR), but I was certainly aware of the long hours they put in at the computer. From what I have subsequently seen of WebOMR, despite being homegrown, it is an excellent system that rivals those of the major EHR vendors.

By the same token, it shares many of the same EHR usability issues that are becoming increasingly recognized as a major barrier to achieving the Triple Aim of enhancing patient experience, improving population health, and reducing costs. I believe that John Halamka, BIDMC’s CIO, would agree – in a recent interview, he described today’s EHRs as “a horribly flawed construct.”

One ‘benefit’ of my long illness is that I have accumulated my own rather extensive electronic medical record data set (although I wouldn’t recommend obtaining one in this way). In the posts that follow, I look forward to using my data set as the basis for sharing ideas about how to display EHR information so that we can perceive it using our lightning-fast, high-bandwidth visual processing system, sparing our more limited cognitive resources for patient care issues.

Specifically, I look forward to presenting a design where we can use our visual system to grasp both the subject matter and the temporal sequence of EHR documents. The design is not intended to be a finished product, but rather a starting point, a springboard for discussion and deliberation. I welcome input from healthcare IT professionals, interaction designers, vendors, and clinicians. I would love nothing more than to see some of the design concepts incorporated into innovative open source applications that could serve as new front ends for existing EHR systems, and eventually, for personal health records as well.

Next Post: My Data Set

Rick Weinhaus, MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

Morning Headlines 6/3/15

Partners’ $1.2b patient data system seen as key to future

Partners Healthcare goes live on Epic across nearly all locations except for its Massachusetts General Hospital facility. The total cost of the implementation grew to $1.2 billion, double the $600 million initially budgeted, making it the largest investment the health system has ever made.

Revisit Rates and Associated Costs After an Emergency Department Encounter: A Multistate Analysis

A study published in the Annals of Internal Medicine finds that 8.2 percent of ED patients will readmit within three-days, often going to a different hospital for the second visit. Skin infections generated the highest rate of revisits at 23 percent, and the second visit was typically far more expensive than the initial encounter.

Comvest Partners Acquires McKesson Care Management Business

McKesson sells its care management system, marketed to payors and risk-bearing health systems, to investors for an undisclosed sum.

Governor: Update fixes health exchange delays

Vermont updates its health insurance exchange to fix problems that were causing delays of up to two-hours for users trying to update their coverage mid-year due to life changes such as marriage or the birth of a new child. The HIE is still unable to enroll businesses, a requirement of ACA, and the governor has reported that he will push to have the requirement dropped before attempting to add the functionality to the site.