The DoD selects Cerner as its next laboratory information system vendor, replacing its existing LIS applications across all Military Health System facilities.
US Representative Mike Thompson (D-CA) along with three co-sponsors introduces a bipartisan bill that would remove geographic barriers to telehealth services and increase the use of remote patient monitoring technologies for Medicare patients. The bill was referred to the House Ways and Means Committee.
The White House publishes proposed research guidelines for its Precision Medicine Initiative, aimed at protecting patient privacy. Public comments are open until August 7. The announcement also highlights several new initiatives aimed at increasing patient awareness about their right to get digital copies of their medical records.
BMJ becomes just the second major medical journal to require research data sharing as a condition of publication, joining PLOS. The NIH, World Health Organization, and Cochrane Collaboration have called for de-identified patient data collected during clinical trials to be shared with the the larger research community, but information sharing is still an uncommon practice.
How Healthcare Providers Can Get Paid in the Mobile Age By Tom Furr
Two-thirds of all Americans aged 18 to 29 and nearly 60 percent of those between 30 and 49 years of age use a smartphone, according to a recent study by the Pew Research Center. In addition, the study found about 30 percent of Americans perform banking tasks – like paying bills – via their smartphones.
What does that have to do with your medical practice, you may ask? How well you understand the dynamics of mobile technology and its use in our society has a bearing on your practice’s survival. The management consultancy Deloitte noted that “overall preferences are trending toward mobile use” as it relates to getting information, buying, and paying for things. We can add paying for healthcare.
If there has ever been a reason to finally abandon that creaky old paper-based billing system, it is the ubiquitousness of mobile devices: smartphones, tablets, and even basic mobile phones. Most sources cite 90+ percent of Americans own a cell phone.
Americans prefer to get their bills online and are far more likely to pay them quickly, if not immediately. If you’re sending statements out in paper form, the third time is truly the charm. The Medical Group Management Association calculated that doctors’ offices must send out more than three statements before receiving any payment for services provided.
It’s high time you stopped licking stamps and start to bill electronically with email alerts sent to your patients. If you’re already using some kind of online bill pay method, understand your patients are moving away from the desktop to mobile devices. Adestra, an online marketing firm, found 48 percent of email opens occurred on mobile, 36 percent on desktop, and 19 percent in a webmail client.
Litmus, an email testing and analytics company, reported earlier this year that more email is read on mobile than desktop email clients. It, too indicated about half of all emails are opened on a mobile device. Of the 900 million Gmail users worldwide, 75 percent use their accounts on mobile devices
Campaign Monitor, another email specialist, noted that mobile email opens have grown 180 percent in three years, going from 15 percent in Q1 2011 to 42 percent in Q1 2014.
The changes that have occurred to this country’s healthcare ecosystem in just the last three years have had — and continue to have — profound impact on every person touched by the industry.
The increase in patient responsibility – or should I say liability – as it regards debt has created unprecedented revenue pressure on doctors, clinics, and hospitals. Oddly enough, this intense pressure has not prompted a swift change in most healthcare providers’ mode of operating. A study by JP Morgan noted healthcare providers have been late to turn their focus from clinical applications to their revenue cycle, collections, and payment processing modules. What’s more, this research determined healthcare providers “need to interact with patients in a more direct collections relationship” but “are not providing the level or sophistication of payments services that consumers expect.” This study also observed “the healthcare industry, as a whole still transacts with high volumes of paper.”
Six years ago, a McKinsey survey of retail healthcare consumers showed that 52 percent of respondents would pay from $200 to $500 or more by credit or debit card when they visit a physician if an estimate was provided at the point of care. It appears consumers are not so much unwilling to pay as they are unwilling to pay blindly.
Your patients are telling you what to do. Make payments more convenient and less confusing. Start by moving from paper to electronic and on to mobile
Whether you go the route of email to a secure website or a mobile application, recognize you’re not dealing with a screen more than a couple of inches wide and maybe three or four inches long. More than being “mobile friendly,” your efforts here need to show you’re mobile savvy.
Everything you do for the mobile environment must be simple and with a clear purpose. Simple because there are some technical limitations the wireless infrastructure forces us to handle. Clear because the viewing area is not very big. Intuitiveness is a must. One reason e-retailers are seeing a bump in abandoned shopping carts is their sites and apps aren’t developed with mobile in mind first.
Get the right message presented in the right way to your patients and they will see it on their phones and take action right then. After all, in this mobile age, people check their phone about 150 times a day. It’s how they operate.
Tom Furr is founder and CEO of PatientPay of Durham, NC.
The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.
The Opportunity and Danger of Influence
Following my farewell speech, several of my team approached me to say personal goodbyes. Waiting in the back, and the last person to step forward, was a manager. He confided that while not active in terms of volunteering at or attending social events I’d hosted, he was deeply impacted by my leadership. Since this was the first time he expressed such feelings, I looked him straight in the eye and asked him, “How?”
He stated that because of my personal emphasis on upholding responsibility for my well being and my active modeling, he’d decided to lose weight. In fact, over the last two years he had lost 185 pounds! Standing before me was a svelte man. I shared how proud I was of him. He went on to say that he observed how I shared and lived my faith and decided he wanted the same as well. A year prior, he’d found faith as a Christian.
My point is this: I never once spoke to him personally about well being or Christianity. But he watched, adopted, and changed. Transformed.
Last week, I attended a funeral and visitation for a former employee. He was not a vice-president, director, manager, or lead, but I knew him just the same. After seven years at the same company, I’d made it my priority to know everyone. I was no longer his leader, but refused to miss this visitation.
That day, I met his wife for the first time and introduced myself. She responded, “Oh, I know who you are. Eric spoke about you all the time.” “What, he spoke about me?” I thought to myself. “What for? What about?”
Eric loved to laugh, so I took a chance and made a subtle joke. His widow and I broke out laughing, then hugging, and then crying—as if we’d known each other as long as I had known Eric. People go home and tell stories—good or bad—about their leaders.
Yesterday, via LinkedIn, I had a message from an operations manager at one of my former hospitals. She shared how impressed she was by the training that one of my staff received through our internal IT program. She ended up taking the course herself and it changed her personal and professional life. She was so impacted that she switched careers and became an instructor for the course.
Your influence has repercussions beyond the immediate.
I could tell you more stories, but you get it. As leaders we wield significant influence. This influence can be for harm as well as good. We must be very careful and aware. It does not matter what you say, it is what you do. Our actions speak louder than words and they have the power for good or evil. Scary.
Choose life.
Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.
CMS’s National Provider Identifier database, which was developed to provide patients with a way of researching physicians, is found to contain tens of thousands of errors and mismatched provider identification numbers.
Rock Health publishes its mid-year digital health funding report. Investments in health IT have mirrored the amounts seen in 2014, with an uptick in later stage funding rounds and M&A activity.
Rep. Steve King (R-IA) proposes an amendment to the 21st Century Cures Act that would delay Meaningful Use penalties and rebate penalties already paid by eligible providers.
The Cystic Fibrosis Foundation nets $3.3 billion by selling its royalty rights to Kalydeco, the first drug approved to treat the underlying cause of CF. The foundation had been funding CF drug research in exchange for a share of royalties on any treatments developed since the late 1990s.
CMS caves to the AMA’s withering and never-ending criticism of ICD-10 by agreeing, in a joint announcement, to create a year-long transition period in which CMS will: (a) pay claims even when their ICD-10 codes aren’t specific enough; (b) allow non-specific ICD-10 codes to be used for PQRS reporting; (c) provide advance payments to physicians if CMS has ICD-10-related problems that cause a claims backlog; and (d) assign an ICD-10 ombudsman and communication center for triaging physician-reported ICD-10 problems. Hospitals should take note: it was AMA rather than AHA pulling CMS’s strings, so hospitals (rather surprisingly) get nothing from the new uneasy detente. That also means that ICD-10 information will be of marginal value for the first year given that full specificity is optional (I assume that was done to allow ICD-9 to ICD-10 crosswalks). On the bright side, AMA is now on board with the ICD-10 transition that takes effect October 1 and hopefully most EHR vendors won’t need to resort to a crude compliance crosswalk anyway. It’s not really a full grace period as some sites have suggested – submitted claims must still use valid ICD-10 codes starting October 1.
Reader Comments
From HIT Wannabe: “Re: getting electronic copies of your medical records. Isn’t this required by Meaningful Use as a core objective? Let me get this straight. The former leader of ONC, who personally oversaw payments to providers when he knew they weren’t in compliance, now asks the public to bring their non-compliance to light. If a hospital can’t provide electronic copes, they should be audited immediately and taxpayer funding should be returned with a penalty.” MU is by attestation, not investigation. It also doesn’t take into account how hard it is to actually get records regardless of the MU technology. Farzad’s idea is that we all become mystery shoppers to see what it’s like for a non-IT savvy patient, which is really the only way to do it since you can’t request record copies from providers you haven’t actually seen. The remaining question is, assuming the process is a disaster for a given provider (which is nearly certain), who do the mystery shoppers report to? Maybe ONC should have an anonymous MU compliance line or online form.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor Evolent Health. The 750-employee, Arlington, VA-based value based care services company — co-founded by UPMC Health Plan and The Advisory Board Company — works with health systems and physician organizations in 25 markets to implement tailored clinical programs, patient engagement tools, specialized care teams, network optimization, back-office infrastructure and analytics, organizational governance, and EHR optimization. Its Identifi solution coordinates and measures value-based care in providing data integration, clinical and business content, EHR optimization, and specific end user applications. It offers a free population health technology requirements checklist gleaned from its experience working with providers across the country as well as a Medicare ACO Cheat Sheet. CEO of the newly IPO’ed company is Frank Williams, previously chairman and CEO of The Advisory Board Company. Thanks to Evolent Health for supporting HIStalk.
I found this Evolent Health testimonial by James Porter, MD, SVP/chief medical officer of Deaconess Health System, on YouTube.
My saga to obtain an electronic copy of my records from a Stage 7, MU2-attesting medical center continues 10 days after my initial (mandatorily faxed) request. It’s the usual hospital lack of follow-through and understanding of policy, as the HIM person I called after not hearing back said the hospital sends only paper records to patients – only physician practices can get an electronic copy. I politely mentioned that the hospital happily took Meaningful Use money and therefore should be able to send me an electronic version, so I’ve been escalated to her supervisor who will supposedly be in touch. Meanwhile, I realized that since they’re an Epic-using facility, I should be able to create a MyChart account and download the records myself, but for some reason my visit isn’t showing up even though the labs and charges from it are there. I sent a MyChart secure message that the hospital claims will elicit their reply within two business days, of which one has gone by without a peep. I’ve worked in health systems most of my life and this experience confirms my overall insider assessment of that experience: most everybody in big hospitals and practices is polite, but often uninformed, hampered by the invisible bureaucracy, or incompetent.
Health IT investments seem to be tapering off, which is perfectly logical given that some pretty lame companies nobody’s heard of took in a bunch of questionable investor money. It’s kind of a shame that the sites and groups got so pee-your-pants excited over the big money rolling in and used that as a success metric rather than actual company accomplishments or patient benefit. However, I am a devout disciple of the Gartner Hype Cycle and we’re probably entering the Trough of Disillusionment overall as we bottom out on the slope of Peak of Inflated Expectations, I’m ready to start seeing the success (the Slope of Enlightenment) that some small percentage of them will have in moving the healthcare needle somewhere down the road.
Webinars
July 14 (Tuesday) noon ET. “What Health Care Can Learn from Silicon Valley.” Sponsored by Athenahealth. Presenter: Ed Park, EVP/COO, Athenahealth. Ed will discuss how an open business structure and strong customer focus have helped fuel success among the most prominent tech companies and what health care can learn from their strategies.
July 22 (Wednesday) 1:00 ET. “Achieve Your Quality Objectives Before 2018.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; Dennis Swarup, VP of corporate development, CitiusTech. The presenters will address best practices for building and managing CQMs and reports, especially as their complexity increases over time. They will also cover quality improvement initiatives that can help healthcare systems simplify their journey to value-based care. The webinar will conclude with an overview of how CitiusTech’s hosted BI-Clinical analytics platform, which supports over 600 regulatory and disease-specific CQMs, supports clients in their CQM strategies.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.
Acquisitions, Funding, Business, and Stock
Emdeon will acquire health plan payment analytics vendor Altegra Health for $910 million. It was one of several health IT companies being rumored a few weeks ago as seeking buyers, along with Precyse Solutions, Mediware, Edifecs, and Caradigm.
Accretive Health CEO Emad Rizk had $20.5 million in compensation for his first year on the job, nearly all of it in the form of stock and options. The CFO of the struggling and NYSE-delisted company made $3.1 million, while the COO was paid $6.1 million. The company lost $80 million in 2014 after Minnesota’s attorney general went after it for predatory patient collection practices that included sending people into ED treatment rooms to get credit card swipes and interrupting surgeries to pester patients for payment.
PipelineRX raises $9.1 milliion in funding to expand its telepharmacy services, where its employee pharmacists remotely process medication orders for hospitals that need coverage or help reducing medication turnaround time.
Sales
OCHIN chooses CareAccord, the state of Oregon’s HIE and HISP, for Direct messaging.
The Indiana State Department of Health selects LiveProcess as its emergency management platform for 144 hospitals.
People
Arcadia Healthcare Solutions names Richard Parker (Beth Israel Deaconess Care Organization) as chief medical officer.
The White House recognizes patient advocate and CareSync COO Amy Gleason, RN as one of nine “Champions of Change” for precision medicine in a Wednesday ceremony.
Announcements and Implementations
Cerner and University of Missouri extend their healthcare collaboration, which includes the Tiger Institute for Health Innovation, for another 10 years. They will add the Tiger Institute Leadership Academy to host industry peers and place new emphasis on mobile healthcare and population health.
Cleveland Clinic’s Lutheran Hospital (OH) pilots Uniphy Health’s physician engagement and secure communication platform.
CoverMyMeds launches a paid training program for 20 .NET and Java web developers who want to learn the Ruby on Rails programming language in taking jobs at its Columbus, OH location. The company commissioned a 9,000 square foot, 160-foot tall roadside display inviting Java developers to “find a better cup of coffee,” of which I could unfortunately find no photo (a big PR opportunity missed for the company that would have required only a snapshot).
DataMotion launches API access to its Direct Secure Messaging and SecureMail services for third-party developers.
Government and Politics
ONC posts an invitation for developers and vendors to submit health IT certification testing procedures, tools, and data that ONC will consider as alternatives to existing certification criteria.
The Cincinnati newspaper finds that CMS’s National Provider Identifier (NPI) database of physicians — and the many third-party systems that use it — is a mess, with tens of thousands of keystroke errors, and more alarmingly, an abundance of apparently intentional changes that hide the checkered past of some of the physician registrants since doctors can change any of their information CMS has on file. The paper reported the problems it found to CMS, who blew it off by telling them to contact individual physicians to correct any errors they noticed (of which there are 35,000 for New York alone). Mistakes are important because consumer information sites like Healthgrades and Vitals.com use the number to display information about a given physician. The paper found that of 100 mismatched NPIs in Florida, 30 percent belonged to doctors who had been disciplined or criminally convicted, with their incorrect license numbers conveniently pointing in every case to a blemish-free doctor.
Rep. Steve King (R-IA) proposes an amendment to the 21st Century Cures bill that would delay Meaningful Use penalties and rebate EPs for any penalties already levied.
Privacy and Security
A Italy-based security software company that counts the FBI among the customers of its snooping software tells users to stop using its product after its own systems are hacked, with all of the company’s files leaked to the Internet. The hacker tweeted, “I’ll write up how Hacking Team got hacked once they’ve had some time to fail at figuring out what happened and go out of business.” Experts suspect that the company’s system administrators used weak passwords, some of them variants of the word “password.” The leaked files, which were not encrypted, revealed that the company’s software has an undocumented “back door” that would let it enter customer systems and, most interestingly, the published information shows who uses its software and exactly who they’re using it to spy on.
Innovation and Research
A California Healthline report highlights Way to Wellville, a year-old health technology project run by technology investor Esther Dyson that will try to address the public health problems in a rural California county and four other US locations. They’re using IBM Watson to target more Medicaid signups and hope to use iPhone collaboration and Fitbit monitoring. The county’s public health officer seems skeptical in how Silicon Valley types can parachute in and change the county’s culture.
Technology
BBC News covers hospital-focused mobile apps Medxnote (secure messaging), Imprivata Cortext (secure messaging), Sensium Healthcare (wireless patient monitoring patches), Gauss Surgical Triton (estimates blood loss from photos of surgical swabs), and a Sarasota Memorial Hospital beacon-based wayfinding app.
Microsoft will award five, $100,000 grants to university and non-profit researchers to develop uses for its HoloLens mixed reality computer. Submissions are due September 5, 2015.
A tiny study by direct-to-consumer genetics testing company 23andMe finds that patients whose genetic tests suggest a possibility of Parkinson’s disease who also report symptoms of the disease can be accurately diagnosed via a video visit with a neurologist, also noting that all of the 50 patients were correct in their self-diagnosis of having the condition. The company also announced $79 million in new funding (of $150 million sought) as it moves toward drug development.
Other
I updated Monday’s post with a response from Cerner about a reader question about Meaningful Use support for the former Siemens legacy products, but here it is again for those who didn’t happen to re-read the original:
Before the acquisition, Siemens Health Services communicated to its clients in person that they would continue to support MedSeries4 and Invision for clinicals and financials, as well as Eagle, but wouldn’t support the clinical components of Invision or MedSeries4 for Meaningful Use 3. Cerner affirms that communication. Additionally, we are providing new regulatory enhancements and other operational excellence improvements for MedSeries4, Invision and Eagle financials, and we have existing client support commitments on all three solutions that extend into the next decade that we will continue to honor.
The PBX of the Grand Junction, CO VA hospital goes down for several days, losing voice mail messages and leading the hospital to suggest that patients use myHealtheVet secure messaging instead.
A Bloomberg report finds that the Cystic Fibrosis Foundation charity, which funded a drug company’s research in return for royalties the drug generated, eventually earned $3.3 billion by selling the drug’s rights to an investment company, providing the charity with more research money than the American Cancer Society, American Heart Association and American Diabetes Association combined. Now the issue is whether patients can actually afford the two drugs it funded given that each costs around $300,000 per year. The foundation’s CEO says the drugs are overpriced, but he doesn’t think drug companies would be developing comparable drugs if they generated only $10,000 per patient per year.
A report commissioned by the World Health Organization finds that the organization lacks the capacity and culture to deal with global health emergencies such as Ebola, where it failed to raise awareness until nine months after initial reports. The report also suggests that WHO members pitch in to create a $100 million disease outbreak fund.
Here’s the best deal of any conference I’ve seen lately: Valence Health will hold its Further 2015 value-based care conference (for its clients and providers in general) in Chicago, September 30 – October 2. Attendees get two nights at the Loews Chicago downtown (the Expedia price for those nights is $389 per), meals, the conference, and entertainment. I enjoyed Chicago enough during HIMSS to think that sounds like a pretty good trip with an easily added weekend for those looking for an early fall break.
CVS Health, which stopped selling tobacco products in its stores last year, resigns from the US Chamber of Commerce after reports surface indicating that the organization was trying to squelch anti-smoking laws all over the world. The Chamber responded by saying it doesn’t support singling out individual industries even though it does not support smoking.
Weird News Andy hopes that an especially hot corner of hell is reserved for Detroit-area oncologist Farid Fata, MD, who admits that he intentionally treated several hundred patients for cancer they didn’t really have so he could bill Medicare for $34 million in unneeded treatments. The doctors, whose practice was the state’s largest cancer practice with offices in seven cities, faces up to 175 years in prison during sentencing hearings this week
Sponsor Updates
ADP AdvancedMD offers “Become much more productive and profitable with AdvancedInsight” and recognizes winners of its AdvancedBiller awards.
AirStrip wins San Diego’s MetroConnect Prize, a program that helps businesses pursue foreign markets.
Aprima will exhibit at the Michigan MGMA Summer Conference July 16 in Boyne Falls.
Besler Consulting offers a “Bringing Clinical & Finance Together” podcast.
HCI Group posts “Healthcare 2025: Improving Care by Embracing Risk and Accepting Change.”
Clockwise.MD graduates from the Atlanta Tech Village.
CoverMyMeds offers “Maryland Prescribers: What You Need to Know About the Electronic Prior Authorization Mandate.”
AMA announces that after negotiating with CMS, the two have agreed on changes to the ICD-10 transition plan that will provide a one year grace period in which ICD-10 claims without the appropriate specificity documented will still be accepted.
Niam Yaraghi, a Brookings Institute fellow in the institution’s Center for Technology Innovation, suggests that MU2 failed because clinicians were never presented with a compelling reason to fully embrace health IT. He proposes mandating efficiency improvements in hospitals and practices, and then granting providers the flexibility to adopt whatever IT solutions they need to achieve those goals.
Personal genetics vendor 23andMe raises $80 million of a planned $150 million Series E funding round, its first investment activity since 2012, before it ran into significant regulatory problems with the FDA.
A federal appeals court upholds a $237 million False Claims Act verdict against Tuomey Healthcare System (SC), exceeding the hospital’s annual revenue. The fine stems from charges that in the early 2000’s Tuomey knowingly filed thousands of illegal claims worth $39 million to Medicare.
Former national coordinator for health IT Farzad Mostashari, MD launches #DataIndependenceDay, a call to action for the public to request electronic copies of their medical records and then share their experiences.
During my travels, I’ve been catching up on my journals. Given my current clinical work, I read both primary care and emergency medicine journals, and then there are the informatics articles that appear across a number of specialties.
I was amused by an editorial about cystic fibrosis in the June 15 edition of American Family Physician. It states, “The continuity and closeness that a family physician has with these patients has the potential to be a stabilizing and encouraging force in assisting with compliance and disease prevention, enabling patients with CF to maximize their quality and quantity of life.”
One of the main complaints I hear from primary care physicians across the country is an increasing lack of continuity. Patients are forced to change insurance when their company decides to update plans, or their providers may be dropped from insurance panels due to cost or quality profiling. Generally speaking, most primary care physicians I know entered the field because they wanted to have longstanding relationships with patients and wanted to help those patients live longer, healthier lives. Considering the average physician compensation across specialties, they certainly didn’t get into it for the money.
Because of my IT work, I’ve spent the last several years practicing in non-continuity settings such as urgent care or the emergency department. Although I occasionally work as a locum tenens in primary care practices, in those situations I usually see acute visits or overflow patients that can’t be accommodated by the other physicians in the practice. Not every practice has the luxury of bring in a locum when a physician is on vacation or leave, however. Many of them end up referring patients to local urgent care centers or walk-in clinics in order to address their needs.
Capacity isn’t just a problem when providers are out. In many of the practices I encounter, the physicians are carrying patient panels that are much larger than they should be to deliver quality care. This results in patients being directed to urgent care centers more often than they should, as well as patients electively choosing the urgent care route due to access and convenience issues. This in turn can drive up the cost of care and lead to increasing fragmentation. Physicians are carrying larger panels not only due to decreases in the primary care workforce, but also in attempts to tweak their payer mix to ultimately bring in more revenue.
Although we can celebrate interoperability and the portability of our health information as a way to smooth this fragmented care, that’s only part of the answer. There is a certain element of quality provided by being able to see a physician who knows you well over time. Merely having more pieces of information doesn’t always give physicians the information they need to provide the best care for their patients.
As the population ages and the burden of chronic disease increases, patients become more complicated. With the technology boom, we’ve seen an increase in the options available to manage patients and this also drives up the complexity of care. Complicated patients with complicated problems require more time and thought to manage. I can’t imagine how personalized medicine is going to play into the mix. We can throw layers and layers of technology at the problem, but that approach seems to frequently create additional problems.
In some situations, new therapies lead to the need for increasingly personal conversations with patients about whether a treatment is right for them and what the various costs and benefits might be. Additionally, we don’t have long-term studies on some of these treatments, so we’re trying to predict risk with our patients without adequate data.
In one of my journals, there was a write-up about a new diabetes medication that has a unique mechanism of action. This may be perceived by many patients as new and improved, but there is no long-term data on the morbidity or mortality benefits of the drug. In one study, it was shown to be equally effective as traditional therapies. My translation of “equally effective” is “no better than,” but there’s quite a different emotional response depending on which words you use.
Although the medication is newly approved and heavily marketed, it comes at a cost. A one-month course of treatment costs $335 compared to the “equally effective” older drug which costs $4 per month. It also is associated with higher risk of urinary tract infections and bladder cancer. Having that conversation with a patient you know well and who trusts your advice is very different than with a patient with whom you don’t have an established relationship. It’s hard to provide culturally competent care (one of the new markers of quality) when there’s not adequate time to develop rapport or resources to form an assistive care team.
The newer models of care delivery include Patient-Centered Medical Homes and other structures designed to deliver care in our increasingly value-based models. We’re offering physicians reimbursement for care coordination and increased payments for higher quality. However, it creates a chicken-or-egg cycle where you have to have more staff to form and train a care team to get more money, which you need in order to have more staff, etc. It’s easy for those of us in the IT and policy trenches to think that physicians should just cut their pay to hire staff. Although that might work in a physician-owned practice, it certainly doesn’t work in employed situations.
Regardless of employment status, new medical school graduates are coming out with record debt – another reason not to choose primary care. Most of the new physicians in my community are entering practice with over $300,000 in student loans. Even at a 30-year repayment it’s like having an extra mortgage payment (or two). Many of those new grads opt for employed positions because they can’t take the financial risks required to open their own practices (assuming someone would even loan them the money to do so with that kind of debt). They wind up in a different kind of bind where their hospitals or employing health systems control staffing and expenditures and often create barriers to developing effective care structures.
I know by this point some readers are wondering what this has to do with healthcare IT and why it’s in HIStalk. In the field, I see many practices where work is being shifted up to providers rather than down to support staff due to increasingly complex systems. A recent engagement involving multiple EHRs revealed clinical reconciliation processes that were so confusing that physicians were reluctant to have anyone else perform the task. Even as an advocate for work redistribution, I agreed with them. I saw two different patient portals in use, both of which had serious usability issues and one that had some potential patient safety issues. Although they may have performed well in some kind of laboratory testing event, they were not meeting the needs in the complex realities of the average office.
Vendors need to have clinicians on staff as well as a network of client and non-client physicians to test new products and proposed changes to products. This also goes to other types of users – clinical, financial, etc. We need to see technology vetted in more real-world environments if we expect to be able to revolutionize how care is delivered. We need vendors to be more nimble and use best practices to translate emerging federal and payer requirements to viable code. We need processes and procedures (both vendor and governmental) that allow product delivery in enough time for practices to implement upgrades and features without the rush and chaos we currently see.
Having better systems, processes, and workflows will help mitigate what sometimes feels like an assault on our nation’s caregivers. It might even convince some physicians who might otherwise be motivated to leave or curtail their practices to consider staying. Ultimately, it might even result in better care.
What are your thoughts about the future of medicine? Email me.
Palo Alto-based lab test vendor Theranos announces that it has secured FDA clearance for its testing process, which it says is cheaper, faster, and requires a smaller sample than traditional lab tests.
The New York Times analyzes a component of the ACA that requires insurers to cover nutrition and obesity screenings and the effect the requirement is having on the for-profit weight loss industry.
In Australia, the Royal Adelaide Hospital, a new 800-bed facility being constructed in South Australia, may fail to bring its Allscripts EHR implementation live prior to its scheduled 2016 opening because it mixed up its own go-live deadlines and has been struggling with clinical adoption issues.
Lab testing upstart Theranos earns FDA approval for its herpes simplex test, the importance of which isn’t the test itself, but rather the fact that the company sought and earned FDA’s stamp of approval for its overall technology that had been labeled by some scientists as secretive and clinically suspect.
Reader Comments
From Pithy Mood: “Re: Quality Systems, Inc. The company just issued a proud announcement that its management team and CEO won a bunch of awards, including CEO of the Year. Why are there rumors that he was pushed out?” It’s not as though some prestigious, metrics-driven, non-profit organization of executive peers chose the just-retired, 63-year-old Steven Plochocki as the best CEO in the country given that QSII shares sell today for the same price now that they did when he took the job in 2008. The “CEO World Awards” are run by a public relations firm – companies pay to apply to a seemingly endless list of categories, with the winners then earning the opportunity to buy advertising, banquet tickets, memorabilia books, trophies, and other vanity junk. The troubling aspect is that a company would even bother to apply knowing how little any resulting award would mean. Plochocki was one of 13 “CEO of the Year” winners. Even his admin got in on the act by being the only announced winner in the “Admin Assistant to the CEO” category. Maybe she’ll replace him.
From X-Industry Consultant: “Re: Leah Binder’s WJS column. I’m tired of the ‘health system CIOs are idiots – why can’t you be like other industries?’ narratives. How many IT implementations from other industries has she studied? I’ve worked on dozens and huge failures abound – the FBI abandoned a $170 million system, Pfizer a $100 million clinical trials system. Give me an industry or government agency and I’ll give you a failure that dwarfs anything in health systems. The industry difference is that health system CIOs manage dozens of business models and hundreds of applications. Not many industry or government CIOs have the political, workflow, technology, and public policy skills to manage IT in a large IDN or AMC. I applaud Leapfrog’s constant pushing for better IT, but this column isn’t helpful.” The opinion piece titled “The Fatal Cost of Hospitals’ IT Ignorance” is naive about how healthcare IT works, where “ignorance” isn’t the cause of many or most problems. Binder says few IT leaders can make technology work culturally, conveniently absolving the non-IT operational leadership of responsibility in hanging the “responsibility without authority” albatross around the CIO’s neck. Mostly she’s griping that not every hospital chooses to run Leapfrog’s medication warning system checks, which as useful as it might be, is hardly the best measure of IT competence. Many hospitals are averse to standardization, transparency, and practicing evidence-based medicine, so it’s no wonder plugging in a new IT system (even successfully) doesn’t change anything. While I’m amazed and awed at how Amazon’s site works, I don’t necessarily assume they could do a better job of developing hospital systems than the vendors and provider IT leadership we already have. We’ve built an illogical, consumer-indifferent, paternalistic, billing-intensive, and political healthcare system that defies efforts to make it better that involve simply automating the underlying mess.
From Pickleballer: “Re: Cerner’s support of the former Siemens applications. Zane Burke originally said Cerner would support Invision, MedSeries4, and Eagle for 3-5 years, but a CIO friend says contract language obligates Cerner to provide updates for bug fixes and HIPAA only, not Meaningful Use Stages 2 and 3. If true, that’s a nasty clause that could hospitals many millions of HITECH dollars when had Cerner just said so upfront clients could have planned ahead.” I have an inquiry in with Cerner and will let you know if they respond. UPDATE: Cerner provided the following response:
Before the acquisition, Siemens Health Services communicated to its clients in person that they would continue to support MedSeries4 and Invision for clinicals and financials, as well as Eagle, but wouldn’t support the clinical components of Invision or MedSeries4 for Meaningful Use 3. Cerner affirms that communication. Additionally, we are providing new regulatory enhancements and other operational excellence improvements for MedSeries4, Invision and Eagle financials, and we have existing client support commitments on all three solutions that extend into the next decade that we will continue to honor.
From Bella: “Re: bachelor’s degree in HIM through UIC online. I’m interested but don’t know how hard it will be. Has anyone completed it? I could do a post-baccalaureate certificate or the degree to earn RHIA certification – which route is better?”
From Blue Canoe: “Re: VA suicide risk EHR algorithm. I read that Cerner presented the same concept on the Hill earlier this year. Do you think something like this would be a factor in the DoD’s decision?” I doubt it will be a primary consideration, especially since the concept hasn’t been fully proven at scale and both Allscripts and Epic collect the same patient information and could run the same algorithm against it. The idea probably impresses IT-naive politicians, so it really depends on how much they influence the DoD’s decision.
From Pure Shortening: “Re: McKesson Connected Care & Analytics. Reorganized, including subsidiary RelayHealth.” Unverified. I’m not really sure what’s going on there if anything, other than McKesson sold its care management business out of that division a few weeks ago. RelayHealth, which always seemed to be the darling of McKesson CEO John Hammergren, hasn’t put out many press releases lately and the folks I knew there are gone. That whole product area would seem to be the most promising to McKesson, which is slowly backing away from some of its other health IT businesses such as the decision to retire Horizon, which gave competitors some nice new sales. RelayHealth still seems like the company jewel to me.
HIStalk Announcements and Requests
Seventy percent of poll respondents think that HIPAA has had a positive impact on privacy. Reader Michael says small practices don’t understand it and doubt that HHS actually enforces it, while Mak likes the concept of snooping penalties and ensuring that patients can get their own records but he’s not a fan of the Washington “forever” jobs it created or penalties for looking at information that is widely available everywhere, including in the government’s own insecure systems. New poll to your right or here: have you as a patient used a provider’s portal within the past 90 days?
Welcome to new HIStalk Gold Sponsor LiveProcess. The Burlington, MA-based company offers HealthCORe, a team communication and collaboration solution that is used for emergency incident response, coordinating severe weather events, managing staff callouts, monitoring ED capacity and mobilizing staff as needed, coordinating hospital-to-hospital patient transfers, and managing care transitions. They have a lot of industry long-timers involved, including Sentillion co-founder Rob Seliger as executive chairman, Terry Zysk (MedVentive) as CEO, and Kelly Flood (Perceptive Informatics) as VP of client services. Thanks to LiveProcess for supporting HIStalk.
I found this LiveProcess HealthCORe overview on YouTube.
I still have matching money available for DonorsChoose donations. A company’s $1,000 will not only magically turn into $2,000 worth of funded teacher projects, it will also earn the donating company a mention right here on HIStalk for helping kids who need it.
Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, or HIStalk Connect. Click a logo for more information.
My grammar (and related) gripes for this week include use of overly casual contractions (such as “it’ll” and “it’d) when writing; calling any sort of lame and usually obvious tips “hacks” to make them sound more edgy; writing “would of” instead of “would have;” incorrectly saying “literally” for emphasis when “figuratively” is obviously correct; redundantly writing a currency figure in the form of “$1 billion dollars;” and the name of a restaurant chain I just noticed, LYFE Kitchen, in which LYFE stands for “Love Your Food Everyday,” whose misspelling suggests food that is mundane rather than enjoyed frequently unless they correctly change their name to the admittedly less-clever LYFED. I’ll also bring up an Independence Day special in differentiating between “grilling” (cooking over high heat) and “barbequing” (smoking over low heat), with the large number of folks who proclaim they’re doing the latter actually doing the former.
Last Week’s Most Interesting News
Allscripts spends $200 million to buy 10 percent of NantHealth, whose chairman Patrick Soon-Shiong invested $100 million of personal funds in Allscripts as his company prepares for an IPO.
An AHRQ-funded study finds that use of patient portals and secure messaging create problems for both patients and providers, concluding that they don’t affect outcomes unless rolled out as part of a comprehensive program.
A CVS study of chronic disease patients finds that patients prefer using online portals to communicate with their physicians, slightly more than those who like email or mobile apps.
A federal grand jury indicted a citizen of an unnamed country outside the US for using information stolen in a UPMC breach to file fraudulent tax returns.
Webinars
July 14 (Tuesday) noon ET. “What Health Care Can Learn from Silicon Valley.” Sponsored by Athenahealth. Presenter: Ed Park, EVP/COO, Athenahealth. Ed will discuss how an open business structure and strong customer focus have helped fuel success among the most prominent tech companies and what health care can learn from their strategies.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.
Acquisitions, Funding, Business, and Stock
Elsevier acquires London-based clinical decision support vendor InferMed.
Aetna will buy Humana for $34 billion, paying a share price premium of 23 percent. I can’t imagine the FTC will find the idea of bigger, fewer insurance companies to be good for consumers, but Aetna seems to be confident they’ll get approval to close the deal. The Affordable Care Act has been very good for insurance company shares.
Shares of video visit provider Teladoc began trading Wednesday, with shares jumping 50 percent on IPO day in raising $270 million for the company, which lost $17 million on $43 million in revenue for 2014.
Sales
Encompass Home Health & Hospice chooses HealthMEDX Vision as the EMR for its private duty pediatric services.
People
Medical second opinion vendor 2nd.MD names Patrick McGinnis, MD, MS, MBA (Memorial Hermann Healthcare System) as chief medical officer. He’s also a flight surgeon in the US Air Force Reserve.
Consumer engagement platform vendor Datu Health hires Jeff Johnson (Intermountain Healthcare) as SVP of strategy.
Announcements and Implementations
ADP AdvancedMD announces its Patient Relationship Management suite that includes patient forms, a check-in kiosk, and a patient portal.
Government and Politics
An interesting requirement of the Affordable Care Act is that insurers pay for obesity screening, which has for-profit diet clinics (including some run by hospitals) salivating at the prospect of earning up to $3,000 per patient per year for overseeing questionably effective weight loss programs.
Privacy and Security
A USA Today article urges people who drive rental cars to clear their personal data from the Bluetooth-paired entertainment system, which stores their phone number, contacts, and call logs for the next renter to find. It also points out that navigation systems retain addresses and the rental company’s black box tracks a lot of undisclosed information.
The Guardian profiles Deanna Fei, one of two AOL employees whose premature babies cost the company $1 million, causing the company’s $12 million salary CEO to publicly blame Obamacare and the cost of “two distressed babies” as the reason he cut the company’s 401(k) plan for everyone. Deborah Peel of Patient Privacy Rights told Fei that CEO Tim Armstrong had violated HIPAA in referring to her daughter in a way that made it obvious who he was talking about. Peel says, “I saw her story when the idiot CEO of AOL was stupid enough to take action with the 5,000 employees and tell them he was changing their 401(k) benefits because of $2m premature babies. You’d think that somebody who runs a technology company would understand privacy, but no.” I’m not sure the CEO really violated HIPAA since he’s not a health plan, provider, or clearinghouse, but I’ll agree on the “idiot” part – he also fired the company’s creative director in front of 1,000 co-workers for shooting video during an internal conference call about layoffs and reorganizations.
Other
The management of South Australia’s Royal Adelaide Hospital is struggling to get its new clinical system ready for the January 17, 2016 opening of its replacement hospital after confusion over the go-live date, which the hospital’s management thought was mid-April 2016 until early last year. The auditor’s report also notes that South Australia Health had “lodged a formal claim” against Allscripts to recoup project delays after Allscripts failed to deliver critical parts of the billing system, with Allscripts agreeing to pay $10 million in November 2014. SA Health named Allscripts as vendor of choice for the 80-hospital, $225 million project in November 2010 and signed the contract a year later, with the last cost update coming in at $317 million over 10 years, which SA Health expecting that “the approved EPAS rollout would result in an overall favourable position of $11 million over 10 years to 2020-21.” The government had to put the stalled rollout on hold last year following physician complaints about poor usability and claims that it was causing medication errors.
HealthStream co-founder and CEO Bobby Frist gives $1.5 million worth of his personal company shares to 600 non-management employees, which he announced in a video phone message to each employee by saying, “This stock grant is being personally funded from me, so this is from me to you. Thank you again and enjoy being an owner of the company.” He holds shares worth $154 million and lives in a pretty grand Nashville estate judging from photos I found by Googling.
Several readers sent a link to ZDoggMD’s R. Kelly remix of “Ignition” called “Readmission.” ZDoggMD, who is actually Zubin Damania, MD, founded Las Vegas primary care clinic Turntable Health. He says his “medical humor & dope rhymes” are “slightly funnier than placebo.”
Weird News Andy ponders, “What’s a Grecian Urn?” and concludes that it’s a lot more in Germany than in Greece, whose self-created and ever-worsening financial mess has caused a brain drain that includes 5,000 emigrated doctors since 2010, 3,500 of which have relocated to Germany, Greece’s largest lender.
Sponsor Updates
Orion Health is named to “2015 Careerbuilder Top Companies to Work For in Arizona.”
Hayes Management Consulting posts “System Implementation: 4 Stumbling Blocks to Avoid.”
Paula Gwyn of CareTech Solutions is appointed to the HIMSS Innovation Committee.
Extension Healthcare offers “Caregiver Alarm Crisis – What is Your Story?”
Galen Healthcare Solutions posts “For the Users, By the Users: ERUG 2015.”
Greenway Health offers “Improving medication adherence through education, communication.”
Madison Regional Economic Development visits Healthfinch on its Innovation Location tour.
Holon Solutions offers “Incentives are Good, but Tobacco Cessation App Can Improve Patient Success.”
Dallas-based telehealth vendor Teladoc raises $157 million in its IPO debut, valuing the company at $620 million. Stocks closed at $28.50, up 50 percent on its first day.
Leah Binder, president and CEO of Leapfrog Group, publishes a Wall Street Journal editorial suggesting that poor health IT implementations are plaguing US hospitals because the health care industry lags behind in technology and, as a result, hospital administrators lack the experience needed to successfully implement the new systems.
A survey of 272 physicians, administrators, and health IT professionals finds that physicians have a significantly lower opinion of their hospital’s ability to defend against a cyber attack than health IT professionals and administrators, and are far more likely to cite EHRs as the hospital’s primary vulnerability.
ONC will allow hospitals participating in Meaningful Use for the first time this year to attest this summer rather than waiting until January 1 as it had previously planned.
Building Pillars of Success on a Foundation of Failures By Randall N. Spratt
As the days fly by toward my retirement later this year, I’ve spent some time reflecting on my 40-year career in information technology. It feels like just yesterday I was receiving my diploma from the University of Utah, eager to jump into my career and make my mark. As college grads begin to enter the workforce, I hope that sharing my path and insights may help them build the foundation of their own leadership aspirations.
I started my technology career as a junior Fortran 77 programmer. I was good — I mean really good. I could write 10,000 lines of code without ever writing down an idea. I could produce a bug-free, error-free compile the first time. I was so good that I was quickly promoted to manager. However, it turned out that being a good programmer did not mean that I was a good manager.
On the brink of retirement, when I look back at my career, I realize that I built pillars of success on a foundation of failures. In my first management position, as a programmer, I would tell everybody how to program. When they failed, I would just do it for them.
I found myself working harder and being less effective because I wasn’t managing — I was doing. Somewhere along those first few management jobs, I had my first ah-ha moment: it was my job to deploy resources to help people do their jobs, not to tell or simply do.
Strong leaders know when to let go. They are effective in sharing a common vision with others and they make conscious — and sometimes difficult — decisions about what they do with their time.
As a programmer, I had 100 percent control over what I did at work. Every single line of code came out of my hand. No one else had anything to do with whether or not the program worked. Now, as a CIO and CTO, I have absolutely no control over anything. It has been a steady process of learning to relinquish control and replace it with influence and coaching while providing opportunities to collaborate as a team.
It took me some time to realize this, but as soon as I did, it immediately strengthened my management skills and things got a lot easier. Eventually, I began to spend more of my time traveling to our customers’ locations to install laboratory information systems. While on site, I gained a better understanding of the customer’s needs. I realized that what I was installing wasn’t necessarily what our customers wanted. To help solve this problem, I wrote more code. I felt that I knew what the end users wanted better than anyone else in my own company.
Once again, I began to fail because I took my eye off of the job of management. I was now a manager of managers. My job was to make sure that our customers were well served and that their voice was heard. The answer wasn’t to write more code — the answer was to relay information gleaned from the customer to the groups I managed so that we shared a common vision, a common set of goals, and a common understanding about what we were trying to accomplish for the customer.
It was very time consuming. The more responsibility I got, the more work there was to do, the more people there were to talk to, the more relationships there were to build, the more details there were to cover, the more people there were to appraise, the more raises there were to give. Everything took more and more time.
This led to my second ah-ha moment: work is part of life but, for some people, work is life. My career and leadership path would depend on how well I knew myself and how I decided to spend my time.
No matter where we are in our careers, we all have one thing in common — we have only 24 hours in every day. No more, no less. After choosing to spend some number of those hours asleep, our paths diverge. We choose when we wake up and we decide what to do once we’re awake. Some of us wake up earlier and choose to go running, while others start later and sit with the paper and coffee. Some fire up email, some talk to a spouse or a friend. But each one of us makes choices about how to use our time.
At that point in my career, I discovered I would never understand the term work-life balance. It is not about balance, it’s about choices, decisions, and how you choose where to spend your 24 hours. Sooner or later you are going to be faced with tradeoffs and decisions. You can’t be a top developer or a CIO of a company and think that you’re still going to service every hobby, every person, and every relationship in your life in the same way.
I created the time to be a leader in my field and I often had to give things up. Throughout the years, I gave up sports and many hobbies. As I began to have children, I chose to spend more time with my family and gave up time with friends. These choices were made consciously, with a deep knowledge of myself and a realization that although I was letting go of some things, I was gaining others.
As I look back at my career, I can recall many choices — some lucky, some wise, some painful, and some necessary. Writing code was easy — just me and the keyboard. The results spoke for themselves. Cultivating the skills to become a leader was much more subtle and nuanced, but in many respects, far more rewarding.
Allscripts invests $200 million in billionaire Patrick Soon-Shiong, MD’s startup NantHealth, taking 10 percent ownership of the company in return. At the same time, Soon-Shiong personally invests $100 million in Allscripts. The two have formed a partnerships to integrate and market their respective product offerings together.
CVS publishes findings from a study of customers with at least one chronic condition, finding that 37 percent reported contacting their physician by email within the last six-months.
A seventh grader in Vietnam has coded a program designed to help doctors and medical students review the latest medical research for conditions they see regularly. The system includes 300 evidence-based treatment plans and is now being used at Hau Giang General Hospital’s Internal Medicine Faculty.
Allscripts takes a 10 percent equity position in NantHealth for $200 million in cash, while NanthHealth billionaire founder Patrick Soon-Shiong personally invests $100 million in Allscripts. Co-development plans include product integration and work on personalized medicine. NantHealth is rumored to be mulling IPO plans, while Allscripts shares have dropped 16 percent in the past year.
Reader Comments
From Dr. N: “Re: EHRs. EHRs were developed out of coding and billing frameworks. This does not relate to MDs and patients. SOAP still remains the most efficient and meaningful format. However, click boxes, no doubt, would be helpful for meta data, also important. Software has the ability to pull down from the SOAP narrative format data to the click boxes. Minimal new language may need to be used by the MD in the narrative. I personally retired rather than using the completely useless EHR formats available. The current EHRs are subtly and obtusely changing MD thinking processes and predominately to the negative.”
From Libby Litigator: “Re: Blue Shield of California. You mentioned that a former executive claims he was fired for trying to reduce the company’s outsourcing payments to Cognizant. BSCA’s former CTO also filed a lawsuit claiming he was fired for pointing out issues with Cognizant. His new employer CEO also worked for Blue Shield as a policy guy and got tired of trying to defend its non-profit status after he saw how it operated. Has anyone ever done that on the hospital side?” That is indeed a fascinating story, as former BSCA CTO Aaron Kaufman says his CIO boss fired him the day before he was due his $450K bonus for 2014 after Kaufman questioned selection of a particular vendor. BSCA countersued Kaufman in claiming that he charged $100,000 in personal expenses to his company credit card. Some of those charges involved a bowling party night out Kaufman spent with his girlfriend, “Sharknado” and “American Pie” actress Tara Reid, which made BSCA doubly unhappy because “inappropriate” photos like the one above made their way into the public eye. Kaufman said he had to use his company credit card because the wife he was divorcing had locked up his accounts. Most interesting (other than a healthcare CTO successfully wooing a Hollywood actress, even a minor and fading one like Reid) is how a supposedly non-profit insurer can justify paying a CTO an annual bonus of $450K. Kaufman is now EVP/chief product officer of SocialWellth, which earns top buzzword scores in unintelligibly describing its app certification business that it bought from the defunct Happtique as, “a digital health company that enables payers, providers, and employers to prescribe curated digital health assets and services to their end consumers at relevant touch points in their health journey, and in turn, receive actionable data to deliver value based care. Our profile-driven mobile computing platform integrates and aggregates mobile health apps, devices, and content while leveraging activation currency and social engagement to deliver personalized well-being experiences for consumers.”
HIStalk Announcements and Requests
It’s been four days since I faxed a form requesting my electronic records from a hospital and they haven’t responded. The only other method of contact listed is to call the HIM department, so I’ll do that next. I’m feeling the presence of an increasingly non-electronic bureaucratic wall.
Webinars
July 14 (Tuesday) noon ET. “What Health Care Can Learn from Silicon Valley.” Sponsored by Athenahealth. Presenter: Ed Park, EVP/COO, Athenahealth. Ed will discuss how an open business structure and strong customer focus have helped fuel success among the most prominent tech companies and what health care can learn from their strategies.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.
Sales
PremierMD (FL) chooses the eClinicalWorks EHR and population health management suite.
UAB Medicine (AL) selects Athenahealth’s AthenaCoordinator Enterprise for patient access, referrals, and care transitions.
People
Verisk Health hires Sean Creighton (CMS) as VP of risk adjustment solutions.
A North Carolina newspaper’s review of 2014 CEO compensation of the state’s largest companies places Premier CEO Susan DeVore highest at $24.9 million, the first time a woman has topped the list. PINC share price is up 32 percent in the past year, valuing the company at $1.4 billion, of which DeVore holds around $8 million worth.
Alternate site billing systems vendor Brightree hires Lori Jones (AirStrip) and Shaw Rietkerk (MModal) as EVPs.
Announcements and Implementations
Wellcentive awards a $5,000 Medical Scholarship for Veterans to former Marine Captain Anthony DeSantis, a fourth-year medical student and Tillman Military Scholar at University of South Florida who was deployed to Fallujah, Iraq in 2007-2008.
Innovation and Research
A seventh-grade student in Vietnam creates Health for Everyone, prize-winning software that contains clinical information, treatment plans, a drug-drug interaction checker, and a weekly medical quiz. The local hospital’s internal medicine department is using it, proclaiming it to be “a wondrous, time-saving device which also updates doctors’ and nurses’ medical knowledge and expertise.”
Other
A Wall Street Journal article called “How to Take Charge of Your Medical Records” urges patients to serve as their own data hub instead of relying on providers and their incompatible systems to send information back and forth. The reporter got a bit confused in thinking that the Blue Button website contains actual Medicare and VA patient information and the article takes a puzzling turn into the privacy of wearable device data, but it was otherwise a pretty good consumer-focused overview. I was interested that the ICEBlueButton app from Humetrix displays a QR code on a smartphone’s lock screen that paramedics can scan to display emergency medical information, with a $20 per year option to also immediately alert their emergency contacts.
An AHRQ-funded study finds that providers like the convenience of allowing patients to upload information via their patient portal, but patients themselves struggle with usability issues and rarely upload anything. Secure messaging was accepted by both groups but sometimes caused provider workflow and workload problems. The study concludes that health IT improves outcomes only if used as part of more comprehensive programs and poor application usability impedes workflow.
Analysts from Goldman Sachs estimate that digital technology (in the form of the Internet of Things) will save $300 billion in annual US healthcare costs and generate $32 billion in revenue. My cynical experience is that the latter is much more likely to be realized than the former. One person’s excess costs is another person’s income and that other person often hires lobbyists, lawyers, and trade groups to keep the excess costs flowing into their pockets.
Eaze, the California company whose fast-track marijuana delivery service is known as “the Uber of pot,” jumps into telemedicine with with EazeMD, which consumers can use to obtain a medical marijuana card following a $25 video visit with a physician.
Tuesday night (June 30) is Leap Second, where the world’s clocks adjust for the slowing in the Earth’s rotation by adding an extra second to the day. Amazon had problems the last time it happened (in 2012) but has since changed its systems to add a tiny bit of time to each day rather than all at once.
A New Zealand doctor whose patient died after he unknowingly prescribed an inappropriate drug says he will no longer rely on his EHR’s automatic warnings and will instead review the records himself. The doctor says he doesn’t remember receiving a computer warning. The local hospital was also blamed for failing to integrate its systems after acquiring another practice.
A decently designed survey of CVS pharmacy customers with at least one chronic condition finds that 37 percent have communicated with their physician by email. Around half are interested in tracking health, refilling prescriptions, and looking up information, with their preferred method being via online portals, which finished slightly ahead of email or mobile apps. Oddly, the study commentary opines that patients prefer email and Facebook to physician portals even though its results indicate otherwise. Nearly 20 percent of respondents said they have contacted their physicians on Facebook, which will surely alarm hospital risk managers everywhere. The study is disappointing only in that it took two years for it to wind its way through the bowels of journal publishing – the survey was performed in May and June of 2013, a decade ago in social media time.
Unrelated but bizarre: two airline pilots from Argentina are fired for posting a YouTube video in which they turn over the controls of their plane during takeoff to a model who has been featured in Playboy. The passengers are filing suit against the airline, while the model says she will sue the pilot and co-pilot for sexual harassment in claiming they fondled her while fastening her seat belt.
Weird News Andy titles this story “Child to Be Raised By Wolves” in expressing relief that mom and baby Romulus are fine. A pregnant woman gets lost in a national forest while driving to her parents’ house and is stranded for three days when she runs out of gas and her cell phone battery dies. She gives birth and is finally rescued by Forest Service rangers responding to the forest fire she accidentally started.
Sponsor Updates
John Moore, managing partner of Chilmark Research, will deliver the keynote address at Galen Healthcare’s Galen Partner Advisory Council in Boston August 3-4.
ADP AdvancedMD offers “Flag these ICD-10 codes for the Fourth of July.”
Team AirStrip wins the San Diego International Triathlon Mixed Relay.
AirWatch offers “IDC confirms: AirWatch by VMware holds largest EMM market share.”
Besler Consulting posts “Making the Case for Dedicated Observation Units.”
CapsuleTech offers “AMIA Task Force Calls for Simplification and Speed in EHR Use.”
Caradigm offers “Super Clinically Integrated Networks will Lead the Way to Population Health.”
CareSync publishes “Project Manager Field Research.”
Though a number of competing bills have recently been introduced in Congress to delay or outright cancel the upcoming ICD-10 transition, AHIMA reports that the Senate Appropriations Bill remains free of any language that could derail the transition.
Researchers develop an algorithm that uses either EHR data or MDS 3.0 data to predict fall risk for patients in the nursing home setting, finding that EHR data was almost 10 percent more accurate at forecasting falls.
The Dallas Morning News looks back on the $18 million Meaningful Use attestation fraud scam that left the owner and CFO of Shelby Regional Medical Center (TX) in jail, citing it as a key example of why the program needs more stringent audits.
June 29, 2015Dr. JayneComments Off on Curbside Consult with Dr. Jayne 6/29/15
I agree with Mr. H that this is a slow time of year for healthcare IT news. Not only is it a slow time for news, but it seems to be a slow time for overall productivity as well.
I’m working with a client right now that is having a hard time getting anything done. Their teams are extremely lean and most staff operate without a backup, so vacations have a significant impact. Additionally, it feels like when we have the right people in place from the client side, there is a good likelihood that someone will be out from the vendor side.
I did some work a couple of years ago that involved a Swedish vendor. We were up against an extremely tight timeline because we had been warned that the entire company (literally) would be on vacation for four weeks during the summer. I remember thinking they must be terribly progressive, some kind of Scandinavian high-tech outlier going to extremes to keep their staff happy. After a little digging, we determined it wasn’t that unusual at all – since the late 1970s, Sweden has mandated five weeks of vacation for their workers. Many take the majority of them in the summer.
There are a variety of reasons that approach wouldn’t get very far in the United States. In addition to the political and economic factors opposing it, think about the planning needed to pull it off. Even for a small company, it would involve a great deal of strategic planning to ensure that the time off is factored into all projects. It would also require that projects are actually executed on time so that there are no last-minute pushes into the vacation.
In digging into the economic factors, though, I wonder if the return on investment for something like that might be real. If you look at the lost productivity encountered at a hospital like my current client, it’s significant. Workers are continually coming to the office late or leaving early for a variety of issues: traffic patterns are different with children out of school; childcare situations may be less predictable during the summer months; and tourism picks up in the city, resulting in parking and other logistical issues. We’re also seeing more people working from home to keep an eye on their children, resulting in a greater percentage of online meetings with barking dogs, background noise, and the occasional yelling dad who forgets to use the mute button.
I was looking for information on countries with more liberal vacation policies and came across this great Washington Post summary. It discusses the work of Swedish environmental psychologist Terry Hartig, who notes that those returning from a relaxing vacation tend to return to the office relaxed. I see more and more people “vacationing” with their smartphones, laptops, and piles of documents. Not only are they not enjoying their time away, but I’ve also seen feelings of guilt for those back in the office who feel bad for having to contact them. For those staffers who manage to avoid calling in for meetings, there are productivity-sapping discussions when their colleagues discuss the Facebook posts of those who are soaking up the sun.
Hartig’s research looked at prescriptions for anti-depressant drugs in Sweden over more than a decade. When people vacationed simultaneously, there were fewer prescriptions. The article (from 2014) lists the annual cost of depression at $23 billion a year in the US, so we can add that into the ROI calculation. Hartig also notes that Europeans spend less on healthcare and live longer than Americans – and have 20 to 30 vacation days a year. US companies seem to be cutting back on vacation unless it’s contractually mandated.
A couple of years ago, my health system did a “realignment” of vacation and sick time policies. They essentially declared that ours were too generous and out of line with other employers in our metropolitan area. We had previously been allotted seven corporate holidays and two personal holidays. The personal holidays were originally intended to allow employees to have time off for those holidays that were not corporately-declared, such as Christmas Eve, New Year’s Eve, Columbus Day, Presidents Day, Martin Luther King Day, Veterans Day, etc. if they were important to the employee. The HR people found out that no one else offered anything like that, so the personal days were cut.
That began a race to the bottom that ended with not only the elimination of the personal holidays, but all personal days in general. They also reduced the ability to carry over vacation days from year to year and eliminated the existing vacation buy-back program. They announced the new carry over rules during the last two months of the year. Many departments were getting ready for a major system migration after the first of the year and vacations weren’t being approved, resulting in many more employees who had to lose it rather than use it. Managers were given virtually no flexibility to accommodate their employees. The end result felt a lot like theft.
The Washington Post piece also notes that “the US is the only advanced economy with no national vacation policy (unless you count Suriname, Nepal, and Guyana).” Nearly 25 percent of workers have no paid vacation at all with those who do have vacation averaging 10-14 days a year. When I left my CMIO role, the vacation policies were a total patchwork. Employed physicians in direct patient care were allotted 15 vacation days and five continuing medical education (CME) days for a total of 20 days plus the corporate holidays. Administrative physicians had the same number of vacation days and holidays, but were allocated no CME days. I suppose that means that once you are an administrator you either lack the capacity to learn or the organization assumes you already know everything.
Anyone less than a manager title only got 10 vacation days, regardless of seniority. Even the sick-time policy was confusing. Hourly employees could take their time in one-hour increments but salaried employees had to take it in four-hour blocks. Although they told us that as salaried employees we had the ability to take an hour off here and there without formally requesting it, there was a lot of pressure to make up any time out of the office. The net result was that very few salaried employees were actually able to take advantage of their sick time unless they were seriously ill.
Losing vacation and sick days is fairly common, with the article mentioning an estimated 577 million unused days each year which equates to “$67 billion in lost travel spending and 1.2 million jobs.” Adding that to the ROI, I’m starting to wonder if we can afford to NOT take more vacation. It also mentions some interesting political facts:
In 1910, William Howard Taft proposed giving American workers two to three months of paid vacation each year.
John Muir recommended compulsory vacationing as better for the country than compulsory schooling.
The 1938 Congress proposed the 40-hour work week, a minimum wage, and two weeks paid vacation.
I’m taking several vacations this summer, mostly to make up for the lack of them during the last several years. I also have the luxury of being my own boss right now, so it’s much easier than before to schedule a vacation. It’s a bit harder to execute, though, since I’m a corporation of one. Even when clients are understanding and know I will be out of the office, it takes a conscious effort to disconnect. Checking my phone is tempting but it usually results in at least half an hour of work, so I try not to do it at all.
I’m staging all my projects for the next couple of weeks in preparation for some wilderness adventures. I can’t wait to be not only out of the office but in a place that literally has no cell towers or electricity. It also has no running water, but I’m not exactly looking forward to that. I’m sure some of my fellow travelers will be bringing solar chargers or Biolite stoves, but I’m not even taking anything with a USB port.
What’s your strategy for disconnecting when you’re out of the office? Email me.
A federal grand jury in Pittsburgh returned a 21-count indictment against a foreign suspect charged with filing 900 fraudulent tax returns using the information of UPMC employees, The employee’s data was compromised in a 2014 breach that impacted 62,000 employees.
A Veracode report finds that healthcare is poor at keeping up with security policy compliance, with 80 percent of tested healthcare applications containing cryptographic issues, and only 43 percent of known issues being corrected.
The Ventura County (CA) civil grand jury says that the Ventura County Health Care Agency failed to adequately prepare for its $50 million implementation of Cerner across two hospitals and 40 clinics. The new system, which the director of the Health Care Agency says is working fine, reportedly caused frequent crashes and problems generating prescription labels.
A federal grand jury indicts a foreign suspect for using employee information obtained in the 2014 hacking of UPMC’s computer systems to file 900 fraudulent federal tax returns that netted a group of conspirators $1.5 million.
Reader Comments
From FM: “Re: Brian Weiss’s article. Great article, Brian. The ‘HIE of one’ is the most simple, and most disruptive, way to achieve interoperability, and all enabled by simple technical building blocks (Direct, C-CDA) plus our inalienable civil rights. All we have to do now is ask. #GetMyHealthData.” I’m doing my own HIE of one, as you’ll read in the next paragraph. I invite readers to do the same and report their results. We keep talking about information blocking, so let’s name names in trying to wrest an electronically transmitted C-CDA from providers who have eagerly lapped from the Meaningful Use trough and therefore should be able to provide one.
HIStalk Announcements and Requests
I am accepting Brian Weiss’s suggestion that we all become Open Provider Authorized Testing Bodies in requesting an electronic copy of my discharge summary from my one and only hospital admission, which lasted less than a day. It’s an EMRAM Stage 7, Epic-using, MU2-attesting medical center that should be able to send a C-CDA to my newly created Direct address (via Carebox, signup for which took 10 seconds). I suspect clashes with a clueless bureaucracy are in my future as I’ve already had to print a confusing HIM-centric paper form, fill it out (minus my medical record number, since it’s ridiculous that they expect patients to know that), and fax it back (using a free Internet fax service since I don’t even have a landline, much less a fax machine). I’ll be interested to see how they verify my identity and respond to my request for an electronic copy, which could be either easier or harder since they use an outsourced release of information company. The form didn’t even ask what method of delivery I preferred, so if it weren’t for the fact that they’ll probably call up wanting a per-page fee paid before sending me my records, I would probably get a package of paper in the mail by default.
Speaking of Brian’s article, I’ll offer a counterpoint to his suggestion that getting a copy of your own C-CDA means the sender’s EHR is open. That’s a great start, but it doesn’t do a whole lot for interoperability with other providers. It’s annoying for health systems and practices to send out C-CDAs to patients, but it’s downright threatening for them to open up their full patient information to competitors, which is what you would want as the subject of the overused “unconscious in the ED” scenario.
Poll respondents are split as to whether the EXTREME criteria adequately define open, interoperable EHRs. The no-voters unfortunately didn’t tell us what the authors missed. IP address analysis showed no evidence of ballot box stuffing, but I noticed that most of the Epic-based respondents chose “no.” New poll to your right or here, as suggested by a reader’s comment: is HIPAA’s impact on privacy positive or negative? It seems like an obvious “positive” on first glance, but as the reader points out, HHS gave providers complete control to use patient information without consent and with minimal disclosure requirements, pretty much killing the idea that patients own their data (not to mention that the full law failed to accomplish the “P” of insurance portability that didn’t happen until ACA). Rampant misinterpretation of HIPAA, where providers conveniently claim that anything they don’t want to do is prohibited by HIPAA, is a different issue.
Need consulting help? Consider using the RFI Blaster, which lets you send a brief description of your project to one or several consulting firms via one simple online form, also allowing you to choose your desired method of contact (phone number is optional, in other words). The CIO of a large health system suggested I create it and he’s had success using it since it puts him in control while requiring little of his time or energy.
I’m on a pet peeve streak, apparently. For those who latched onto the trite phrase “not so much,” it’s as eye-rollingly out of touch as a leisure suit. I’m also annoyed at the traffic-desperate “news” sites that repeatedly tweet out old stories like “Epic CEO to donate 99 percent of fortune” over and over again for many days (the actual story was published 12 days ago and they’re still tweeting about it, while another just-tweeted story was posted 22 days ago) hoping to eventually con followers into clicking. It’s also like CNN, which keeps old stories high on the page hoping bored passers-by will click out of instinct, which at least isn’t as bad as milking minimal impact stories (still-missing flights or still-fleeing prisoners) while ignoring less entertaining but far more important topics, such as whether Greece will default or the impact of terrorist attacks in Tunisia.
It’s going to be an easy read today because nearly nothing is happening in healthcare IT this holiday week. I won’t waste your time passing off junk as news.
Last Week’s Most Interesting News
The Supreme Court upholds the legality of the Affordable Care Act’s subsidies for residents of states that don’t run their own health insurance exchanges, leaving ACA intact and sending shares of insurance companies and for-profit hospital companies soaring.
Google confirms that it is developing an industrial-grade, prescription-only wristband that will collect patient and environmental information for clinical studies.
Aurora Health Care (WI) takes a lead investor role in StartUp Health.
A Federal Aviation Administration RFI discloses its intentions to connect its pilot medical exam system to government EHRs, hoping to detect safety-endangering medical conditions such as depression.
Video visit provider MDLive raises $50 million in funding.
Webinars
June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.
July 14 (Tuesday) noon ET. “What Health Care Can Learn from Silicon Valley.” Sponsored by Athenahealth. Presenter: Ed Park, EVP/COO, Athenahealth. Ed will discuss how an open business structure and strong customer focus have helped fuel success among the most prominent tech companies and what health care can learn from their strategies.
Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by July 31.
Announcements and Implementations
Private equity firm co-founder Joshua Harris donates $5 million to create a precision wellness center at Mount Sinai Hospital (NY).
Privacy and Security
Google is caught secretly installing audio listening software as part of its Chrome browser extension that allows it to respond to audio commands.
A Veracode report finds that healthcare implements security poorly, with 80 percent of applications having cryptographic issues such as weak algorithms and only 43 percent of known vulnerabilities being fixed. Still, healthcare scored much higher than the bottom-dwelling government. The numbers aren’t necessarily relevant, however, since they include only those self-selected organizations that engaged Veracode to assess their software risk.
Other
A grand jury finds that Ventura County, CA prepared poorly for its $50 million Cerner implementation, with frequent downtime causing care delays. The agency defended itself by questioning why their project required a third review, with the jury foreman explaining, “We had complaints from the public concerning what happened after the system was live. There were still an awful lot of complaints.”
Bristol Hospital (CT) lays off 5 percent of its workforce in four areas, one of them the IT department.
The City of Pittsburgh drops its lawsuit challenging UPMC’s tax-exempt status and UPMC does the same with its countersuit, with the cash-strapped city hoping that more cordial relations will save legal costs and possibly convince UPMC (as well as Highmark, the University of Pittsburgh, and Carnegie Mellon University) to chip in some of the $20 million the city wants non-profits to pay toward their consumption of city services.
A former executive of Blue Shield of California files a wrongful termination lawsuit claiming that he was fired for trying to reduce its use of outsourcer Cognizant. He claims that a Cognizant VP tried to bribe him by offering, “You can join me for a party at a sex club in Sacramento. We have some very beautiful women there.” The company fired him for sexual harassment of women, saying his homosexuality was irrelevant.
Weird News Andy says this was an easily made termination, although firing isn’t enough. The Detroit Fire Department terminates an EMT who refused to respond to the house of an eight-month-old baby whose mother called 911 to report that she wasn’t breathing, with the EMT providing as an excuse to the dispatcher, “I’m not about to be on no scene 10 minutes doing CPR. You know how these families get.”
Sponsor Updates
Valence Health announces Penn professor and author Ezekiel Emanuel, MD, PhD a keynote speaker for its value-based care conference in Chicago September 30 – October 2.
Aventura describes implementation of its Roaming Aware Desktop at Republic County Hospital (KS).
Surgical Information Systems announces that motivational speaker Denise Ryan will keynote its Go!2015 User Meeting August 23-26 in Atlanta.
T-System will exhibit at TxHIMA June 28-30 in San Marcos, TX.
Zynx Health posts “Going Beyond the Web and Mobile Tech: Enhancing the Patient Experience Through the Next Wave of Digital Innovation.”
Valence Health will exhibit at the Health Technology Research Alliance & Council Summit June 28-30 in Gettysburg, PA.
ZirMed offers “How to reduce time spent working denials by 66%, streamlining front-end tasks to spend more time on patient care, and ANI news.”
Voalte offers “With Humility Comes Many Blessings.”
West Corp.’s Laura Bramschreiber offers “Helping patients graduate to good health” on the HIMSS Future Care blog.
ZeOmega offers “Payer/Provider Collaboration: What Works?”
Xerox Healthcare offers “Data Science That Simplifies Healthcare Delivery Analytics.”
Verisk Health partners with the Association for Community Affiliated Plans to provide its members with healthcare analytics education and results-driven programs.
HIStalk Text Ads Big audience, low price. Seven lines on the most talked about site in the industry. Easy - your ad starts in hours and is seen by thousands of visitors each day. more ...
The primary point of using the Cloud is using operating expenses vs limited capital ones and avoiding having to update…