Startup CEOs and Investors: Brian Weiss

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

Open EHRs, Soft Drinks, and Leprechauns

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

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

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

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

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

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

Send Me the Encyclopedia

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

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

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

Welcome to our Dysfunctional Family

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

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

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

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

Don’t Forget To Update Me on Progress Next Decade

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

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

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

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

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

You Probably Already Have an Open EHR

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

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

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

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

Open Provider

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

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

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

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

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

Which Brings Me Back to Cerner

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

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

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

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

Are We There Yet?

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

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

One Less Study for Mankind

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

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

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

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

Brian Weiss is founder of Carebox.

Morning Headlines 6/26/15

Supreme Court saves Obamacare

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

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

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

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

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

HIStalk Practice Interviews Steven Stack, MD President, AMA

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

News 6/26/15

Top News

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

People

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

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

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

Announcements and Implementations

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

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

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

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

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

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

Government and Politics

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

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

Privacy and Security

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

Technology

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

Other

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

EPtalk by Dr. Jayne 6/25/15

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 6/25/15

MDLIVE raises $50M from private equity firm

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

Best Places to Work in IT 2015

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

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

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

Welcome to our Newest CommonWell General Members

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

HIStalk Interviews Adam Turinas, CEO, Practice Unite

Adam Turinas is CEO of Practice Unite of Newark, NJ.

Tell me about yourself and the company.

Three of us started the company. I have a background in digital communications, building various digital user experiences for a couple of decades. My partner Stu Hochron is a 30-year practicing physician. The third leg of the stool is Ed Guy, who’s a PhD in computer science and who has developed mobile applications and voice over IP and things like that for as long as these things have been in existence. That’s the three of us who created Practice Unite.

This is our fourth year in the market. We started as a specialized consulting organization focused on helping healthcare organizations improve communications because we think that it’s, if not the biggest, certainly one of the biggest problems in healthcare. Within a few months, we thought, wait a second, mobile applications can clearly help solve a lot of these problems. That inspired the idea for Practice Unite. That was about three years ago.

We’ve evolved Practice Unite to be a mobile enablement platform for healthcare. What that means is that we have a system for delivering configured mobile applications that help clinicians communicate more effectively, help improve the way that healthcare systems engage with the patient, and also help address communication workflows and things like the management of high-risk patients. Even solving some of the issues in home care.

We’re casting across all of the different domains in healthcare because there are some common communication problems. We’re able to do that because we have a system that allows us to create highly configured applications pretty much on the fly.

Who are your competitors and how do their products compare?

The core competitors are in the secure texting space — TigerText, Cortext, companies like that. Our differentiation is the ability to deliver a much more customized and configured solution. We can deliver a customized solution which includes an integrated on-call system with the ability to escalate integration with the EMR so that lab results and consults are delivered into different containers within the application. Then it gives the hospital system the ability to do things like target different types of content for different users.

For example, we can do things like deliver KPIs to an individual physician. If you think about secure texting as being the fundamental commodity — the foundation of this new generation of communications products — we’ve taken it to another level by using that as a foundation for creating different communications solutions.

The other element is that we bring in other modes of communication. We include voice communications, whether that’s simply using the phone’s dialer in a way that makes it easy for physicians to call each other or integrating voice over IP. We have our own client for that. We’re now rolling out secure video communications as well.

When you look across the market right now, the primary buyers for mobile communications solutions are the CIOs, the IT teams for the various healthcare organizations. They default to secure text, so there’s lots of RFPs out there for secure texting solutions. But as they get into it, they immediately see that there’s a lot more that we could be doing with this mobile application. If we’re going to go to the trouble of deploying a secure text solution, let’s address a range of use cases. It might be about improving different workflows. It might be about making it easier to find a physician on call. It might be escalation or delivering clinical data. The market has evolved from being a point solution for secure texting to becoming platforms for delivering all kinds of different solutions.

When we entered the market, there were a number of secure texting vendors who were out there doing very well with it. We thought, we’ve got to go a step beyond that. When we built Practice Unite, we built it with a view of, this is where the market is going to be in two years. We’re finding that that’s the case.

What are examples of clients using photos and video?

I’ll give you a simple text and voice example. One of the things that we’re doing is integrating hospital systems and phone systems into the solution. You have a nurse web-based desktop because nurses tend to want to put the application on their own devices, a whole other BYOD thing. The desktop is configured so that when they send a message out to a physician, it automatically puts their extension in. The nurse might send a message to Dr. Smith, “Please call me about patient Jenny Jones. I need to update you on her condition.” The doctor receives that text message and can click the message and automatically be routed through to that nurse. One of our hospitals actually went from doing 150 overhead pages a day down to three because the nurses don’t have to page anybody any more. That’s a simple use case.

There’s a video on our website — it’s a wonderful story. The very busy ENT surgeon at one of our customers is also chief medical officer. At the end of the day, a small child presents with an upper airway obstruction. He has the child admitted, runs some tests, and tells the hospital that he’ll come back in the morning and most likely operate, but he’s not really sure because he isn’t really sure what is going on with the child. By the time he gets home, he gets a critical lab result that shows that the child’s white count is highly elevated. He gets a radiology impression, which confirms that the child has a mass that is probably an abscess. He opens up the app, opens up the on-call system, finds the resident on call, texts and says, “Send me a screenshot of the the MRI.” The resident takes a screenshot of it, texts it to him, and he responds back saying, “Put the child in for the OR and I’ll operate in the morning.” He came in the next morning, operated, and the child was back in his bed by 7:30 and was discharged later that day.

What he said to us was, putting aside the economics of it, the child spends probably less than 24 hours in the hospital when he’d likely be spending 36 or 48 hours in the hospital. Putting that aside, it’s better for the patient. The parents of the child know what’s going on because he’s able to give them accurate information quickly. The surgeon’s life is a lot better because he knows what’s going on. A simple combination of different communications modes working together very quickly is what’s compressing the time.

We’re getting into some very interesting telemedicine pilots. I can’t go into the details, but we’re in conversation with a group that’s taking care of some very high-risk patients with a serious infectious disease. What they want is for the care manager to have the ability to do a secure video communication with the patient on a daily basis. You can do that with Skype, but because they’re doing it through a mobile app, you can then add other features into the mobile app.

For example, the patient can provide updates on their condition or they can send a text message to the care manager between the calls, because they’re probably only going to do a video call once a week. Between those calls, they can send a daily update on the condition. They can send a text message that says, “I’m really not feeling well today.” That way the care manager gets ongoing feedback from the patient on the condition and then once a week can do a video call with them.

What’s the future of secure messaging over the next five years?

Secure texting is becoming a basic fundamental part of everything. The notion of a standalone secure texting application will pretty much be obsolete within a couple of years. I can’t see a reason why people would just buy a secure texting application on its own. Secure texting will become an ingredient for a different solution.

Where I think the market is going for us and where I think we’re evolving to is the ability to be in the middle of mobile-enabling all of these different workflows and all of these different interactions between clinicians and each other and clinicians and their patients.

Morning Headlines 6/24/15

Google Reveals Health-Tracking Wristband

Google X Labs has developed a health tracking wristband that monitors pulse, heart rhythm, sink temperature, and environmental conditions such as light exposure and noise levels. “Our intended use is for this to become a medical device that’s prescribed to patients or used for clinical trials,” says Andrew Conrad, head of the life sciences team within X Labs.

Less than 15% of Doctors Use RI Health Information Exchange

In Rhode Island, less than 15 percent of providers are using the state’s $25 million health information exchange, while 75 percent have yet to even setup their account.

Healthcare Revenue Cycle Management | 2015

Peer60 publishes a report on value-based payment models, with 36 percent of respondents reporting that they have already migrated to a new reimbursement model. Respondents expect that the changes will reduce capital spend, but only seven percent expect efficiency gains.

Beacon Hospital to become Ireland’s first paperless hospital

In Ireland, Beacon Hospital signs with EHR vendor Sláinte Healthcare in a deal worth $3.5 to $5 million USD. While a local paper predicts the deal will result in the first paperless hospital in Ireland, Sláinte’s CEO subtly clarifies, “It will scan historical charts and paper files as necessary.”

News 6/24/15

Top News

Google’s research division creates a prescription-only vital signs tracking wristband that will provide research-quality data for clinical trials. Testing of the device — which monitors heart rhythm, skin temperature, and environmental factors — will begin this summer and the company hopes to earn FDA approval.

Reader Comments

From The PACS Designer: “Re: USB computer. The Intel Compute Stick can be used anywhere with a wireless keyboard and could be used in wireless more via the HDTV USB port.” The $150 USB gadget turns an HDMI-ready TV or monitor into a computer, with the Atom-powered Windows 8.1 version including 2 GB of memory and 32 GB of storage. Intel suggests such use as digital signage, home entertainment, or as a thin client. User reviews on Amazon are mixed, mostly complaining about slow performance, iffy Wi-Fi, the single USB port, and the limited storage capacity. You could get a Chromebook, Android tablet, or almost a low-end laptop (certainly a refurb) for about the same money and then you’d have the keyboard, monitor, and USB ports.

From Graham: “Re: your comment about the healthcare status quo stifling innovation with political influence and financial clout. Regulatory capture will deepen for the next five years. It’s going to be a very rough ride, particularly in the USA where money is so influential in government. But eventually the stink will become too great for the treasure to ignore and change will happen.” My theory is that no matter what change begrudgingly occurs, the same companies and people will end up with all the money, just like that economic theory that you redistribute the wealth of the world’s 100 richest people and they would have it back within 10 years. That’s OK as long as overall healthcare cost and quality is improved – we’re wasting untold fortunes on US healthcare,  so at least we should perform better or spend less.

From James: “Re: Cache database. InterSystems claims it’s the fastest object database. I’d like to substantiate that claim by trying out their benchmark, but have made an inquiry with no response. Do your readers have insights?”

HIStalk Announcements and Requests

I always forgot to observe HIStalk’s birthday, which I believe was June 6. I started writing it in 2003, so that makes it 12 years old.

The folks at FormFast made a generous $1,000 donation to my DonorsChoose project, which was even more effective because of the matching funds provided by an anonymous health IT vendor executive (your company’s donation is welcome as well). I put the total $2,000 donation on the educational street quickly, as follows:

• iPad Minis, math manipulatives, and write and wipe boards for a K-2 class in Lake Charles, LA.
• Two Kindle Fires for small group math exercises in a Grades 5-6 class in New York, NY
• A STEM bundle for a Grade 4-5 class in Glasford, IL.
• A STEM bundle for a Grade 2-3 class in Knoxville, TN.
• Electronics kits for STEM lessons for Grade 6-8 intellectually disabled and autistic students in New York, NY.
• Wireless math manipulatives for a Grades 6-8 class in Shreveport, LA.
• A STEM bundle for a Grade 5 class in Little Falls, MN.
• Math games for an 8th grade class in Niagara Falls, NY.

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.

I’m running a summer special on both produced and promoted webinars since the industry is like a snoozing man in hammock for the next few weeks and I get antsy when it’s quiet. Sign up by July 31 and get a sizeable discount. Contact Lorre. We get good turnout — especially when companies take our advice about content, title, and presentation – and the ones we produce keep getting hundreds of views well after the fact from our YouTube channel. The record is held by the one Vince and Frank did on the Cerner takeover of Siemens, which has been viewed over 5,000 times.

Acquisitions, Funding, Business, and Stock

Fantastically named Myelin Communications acquires Dodge Communications, which does quite a bit of public relations work for health IT vendors. That also pairs Dodge with an odd sibling – Duet Health, which sells patient engagement technology.

Accretive Health, which has been on a financial rollercoaster and executive merry-go-round since its strong-arm patient collection techniques got the attention of Minnesota’s attorney general in 2011, lost $80 million in 2014 as net services revenue dropped nearly 60 percent.

Aurora Health Care (W) takes a lead investor role in StartUp Health, giving it early access to digital health investment opportunities and technologies.

Heal, which desperately wants to be Uber in offering $99 doctor house calls in Los Angeles in San Francisco, raises $5 million in funding for expansion. The company uses technology such as AliveCor ECG, CellScope otoscope, and electronic medical records.

Sales

St. Barnabas Hospital (NY) chooses Strata Decision’s StrataJazz for decision support.

Dublin-based Beacon Hospital signs for Slainte Healthcare’s EHR, hoping to become Ireland’s first digital, paperless hospital. Hint: as in US “paperless” hospitals, the folks making the proclamation aren’t watching the pallets of paper coming in via the loading dock, the elimination of which would send the hospital into immediate chaos.

People

McKesson names Kathy McElligott (Emerson) as CIO/CTO.

Ed Kopetsky, CIO of Stanford Children’s Health, is presented with a lifetime achievement award from a Bay Area business publication group.

Staff scheduling system vendor OpenTempo names Andy Comeau (Cerner) as CEO, with former President, CEO, and Co-Founder Rich Miller moving to chief strategy officer. Andy’s LinkedIn profile has an artistic but news-worthless long shot of him standing unrecognizably in front of a mountain (which I’m using above anyway to make a point), so perhaps it’s a good time to recite the LinkedIn photo rules: (a) use a professional head shot only, not one cropped out of a frat party group photo or police lineup; (b) post the photo in large size and high resolution so that news sites can use it without excessive graininess – LinkedIn will automatically thumbnail it so that clicking brings up the high-res version; (c) don’t get artsy-craftsy with a picture taken at a weird angle, with head or chin cropped out, or with a mountain in the background. LinkedIn is for business and profiles should include an appropriate photo, although mine doesn’t because the LinkedIn police made me take by Carl Spackler photo down (kudos to them for recognizing it, though).

EXL names Scott McFarland (McFarland & Associates) as SVP/GM of its healthcare business.

Announcements and Implementations

McKesson releases Paragon Clinician Hub, a Web-based navigation and workflow tool, as part of Release 13.0. Also included in Release 13.0 is integration with Zynx Health’s ZynxOrder order set management.

Peer60’s revenue cycle management report finds that CFOs are worried about value-based payment models and are anxious to reduce capital spending and IT costs. A pessimistic 14 percent of respondents say value-based payments will “bankrupt us,” while the roll-up-our-sleeves types are focusing on ICD-10 migration, improving the patient experience, and improving point-of-sale collection.

ZirMed announces a Denial and Appeals Management solution.

Nuance will include data analytics from Jvion in its Advance Practice Clinical Documentation Improvement to compare clinical documentation to payments and quality scores.

T-System joins the CommonWell Health Alliance.

A statistically lacking HIMSS survey of health information organizations (75 responses) finds that Direct messaging is popular for care coordination, but connectivity to EHRs isn’t great.

Other

Orange County (CA) Health Care Agency requests double its original estimate of $796,000 to complete the second phase of its Cerner behavioral EHR project for mental health patients, with the total project cost increased to $8.8 million.

The Providence, RI newspaper observes that less than 15 percent of the state’s physicians use the state’s HIE, which cost $25 million in federal money plus the state’s cost. A representative from the state medical society says, “It will make docs’ lives easier eventually, but so far, it’s only made insurance companies and EHR companies happy.”

The American Society of Clinical Oncology publishes a formula to assess the cost vs. benefit of new cancer drugs, the first step in developing software that can be used by oncologists at the point of care. One drug that costs nearly $10,000 per month in generating $2.8 billion per year for its manufacturer scored a zero in net health benefit.

Weird News Andy says, “You CAN handle the truth” in describing the $13 bacteria-killing door handle invented by two Hong Kong high school students. WNA also proclaims “strangling her legs” in describing a case study of a woman with temporary leg nerve and tissue damage caused by squatting too much in her skinny jeans, which were so tight doctors had to cut them off.

Sponsor Updates

• ZeOmega posts “Payer/Provider Collaboration: What Works?”
• Coalfire Systems analyzes the security of InstaMed’s healthcare payment solutions and concludes that they “have the most effective data security controls available in healthcare today.”
• Experian Health partners with two companies to offer healthcare organizations a credit card processing device that meets the October 1 deadline for implementing EMV chip-authenticated credit card standards.
• AirStrip offers “Shifting Our Thinking to Prepare for the Future.”
• Besler Consulting offers a podcast on the “QualityNet Hospital-Specific Report.”
• Clinical Architecture offers “Understanding ICD-10-CM – Part III – A Terminology by the Book.”
• Atlanta public radio highlights Clockwise.MD in “Local App Reduces Time Spent in Urgent Care Waiting Rooms.”
• Gartner positions Commvault in the Leaders quadrant of the Magic Quadrant for Enterprise Backup Software and Integrated Appliances.
• CoverMyMeds offers “Proactive, Analytical and Interoperable Trends Affecting Today’s EHR Systems.”
• Culbert Healthcare Solutions offers tips for “Allscripts Upgrade Services.”
• AirWatch offers “Virtual Training Experience available with AirWatch Labs.”
• Burwood Group is named one of “Chicago’s Best and Brightest Companies to Work For.”
• Anthelio Healthcare Solutions will exhibit at the 2015 TxHIMA Convention June 28-30 in San Marcos, TX.

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 6/23/15

Provider Experiences with HIE: Key Findings from a Six-State Review

ONC publishes a report on provider perceptions of state health information exchanges, finding that the needs of providers and ACOs have surpassed the basic requirements outlined in MU. Access to care summaries, ADT alerts, and medication reconciliation support are the most valued services offered by HIEs.

Cigna rejects Anthem takeover bid

Cigna has rejected a $47 billion offer to acquire the insurer by larger rival Anthem, calling the offer inadequate and “woefully skewed in favor of Anthem shareholders." The offer came in at $184 per share, an 18 percent premium on Cigna’s closing stock price on Friday.

Budgetary and Economic Effects of Repealing the Affordable Care Act

The CBO publishes the financial implications of repealing the ACA, finding that regardless of whether the entire law is repealed or only the contested federal subsidy portion, any repeal will add to the national deficit.

House votes to repeal medical device tax

A bi-partisan majority in the House of Representatives votes to repeal the Medical Device Tax enacted as part of the ACA. The President has promised a veto should the bill clear the Senate.

Curbside Consult with Dr. Jayne 6/22/15

A reader commented on last week’s Curbside Consult asking about effective leadership teams:

I would love to hear about effective leadership teams and how they become that way. I am not part of our organization’s leadership, but occasionally interact with them and also hear info from people who more frequently interact with them), and it just seems that the more layers we add – VP, SVP, EVP – the more work is created without true hierarchy and responsibility. We don’t even have a clear IT leader. Is it our VP of IT? Our Chief Innovation Officer, who replaced our Chief Information Officer, but she seems to have limited interest in core IT functions? Our new EVP of “peripheral” services like IT, Finance, Pharmacy, etc.? God only knows. And yet even with an expanded leadership “team,” they all give the impression of having too much on their plate to concentrate at the issue at hand or even, yes, show up for meetings (much less on time!)

There are plenty of books out there about building effective leadership teams. Although they may have good information from an academic standpoint, it’s often hard to put those theories into practice, especially in an environment as chaotic as healthcare.

Most of my early experience in leadership was not on the IT side but rather the operational side of an employed medical group. As I moved through the ranks to CMIO, I was exposed to a lot of different leadership structures within my own health system and was a member of several highly functional teams. Unfortunately, I was also a member of several highly dysfunctional teams. Through interacting with other customers sharing our core vendors I’ve been exposed to even more teams all across the spectrum. Those experiences have given me a lot to consider in answering the question.

Now that I’m in consulting, I’ve had to put together my own methodology for helping people move in the right direction. There’s no one answer for how to get a team to be effective, but there are some key characteristics that have to be present.

First, the group has to communicate effectively to lead effectively. Although some people are naturally strong communicators, most aren’t. In order to drive people in the right direction, I’m a huge fan of applying a great deal of structure regarding communication. All of my clients have to sit through a communication skills for leaders class with me and do a communication matrix exercise where the team decides and documents how they’re going to communicate, at what points in the project/initiative, with what methodology, to what audience, and by whom. Once they put pen to paper, I ride herd on them to make sure they’re sticking with the program. A successful team will realize that they don’t need a consultant to keep them in line and will take on the tasks themselves. I continue to prod them a little to make sure it’s sustainable.

Communication isn’t just how they report things out — it’s how they document things day to day and operate when they’re communicating (for example, in meetings). Do they have written (and time-boxed) agendas before the meeting? Does someone facilitate the meeting, allowing people to participate without worrying about minutes or timekeeping? Does someone take good minutes and get them out the same day? Are meetings halted when key people are missing rather than wasting everyone’s time because topics will have to be revisited with the appropriate people in the room? Are there ground rules for meetings to make sure everyone plays nice with the other kids? Making sure the answer to all those questions is “yes” helps a leadership team become more effective.

Second, effective teams have buy-in to their project. Ideally the team has been together since the project’s inception, participating in charter creation, writing a mission statement, etc. That’s usually not the case for most organizations, where people come and go or restructuring seems like its own constant. Teams that actually understand and agree to try to deliver the mission do much better than those with only a loose understanding. For people who don’t natively buy-in, an organization needs strategies to either coach them to arrive at that point or employ incentives (or penalties) to elicit the desired behavior.

Even people who may not agree with a given mission tend to be motivated by financial or other incentives. Consider Meaningful Use: whether it was the carrot or the stick, it sure got a lot of physicians who didn’t natively give a hoot about EHRs to actually install them in their practices and start using them. In working with end users, recognition and small rewards (giveaways, raffling off gift cards, etc.) can make a huge difference in aligning people’s actions with the end goals. Teams that either have buy-in or are otherwise motivated tend to show up on time and ready to participate.

Third, effective teams have to have clear leadership. I sympathize with your comment that the more leadership layers that are present, the less effective the leadership is. I recently worked with an organization that suffered from what I can only call “title bloat.” Their VP level people were what would have been considered directors at best in my former health system. Did I mention they had assistant VPs, associate VPs, VPs, senior VPs, executive VPs, system VPs, and more? Many of the titles had no discernible meaning, but were used as ways to try to elevate people or reward performance without giving raises. It led to an arms race where they had to keep promoting others to keep parity among the ranks.

Regardless of what people are called, someone has to be in charge. There has to be, in the words of one of my favorite executives of all time, a “single neck to choke.” That person should come into the office every day asking, “What’s at risk today, this week, this month” and address the issues when his or her team answers the questions. In shared initiatives, there have to be clear leaders for operational, technical, and clinical pillars. For those types of shared structures, I like to add additional necks to choke in the form of a steering committee that meets regularly and addresses a standard list of project metrics (budget, timeline, risks and mitigation strategies, etc.) People always ask me who is best to own a project. Operations? IT? Clinical leadership? I’ve seen them all work, provided the structures are in place to ensure accountability. I’d rather have a well-organized leader from an “underdog” part of the organization than a disorganized alpha dog.

The leader has to have skin in the game. They should feel personally responsible if their project is not meeting expectations. The right person will have this quality intrinsically. Others can be motivated (again, think bonus goals or incentives) to put it on the line. The leader also has to have dedicated time and resources to lead the project. In a stakeholder assessment I did recently, the designated IT leader was overseeing hospital revenue cycle and ambulatory EHR implementations, both at the same time. The projects were headquartered on opposite sides of town and both were billed as “highest priority” for the health system. The sheer logistics made it almost impossible for her to be hands-on in the way needed for success because she always seemed to be driving to one location or another for a meeting, while taking another meeting in the car. It was no surprise that both projects were failing.

In my opinion, these three elements are key. When they’re not well defined or executed, things can very quickly fall apart. Of course there are dozens of other “essential” facets of effective teams, but these are the ones I see malfunctioning the most often. Sometimes they’re easy to fix and sometimes you scratch your head figuring out how in the world you’re going to patch things together enough to get the job done. Sometimes it takes an outsider to figure out which person is the square peg in the round hole and how to rearrange them. Sometimes it takes a major project failure to get people to wake up and pay attention. I’d be interested to hear what others think.

Have an opinion on what it takes to build an effective team? Email me.

Email Dr. Jayne.

HIStalk Interviews David Lareau, CEO, Medicomp

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

Tell me about yourself and the company.

I’ve been here since 1995. I discovered Peter Goltra and Medicomp when I was in the billing business and had a customer who wanted electronic health records.

We provide the MEDCIN engine and software. Our sole purpose in life is to present the relevant clinical content to a clinician at the point of care so that they can treat the patient, get their documentation, and have all the billing and Meaningful Use stuff happen in the background so they can focus on the patient, find the information they want quickly, treat the patient, and get on to the next patient. Not slow them down or get in their way.

You have quite a few physicians developing content and helping design the Quippe product and you’ve recently hired Jay Anders as chief medical officer. How do those physicians drive product direction?

We have a knowledge engineering team that, going back to our start in 1978, sits with the physicians and says, you’re treating somebody with asthma — what are you thinking about? What are the symptoms, history, physical exam? What are the tests and therapies? What are the other things that intersect with asthma? What are the co-morbidities? What would differentiate asthma from something else that has a similar presentation? It’s an endless series of peeling away the onion.

The questions that we have for the providers are, what would you want to see given this presentation? Some people think we’re trying to tell the docs, "Here’s what you should do." We’re presenting back through software what the doctors have told us they would want in that case. As you might imagine, it’s an iterative process. It never ends. Things are always changing.

We have anywhere from 15 to 20 physicians active at any point in time. They work with our knowledge engineering team. Jay Anders has joined us recently, because as you add more content to anything, it can tend to complicate life for the user. The more concepts you add to things like SNOMED, to other terminology sets — you’re seeing it with ICD-10 now — more content puts more pressure on the provider of software to make it usable at the point of care.

Jay Anders came on board because he represents the clinical end user for us. OK, Jay, I want your input on everything we do. Are we making it easier or are we making it harder? What should we be showing? What options do we need? How do we let the users control what they’re doing without slowing them down and getting in the way?

Putting more information in front of a user is not always the answer. It’s the right information at the right point in time. Does the engine have the content? Do the UI tools that we’ve built around it to help people deploy it provide for a proper presentation that the docs like, allow them to focus on the patient, and get all that other stuff in the background? There’s a lot more interaction.

One of the things Jay is doing for us is defining ways to do better work flows at the point of care and also recruiting our clinical advisory user  group of physicians, not just a knowledge engineering group. We have two teams that work in parallel.

How many employees does the company have and what do they do?

We have 20 employees now. The last time we talked, we probably had about 10 or 11. We have seven people who are developers. We have three people who do terminology, stuff like mapping to ICD-10, SNOMED, LOINC, Meaningful Use, etc. We have three people who do testing. We have three people in product management. We have three or four people in knowledge management.

Then we have the clinician advisors. We have two-full time physicians on board doing that. Then we have about 10 or 15 who are on staff at major medical centers. They’re not employees, they’re contractors. They do a lot of work with our knowledge engineers on the knowledge base using our knowledge editing tools.

Peter Goltra had a great idea in MEDCIN, but it didn’t feel like a real business early on. What does it take to turn a great idea into a great business?

Focus. Absolute core focus on what you do, what you do well. Any time you’re in the kind of business that we are in — development of intellectual property, development of content, development of techniques to present things — your sole asset is your people. You’ve got to find the best people and you’ve got to keep them.

I consider salaries the only expense I will never cut because those are the people who produce what we have that is of value. Everything else is negotiable. I can move into smaller office space. I can do less travel. I can have non-fancy furnishings, which we do. But we want the best people. We never want to lose anybody, because when you lose somebody, it slows you down. You lose their energy and other people have to make up for it. 

One of the things that happens in other companies is that they don’t focus on one thing. As they get successful, they start doing things they shouldn’t be doing. When bad times hit, they cut their head count. Our head count is our asset. That’s it. I’m not talking about in terms of numbers, I’m just talking about terms of quality. We pay people very well. We treat them very well. We contribute six percent to their 401(k) whether they do or not. We recognize them. We listen to them. We empower them. They love working here. We don’t lose people. That gives us continuity. That allows us to build in successive versions of what we do, on what we had before. 

We do not become unfocused by saying, “They said we should do dental software.” Somebody else says, “Why don’t you guys do a drug database? or somebody else says, “Why don’t you do this?” No. We provide an engine to present relevant information to clinicians at the point of care. That’s what we do. If it doesn’t have to do with that, I don’t want to do it. That’s it. Great software gets produced in small, very collaborative, highly productive teams of experienced people who know what they’re doing and are very committed to it.

I assume Medicomp has been around long enough that you don’t have impatient investors demanding that you do something that sacrifices long-term success for short-term profits. Do you see that happening with other companies?

Absolutely. Anybody that has to answer a quarterly conference call is under that pressure. Any time there’s a blip in earnings or revenue, they really can’t do long-term investment at the expense of short-term results, so they cut people.

We’ve seen some of our own licensees — I won’t mention any names, but the news shows up in HIStalk all the time — they cut and then they hire and then they cut and then they hire and they rearrange and they right size and they downsize and they expand and they cut. It’s a tough way to build a business.

Our advantage is that Peter got into this because he loves what he’s doing. He carried the company through from 1978 to about 1992. We are owned by employees, Peter, and some family members. Everybody here is a stockholder. We’re all invested in the same thing. We all have a long-term vision because we believe that eventually, these systems have to be usable by clinicians at the point of care, and right now, they’re not. That’s why we’re starting to make some inroads.

Are EHR vendors are concerned about usability issues given that most of their development agenda is sucked up by ICD-10, Meaningful Use, and quality measures?

They’re not concerned about it yet. There’s a couple of reasons. The government has just pumped $30 to 40 $billion into HIT. They said that in order to qualify for this money, these are the things you have to do. That’s been a great boon to the sales, revenue, stock price, and valuation of the big vendors because here it is — just do this and you’ll get it.

At the same time, ICD-10 CM is no picnic and neither is Meaningful Use. Those things are so challenging that many physicians have said, well, to heck with this — I’m going to sell out and become an employee. Then they become disempowered by the organization. It’s happened here in northern Virginia. There’s one health system that dominates. They’re buying up practices left and right. They don’t have to listen to the docs right now. They haven’t had to listen to them for a few years because they’re doing great. They’re addicted to this money, which has let them do what they do, not have to adjust, etc. The docs aren’t really empowered, so usability, schmoozeability, we don’t care. It’s not a factor yet.

We think it will be, which is why we have folks like Phoenix Children’s Hospital coming to us and saying, our vendor’s not delivering on usability. Our docs need something they can use. Can we give it a shot with your software and put it in? And they did. Their vendor, Allscripts, tried to talk them out of it, but ultimately cooperated with them. They put it in. Within nine months, their docs love it. They’re seeing 30 percent more patients per day and they’re leaving early. 

I believe that once the tsunami of money coming in dries up, they’re eventually going to have to turn back to, how do we make doctors more productive? Particularly given that with the new health insurance laws, there are more patients to treat and possibly fewer primary care docs to do it. As we go to outcomes-based reimbursement, they’re going to be paid for how well they care for patients. We still think that’s going to happen one patient, one clinician at a time. You need to be able to efficiently provide care, so at some point, you’ve got to make this usable by the providers. 

That’s what we’re hoping. We’re starting to see that. We’re starting to get some traction in that. And as you said, we’re a more patient company than most.

I thought your business was working through EHR vendors who signed up to embed your product into theirs, but Phoenix Children’s went their own direction. Will you offer Quippe or the MEDCIN engine directly to customers without their vendor’s involvement?

Well, possibly. I don’t want to do that. I want to go through the vendors. But Phoenix came to us. They asked their docs, “What do you want for documentation?“ They did about a six-month analysis with the docs. The docs found it. They presented it to Allscripts. Allscripts said we’re not going to do that yet — we might have something in two years. 

Then they came and played our Quipstar game at HIMSS and said, you guys have what we want — can we try it? We said no, we don’t do that. They said, we’re a co-development site for Allscripts. We have access to their code. We’ve convinced them to let us do it. They think we’re going to fail, but they said they’d let us do it.

They had a great team, which is why I don’t want to do it with many other people. They had the best team I’ve ever seen. There’s a reason they got that award a few years ago as the best IT department. David Higginson is a demanding visionary leader, I’d call him. He had one programmer work on this part time for about nine months. They did the full integration with SCM. It went very well, beyond their and our wildest dreams. We had to back up and say, hold on, what are we going to do now?

We’ve done a couple of things. We learned a lot in that process. We’ve made it much easier to integrate Quippe with an existing system. As evidence of that, the next thing we did was when Bangkok Hospital in Thailand came to us. They have an IT subsidiary called Greenline Synergy. We’re getting some really good traction in Asia, in the Asia Pacific region, but we’re not implementation and training people. That’s not what we are and that’s the danger for us. When I talk about focus, I don’t want to do that.

They came to me and said, we want to do a little pilot. We want to see how quickly we can take Quippe and stand it up in one of our ambulatory clinics, and if it goes well, we will consider becoming your implementation, training, support, and distribution partner in Southeast Asia. Because we already have Bumrungrad Hospital live on the nursing stuff and we’re getting a lot of traction in Malaysia, I said, OK, let’s try it. They came here on April 27.  They sent three people — two developers and their clinical lead. They spent two weeks with our team. They went back. They got back to Bangkok on May 15 and they are now live in their ENT clinics with Quippe for physician documentation.

Is the product the same no matter where it’s installed? There’s nothing that needs to be localized?

It needs to be localized. We’ve had to build in some options for people that allow for localization. We did a project about four or five years ago where we said, if they really want to present it in local language, we will never get caught up, because there are 300,000 concepts, positives and negatives for each, and multiple presentations of each. But we did a little study and found that about 10,000 meds and concepts constitute about 95 percent of all documentation activity. Common things are common.

We did that. We did a translation into Thai, Chinese, and Spanish just as a test. When it came back, people said, we don’t really care about that because we operate in English a lot, but we use different forms of things in English. In Australia, they say "nappies" instead of diapers. We had to build in some additional tools to say to people, you can replace things by user, by site, by specialty, by country, etc. It’s sort of a localization pack.

We also have made it much easier for people to change the way that the engine behaves, because infectious disease things in Singapore are taken much more seriously than they are here because of the density of the population — they don’t want hand, foot, and mouth disease getting loose in even one building because it’s so contagious, so they want the software and the engine to work a little bit differently. They want to promote those things and get them right in front of users. It’s similar to what happened here when everybody decided we had to ask a few questions about Ebola. Think about that as a massive localization at every hospital in the United States for a while, although it’s kind of died down now. We’ve had to put in tools that make it much easier to localize our content and localize the operation of the engine.

What will be the biggest factors impacting healthcare IT over the next five to 10 years?

The concrete is poured, in the United States at least, for people who have spent the time and money to put in the systems that they have, which are heavily based on transactions, billing, and organizing admission-discharge-transfer stuff. This is our hope and this is our plan — that attention will turn back to, what are we going to do? How are we going to make all of this big data that everybody’s talking about actionable at the point of care? 

People are going to take a couple of different approaches. People like IBM with Watson, people working on all the natural language processing stuff, big data, all that. They’re going to approach it from the standpoint of, we can analyze all this information on the population and we can detect trends. Now whether they can do just correlations or causation, I don’t know, but at some point, if you’re going to improve outcomes, that stuff has to come back and be usable at the point of care.

We think that’s our opportunity. That’s what we provide. If we’re wrong and nobody cares about that, I probably won’t be around for you to talk to me in 10 years. But we think it’s turning because we’re getting more and more people come to us and say, can we do what Phoenix Children’s did? We spent all this money, our doctors still can’t use this stuff, we’re not getting the data we need, and we’re not pushing it back to the point of care – please help us do that. I think after the dust settles with ICD-10 and Meaningful Use, the industry is going to turn back and say, we’ve poured the concrete, now how do we build a road that these docs and nurses can use?

Morning Headlines 6/22/15

Aerospace Medicine Safety Information System (AMSIS)/ Request for Information

The FAA publishes an RFI for a system that it will use to track medical certifications, coordinate its substance abuse program, and integrate with NHIN and state and regional HIEs to collect medical information on pilots.

Personalized Technology Will Upend the Doctor-Patient Relationship

Harvard Business Review predicts that wearables, implanted devices, and medical apps will eventually deliver a 24/7 picture of individual health, revolutionizing the way chronic diseases are treated and managed and creating a gold-rush style influx of activity from existing businesses and startups. 

8 Indicted in Identity Thefts of Patients at Montefiore Medical Center

Eight Montefiore Medical Center (NY) were indicted Friday on charges of selling 12,000 medical records for $3 each, exposing the names, birthdays, and Social Security numbers of its patients.

Tamper-proof pill bottle could help curb prescription painkiller misuse, abuse

Engineering students at Johns Hopkins University’s Whiting School of Engineering createda 2.7 pound, 9-inch tall, tamper-proof pill bottle that uses fingerprint scanning technology to ensure that narcotics are dispensed only to the prescribed patient. The team cites the growing number of prescription drug-related overdoses as the motivation behind their work.

Monday Morning Update 6/22/15

Top News

The Federal Aviation Administration wants to connect its Amsis pilot medical certification tracking system to government EHRs via NHIN and HIE connectivity, hoping to detect safety-endangering medical conditions such as the depression of the Germanwings pilot who deliberately crashed his plane into the French Alps. The privacy considerations would be extensive.

HIStalk Announcements and Requests

More than half of poll respondents don’t use any smartphone health apps other than fitness trackers, although 17 percent say they use five or more. New poll to your right or here: do Sittig and Wright’s EXTREME criteria (defined here) accurately define EHR openness and interoperability? If you vote no, it’s only fair that you click the poll’s Comments link to describe what they missed.

Welcome to new HIStalk Gold Sponsor Dbtech. The Edison, NJ based document management, electronic forms, and document imaging company offers solutions for document and data archive, paperless registration, patient portal, reporting standardization, and no-silo storage of images. Dbtech’s Ras document management is installed in 350 community hospitals and works with all applications (Cerner, Epic, Meditech, etc.) regardless of hardware, OS, or database and contains workflow automation for SmartLinks, data extraction, AutoPrint, forms, email workflow, and HL7 and other integration standards. Case studies include Saint Michael’s Medical Center, Greenwood Leflore Hospital, Palisades Medical Center, and Mount St. Mary’s & Evangelical. Thanks to Dbtech for supporting HIStalk.

Listening: The Struts, British 1970s-style hard rockers that sound to me like Queen genetically spliced to The Hives and Quiet Riot.

My latest grammar gripes: Yelp restaurant reviewers who talk about their “palette” when referring to their “palate,” almost as annoying as those who didn’t realize the 15-minute shelf life of the trite phrase “to die for” ended years ago. People who needlessly insert “very” in front of words or phrases. Unskilled writers who ask their imaginary readers questions and then answer them instead of just making an authoritative statement in the first place, such as “Do we need ICD-10? Yes.” instead of saying “We need ICD-10.” Starting a sentence with “know,” in a pompous attempt at conveying sincerity, as in “Know that we will support our employees” instead of simply saying, “We will support our employees.” It also bugs me that people still think “the reason why” is somehow better than the correct “the reason.”

Last Week’s Most Interesting News

• England’s NHS announces ambitious health IT plans that include making real-time medical records available to patients by 2018 and issuing wearables for inpatient monitoring. NHS also goes live on its new e-referral service and then shuts it down almost immediately for an undetermined time due to known problems.
• Dean Sittig and Adam Wright propose EXTREME, five criteria that define whether a given EHR is open and interoperable.
• The draft budget submitted by the House Appropriations Committee holds ONC’s funding flat, does not include money for ONC’s proposed Patient Safety Center, and calls for AHRQ to be shut down immediately.
• CVS opens a Boston digital innovation center that will eventually house 100 employees, while the company also announces that it will acquire Target’s pharmacy business for $1.9 billion.
• HHS OIG finds that the federal government is paying many billions of dollars in insurance subsidies based purely on estimates since CMS still hasn’t finished the software modules that are needed to calculate the amounts correctly.
• The VA announces a three-hospital pilot of its open source, open system eHMP integration tool that allows VA clinicians to view context-aware information from non-VA systems such as the DoD’s EHR. Meanwhile, a GAO report that details the delays and cost overruns of high-risk federal government IT projects points out the repeated, expensive failure of the VA and DoD to integrate their EHRs.
• CHIME co-founder Rich Correll announces his retirement.

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.

Acquisitions, Funding, Business, and Stock

Virtual nurse technology vendor Sense.ly raises $2.2 million in a Series A funding round.

Investors who invested $50 million in preferred shares of Merge Healthcare to finance its February 2015 acquisition of DR Systems waive their right to have Merge redeem their shares by August 25, 2015, a vote of confidence that their hastily made investment is still attractive post-acquisition.

Sales

Fairview Health Services (MN) chooses Paragon Development Systems (PDS) for IT end user device asset management.

HealthShare Exchange of Southeastern Pennsylvania chooses Mirth solutions for Direct messaging, integration, MPI, and CDR.

Announcements and Implementations

SSI Group will resell Recondo Technology’s automated claims status solution as part of its revenue cycle solution suite.

Government and Politics

The State of Virginia notifies providers that not only must they be ready for the October 1, 2015 switchover to ICD-10, but also that the state will simultaneously stop using of the similar but separate DSM codes for mental disorders.

CMS awards Data Computer Corporation of America a $24 million contract to support the IT system that supports payout of Meaningful Use money.

A union representing the Pittsburgh VA, trying to gain bargaining power, says implementation of an inventory management system from Shipcom Wireless is stressing out its members. The system, which is being rolled out to all 152 VA hospitals in a contract worth up to $275 million signed in September 2013, is already live in 12 VA hospitals.

Privacy and Security

A clerk at Montefiore Medical Center (NY) is charged with selling 12,000 patient records for $3 each to co-conspirators who used the information printouts to go on luxury shopping sprees. It’s interesting that hospitals always seem to be involved in this kind of breach while retailers aren’t – maybe hospitals are different in their security precautions, hiring practices, breadth of information collected, or employee oversight.

Technology

NTT Data not only sponsors Chip Ganassi’s IndyCar racing team, but provides it with technology ranging from inventory tracking to a wearables device being created by the company’s healthcare division that will monitor the driver’s physiology. I’m suddenly struck by yet another fantastic business idea, of which surely one of mine will pan out one day: sell ad space on the white coats of doctors like NASCAR does its driver fire suits, where every available inch features the emblem of a paying sponsor. Uber could do the same, paying contract drivers to turn their cars into rolling ad space.

Mechanical engineering students at Johns Hopkins University develop a tamper-resistant, biometric-secured, one-at-a-time pill dispenser, which assures that pharmacy-dispensed drugs like oxycodone are used only by the intended patient.

Other

Nebraska Medicine announces its use of Epic’s MyChart on Apple Watch, allow its patients to receive provider messages, appointment reminders, medication information, new results availability, and notification that earlier appointments are available so the patient can accept the proposed time directly from the watch.

I think Vince Ciotti misses writing his HIS-tory series that I ran for a couple of years, as evidenced by this new episode that looks back on the buyer seminars his company has been putting on since the good old days.

A Harvard Business Review article says personalized technology such as wearables and apps that provide continuous monitoring will transform healthcare in the next 10 years, with help from telemedicine, home diagnostics, and retail clinics. The authors say the two business models will be (a) gold miners (insurers, and health systems) that will dig deep in successfully managing patients with expensive chronic conditions via care coordination and monitoring, and (b) bartenders (new healthcare entrants) that will empower consumers with advice and information that bypasses the doctor-patient relationship. Goldminers might approach an atrial fibrillation patient with an app-driven monitoring program administered by a clinical care team, while Bartenders would sell tracking apps that suggest interventions, provide reminders, and let the user retain and interpret their own data.

I’m not sure I see things quite that way since app-empowered healthcare consumers will still make up a tiny percentage as quantified selfers. I expect health systems to use their market share and profits to chase away nimbler competitors and steer consumers away from them in creating fear, uncertainty, and doubt that those upstarts aren’t proven or local like the impressive, comfortingly bureaucratic edifice down the street. Consumers will exercise choice only where they discern little differentiation,using convenient retail clinics and video visits for obvious and self-limiting conditions where all that’s really needed is reassurance and possibly a prescription. Health systems will create narrow networks and manipulate quality and satisfaction metrics so that confused, low-expectation consumers will simply keep going to whatever provider they’re told. Chronic conditions will be much better managed by technology because providers will be paid specifically for outcomes, which is one bright spot, and while companies may well do an end-run around the doctor-patient relationship (which is rapidly eroding anyway), they won’t be able to crack the health system-patient relationship. Any effort to upend the status quo will be squelched via lobbyist influence and deep war chests unless health systems, doctors, drug companies, insurers, and device manufacturers are somehow turned on each other, which is less likely now that employers are bowing out of the healthcare war and leaving their employees to fend for themselves. There’s no equivalent to “changing healthcare” except perhaps “changing government” and the folks running both aren’t going to just step aside.

The San Diego paper profiles 20-employee Humetrix, which along with iBlueButton has developed Tensio, a blood pressure management app that uses information from Apple HealthKit-attached devices.

A New York Times article examines more rapid treatment of heart attacks, with technology earning modest credit: ambulances that can send EKGs to hospital EDs and hospitals using paging systems to assemble response teams quickly. The article seems to confuse heart attack deaths with deaths from heart diseases, however.

The local paper, skeptical of Hartford HealthCare’s (CT) claim of financial distress that requires it to eliminate over 300 positions, notes that the health system paid it top 18 executives $12.8 million in 2013, with bonuses averaging $135K each. The CEO made $2.1 million, while the CIO took home $630K.

Bizarre: Chinese citizens anxious to unload shares as the country’s stock market plunged last week include a woman who crashed her car while executing trades on her smartphone and another who sold her portfolio from her iPad while medicated and laboring in a hospital’s delivery room.

Weird News Andy is happy to hear that AIDS, SARS, MERS, and Ebola have been cured thanks to North Korea’s Great Leader Kim Jong-un, who claims to have created a miracle drug from ginseng and other ingredients he declines to name, to which WNA adds, “It’s a floor wax AND a dessert topping!”

Sponsor Updates

• Experian posts “Using Data to Manage the Cost of Healthcare” and a video titled “Healthcare Data Diagnosis: Using Data to Manage the Cost of Healthcare.”
• Nordic offers a new episode focusing on technical cutover in its “Making the Cut” video series.
• Orion Health publishes an “AHIP 2015 Recap: It’s all about the Consumer, Transparency, Interoperability and Data Exchange.”
• Experian / Passport Health offers “Using Data to Manage the Cost of Healthcare.”
• Patientco explains “Where to Find Patientco at HFMA ANI 2015.”
• PatientPay offers “How Many More Reasons Do You Need?”
• Washington Hospital Services will offer ZeOmega’s Jiva HIE-enabled population health management solution to its members.
• NVoq offers “The EMR Journey to Optimization and Innovation.”
• Phynd will exhibit at the 2015 Annual Physician-Computer Connection Symposium June 23-25 in Ojai, CA.
• PMD offers “Three Lessons Your Baby Will Teach You About Software Implementations.”
• Streamline Health will exhibit at the 2015 AMDIS Physician-Computer Connection Symposium June 24-26 in Ojai, CA.
• Greenway Health highlights its partnership with Talksoft.
• TeleTracking offers “From Patient Flow to Real-Time Operational Management.”
• Verisk Health publishes “Gearing Up for VHC2015.”
• Voalte discusses digital health and wearables in “Let’s pick up the pace.”
• Huron Consulting posts pictures of its work with Sea Island Habitat for Humanity.
• Xerox Healthcare offers “Three Ideas That Will Make Healthcare Work Better.”
• Zynx Health comments on the Medicare Shared Savings Plan ACO final rule.

The following HIStalk sponsors are exhibiting at HFMA ANI June 22-25 in Orlando:

• ADP AdvancedMD
• Allscripts
• Besler Consulting
• Billian’s HealthDATA
• Craneware
• Experian/Passport Health
• GE Healthcare
• Greenway Health
• Health Catalyst
• Ingenious Med
• InstaMed
• Legacy Data Access
• Leidos Health
• MModal
• McKesson
• Medecision
• Medhost
• Navicure
• NextGen
• NTT Data
• Nuance
• Patientco
• Peer60
• Recondo Technology
• Relay Health
• Sagacious Consultants
• SSI Group
• Strata Decision Technology
• TransUnion
• TriZetto
• T-System
• Valence Health
• VitalWare
• Wellcentive
• Xerox
• ZeOmega
• Zynx Health

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 6/19/15

Health and social care leaders set out next steps to transform NHS services and improve health outcomes using technology and data

In England, the NHS announces that patients will be given real-time access to their entire digital health records by 2018. UK citizens are already able to book appointments, request prescription renewals, and view medical record summaries online.

New NHS e-Referral service ‘unavailable until further notice’

Also in England, the NHS’s new online appointment scheduling system has been taken offline until further notice after going live on Monday. The service, whose predecessor was used by 40,000 patients per day to schedule appointments until last week, launched despite 33 known issues, including missing functionality and slow loading times.

Making appropriations for the Departments of Labor, Health and Human Services, and Education

A draft budget created by the House Appropriations Committee reduces ONC’s requested $75 million budget to $60.4 million, and provides no funding for its proposed ONC Patient Safety Center.

National Medicare Fraud Takedown Results in Charges Against 243 Individuals for Approximately $712 Million in False Billing

The Department of Justice announces that it has arrested 243 individuals, including 46 doctors, in connection with a Medicare fraud scheme that netted $712 million through false billing. The arrests were the largest coordinated takedown in the history of the DOJ’s Strike Force.

News 6/19/15

Top News

England’s NHS makes tech announcements: commits to giving patients real-time access to their entire electronic medical record by 2018, ambulance services will also be connected electronically to hospital EDs. NHS is also looking into the possibility of making all of its facilities free Wi-Fi zones and rolling out wearables to patients for in-hospital monitoring. Other proposed projects include endorsement of third-party health apps, providing technology training to citizens, and adding learning disability and dementia status flags to the Summary Care Record. Patient digital services will be delivered via the NHS Choices website. The announcements were made at the National Information Board meeting, taking place at Kings Fund Digital Health Congress 2015 in London (if you are attending, HIStalk sponsors TeleTracking and  Orion Health are exhibiting).

Reader Comments

From Not in Monterey: “Re: 3M’s coding product. Our hospital system was told they will update their product just weeks before the ICD-10 implementation date. I find this to be insane. I would be interested to hear if users of large EHR systems are receiving endless dribbles of code fixes for ICD-10 even now since we are experience this with Cerner.”

HIStalk Announcements and Requests

It’s that time of year when schools are out and health IT news is slow, so we can all enjoy a slight break until September.

Response has been excellent to “What makes an EHR ‘open’ or interoperable?” as published in JAMIA and summarized by the authors on HIStalk. Dean Sittig and Adam Wright wrote the original article after I challenged someone other than vendors to define what “open” and “interoperable” really mean since vendors have turned those terms into meaningless marketing froth (former Allscripts CEO Glen Tullman was easily the worst offender for repeatedly stating that all of the company’s mixed-ancestry EHRs are open and interoperable by definition since they all run on Microsoft SQL databases). Most notable to me is that nobody has challenged the definition proposed by Sittig and Wright, so they seem to have captured consensus. I have ideas about where it could go from here:

• Assess the three DoD EHR bidders – Epic, Cerner, and Allscripts – on just how open and interoperable their systems are since DoD claims it wants an EHR with those characteristics for our $11 billion taxpayer investment.
• Ask the top EHR vendors, hospital and ambulatory, to provide a live customer example of being able to perform each of the five items in a real-world environment (extract information in an understandable form, send information to another EHR, accept real-time information requests and return structured information, move all of a customer’s patient records to a new EHR along with metadata and a data dictionary, and open up access to its systems using programmatic, secure APIs).
• Athenahealth complains and/or brags the most about openness among EHR vendors. Let’s see the company throw down against its competitors using these measurable criteria. That should raise visibility and give Jonathan Bush something fun to talk about.
• Ask the top EHR vendors to state in writing that they don’t limit openness and interoperability via contract terms that require developer certification, non-disclosure terms, license fees for outside access, custom programing, or documentation fees. As proof, let’s see their most recent signed customer contract.
• Challenge vendors to publish where they stand on each item or their plans to achieve all five.
• Turn the list into a layperson-friendly version that could be used by Congress and other interested political bodies, perhaps inviting the authors to testify at the HELP subcommittee hearings.
• Add the criteria to EHR certification.
• Further expose the criteria and how prospective EHR customers can evaluate vendor performance against them via ONC’s publicity and informational offerings, including ONC-produced contract boilerplate that prospect customers can insist vendors include.

The industry tends to get too deep into semantics when it comes to the technologies that can support openness and interoperability. These criteria leave the technology out of the picture and instead focus on outcomes – systems can either do these things or they can’t no matter what the marketing people say.

I mentioned the other day that Twitter is expanding the character limit on direct messages from 140 to 10,000, which several readers (including Dr. Jayne) misread that to mean that all Twitter messages can now be that length. Direct Messages are the ones where you tweet someone privately using the Direct Message option, which is possible only if they follow you (although I remember joking years ago that if Twitter ran into revenue problems, which seemed inevitable, they could offer a premium membership that expands the tweet box to more characters, knowing that the verbose among us wouldn’t be able to resist). Expanded Direct Messages give Twitter at least a theoretical messaging tool to compete with similar offerings by Facebook and LinkedIn, although the limitation of all three is that unlike email, you can’t message anyone who hasn’t already connected with you, which is often the reason you want to contact them in the first place.

This week on HIStalk Practice: ThoughtWorks partners with Save the Children to develop EHR for infectious-disease outbreaks. ONC releases massive data set on every meaningful user. Quest Diagnostics Care360 EHR ranks high with small physician practices. MyIdealDoctor announces new funding. PAA survey reveals physician frustration with EHR charting and loss of productivity. Young female PCPs show the ACA some love. Federation of State Medical Boards CEO Humayun Chaudhry, DO discusses next steps for the Interstate Medical Licensure Compact.

This week on HIStalk Connect: the FDA partners with online support group vendor PatientsLikeMe to use its database of patient-reported adverse drug events to improve the FDA’s post-market surveillance programs. Telehealth vendor Doctor On Demand raises a $50 million Series B, while Aledade, Farzad Mostashari’s new startup, raises a $30 million Series B. Apple patents a new approach to calculating resting heart rate that should solve many of the problems users are experiencing with the Apple Watch.

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.

Acquisitions, Funding, Business, and Stock

Hospital bed maker Hill-Rom will acquire point-of-care device manufacturer Welch Allyn for $2 billion. Both companies offer technology products, with Hill-Rom selling tools for asset tracking, hand hygiene, staff locating, nurse call, fetal monitoring, and patient safety.

Xconomy profiles Madison, WI-based prescription refill management platform vendor Healthfinch, which has raised $3 million in funding since 2011 and has grown from four employees to 21 in the past 18 months.

Allscripts, which in November 2014 was ordered to pay $9.7 million to Etransmedia for deceptive trade practices after a failed business relationship, petitions North Carolina to deny Etransmedia’s request for further litigation that Allscripts says would cover issues that have already been resolved in arbitration. The November arbitration panel ruled that Allscripts convinced Etransmedia to buy MyWay EHR licenses for resale via a Costco Wholesale program but then “deliberately sabotaged” Etransmedia’s sales by retiring MyWay in October 2012, sticking Etransmedia with millions of dollars in unsold licenses.

In an “only in America” major medical advance, Botox maker Allergan will pay $2.1 billion to buy Kythera Biopharmaceuticals, which just won FDA approval to sell an injection that eliminates double chins, which the company previously estimated as a $500 million per year US business. Allergan offers a number of cosmetic drugs and hopes Kybella will bring women into doctors’ offices for cross-selling opportunities. As a bonus, the money-losing Kythera is also developing a baldness drug. The smart money (like Allergan’s) is that doctors will ignore Kybella’s specific indications and start shooting it indiscriminately into cellulite-laden thighs and butts. KYTH shares are up 91 percent on the year and 209 percent in five years.

Video visit provider Doctors On Demand, which offers $40 medical consultations, closes $50 million in a Series B funding round.

Sales

Recondo Technology announces sales of its patient access and business office solutions to University of Virginia Health System (VA), Northside Hospital (GA), and Hannibal Regional Healthcare System (MO).

Dayton Children’s Hospital (OH) chooses Phynd to manage 7,000 providers across its EHR and other systems.

Legacy Health (OR) selects GetWellNetwork’s interactive patient care system.

People

Health Data Specialists names David Astles, PhD (Encore Health Resources) as VP of revenue cycle.

Regional Medical Center (AL) promotes Pete Furlow to CIO.

Deven Mcraw (Manatt, Phelps & Phillips) joins HHS’s Office for Civil Rights as deputy director for health information privacy.

Healthline hires Paul Clip (RelayHealth) as SVP of engineering for its health IT group.

The HCI Group promotes Cynthia Petrone-Hudock to president of international business. I interviewed her a few months ago.

CHIIME co-founder Rich Correll announces his retirement, with accolades from industry long-timers that include John Glaser, Bill Spooner, Rich Rydell, and Larry Grandia. His LinkedIn profile lists his occupation as “senior old guy.”

Announcements and Implementations

Premier introduces Quality Cycle Management, a SaaS and services offering that helps health systems recognize areas of clinical outcomes that are reducing their CMS payments under value-based purchasing.

Huntzinger Management Group launches a big data consulting service called V6 Data Analytics.

Practice Fusion releases native iOS and Android tablet versions of its free EHR.

Grant-funded and volunteer-led Games for Health will co-locate its annual conference with HIMSS’s mHealth Summit in December. 

Planned Parenthood pilots an app that lets California users order a $149 at-home urine test for chlamydia and gonorrhea, and if the mailed-in urine samples are positive, the user is notified via the app and is issued either an electronic prescription or an appointment prompt, respectively. The organization already offers residents of Minnesota and Washington app-based video consultation by which users can receive birth control and sexually transmitted disease test kits.

@Cascadia notes that Providence Home Health (WA) is offering Seattle-area house calls for $99, scheduled online and prepaid by credit card.

GE Healthcare will move customers of its patient flow solutions to those offered by TeleTracking in a newly signed collaboration agreement that also includes shared analytics.

Government and Politics

A draft budget by the House Appropriations Committee would fund ONC at $60.4 million, the same as it received in FY2014 versus the $75 million requested by the White House. No funding is proposed for ONC’s Patient Safety Center. The draft also calls for AHRQ to be shut down immediately. The Republication-majority committee’s first bullet point in announcing the funding bill is to “stop the implementation of ObamaCare.”

Joe White, the former CFO of Shelby Regional Medical Center (TX), is sentenced to 23 months in federal prison and is ordered to replay $4.5 million to CMS for falsely attesting to Meaningful Use for his for-profit hospital owner employer, whose facilities received $16 million in total MU payments.

The Department of Justice conducts what it says is the largest Medicare fraud take-down in history, with charges of $712 million in false billing filed against 243 people, of which 46 are licensed professionals. Among the charges: paying and receiving kickbacks, coaching patients to appear eligible for services, a physician home visit company that billed $43 million for a single doctor, providing medically unnecessary wheelchairs, billing for services not performed, and mailing $38 million worth of talking glucose monitors to people who didn’t ask for them. The splashy announcement is probably intended to make criminals think twice before committing Medicare fraud, but I can’t imagine a more compelling incentive than the agency happily writing a single doctor $43 million in checks before finally catching on that something wasn’t quite right.

Innovation and Research

CVS, fresh off this week’s announcement that it will buy Target’s pharmacy business, opens a digital innovation office in Boston’s Back Bay to increase access to tech talent and to foster collaboration with local providers and startups. CVS already has 40 people working from the new office and expects to top out at 100 employees. VP of Digital Strategy and Innovation Andrew Macey says the projects will always be prototyped and marketed within one year, adding that CVS is opening up its systems with APIs and is also studying how streams of wearables data can be used to help people get healthier.

Technology

Sprint is forced by new net neutrality laws to stop throttling back customer cellular data bandwidth during busy periods, quickly reacting to the news that FCC will fine AT&T $100 million for misleading customers by selling unlimited data packages but capping their data speeds after 5 gigabytes in a billing period.

Other

In England, hospital executives admit that they should have paid more attention to the concerns of a 19-year-old cancer survivor instead of telling her to stop Googling her symptoms. She died of cancer 10 days after being admitted, with her family complaining that during her stay, she was not given pain relief, referrals were delayed, and doctors were “evasive and aloof” when the family tried to gather information. The hospital has enlisted her mother to help it improve (or at least to improve its image).

Also in England, the NHS’s new e-referral system has been taken offline “until further notice” days after its launch after several of its known problems were deemed to be unfixable on the fly.

The former pharmacy director of Beth Israel Hospital (NY) pleads guilty to stealing 200,000 oxycodone tablets worth $5.6 million on the street by falsifying entries in the hospital’s electronic narcotics inventory system.

What’s ugly about US healthcare in a nutshell: lawmakers argue over the decision by Yale New Haven Health System to close two clinics, with the hospital blaming lower Medicaid payments and higher state taxes, while opponents say the health systems uses anti-competitive practices and opportunistically timed state budget political pressure to support its huge profits and million-dollar executives.  It’s fascinating to me that Connecticut in 2012 starting charging hospitals a new tax worth $350 million, which earned it an extra $200 million from the federal government, and then the state gave the hospitals back their $350 million plus another $50 million in vig, keeping $150 million for itself by beating federal taxpayers in a financial shell game.

Two labor unions sling arrows at each other in trying to gain power over Kaiser Permanente workers, with upstart union NUHW claiming that SEIU-UHW gained Kaiser concessions by blocking whistleblower protections and agreeing to drop ballot measures that would have capped hospital prices and executive paychecks. Consumers lose just about any way you look at it.

Bizarre: hearings continue in the negligence lawsuit brought by a fan of the Kansas City Royals, who claims that in 2009 he was permanently impaired when the baseball team’s former mascot threw a foil-wrapped hot dog while the man was looking at the scoreboard, striking him in the eye and detaching his retina. The lawsuit is in its fourth inning, having already been heard with inconsistent verdicts in three rounds of courts.

Weird News Andy says DNR might stand for “Do No Rong” as nurses in England allow an inpatient to die because someone forgot to remove a previous bed occupant’s “do not resuscitate” sign.

Sponsor Updates

• DocuSign CFO Mike Dinsdale is recognized as the 2015 Bay Area CFO of the Year for Emerging Business.
• Healthgrades releases a white paper on robotic-assisted surgery clinical outcomes in women’s care.
• Extension Healthcare will exhibit at the 15th Annual Healthcare Summit Disruptive Forces in Healthcare June 22-23 in British Columbia.
• FormFast offers “4 ways to improve efficiency in multi-facility hospitals.”
• Galen Healthcare offers “Successfully Attest for Meaningful Use While Simultaneously Converting to a New EHR.”
• GE Healthcare General Manager of Monitoring Solutions Didier Deltort explains how the demand for digital talent will change the healthcare job market.
• Hayes Management Consulting offers “It’s Almost October 1. Do You Know Where Your Documentation Is?”
• HCS will exhibit at the 2015 Long-Term and Post-Acute Care Health IT Summit June 21-23 in Baltimore.
• The HCI Group offers a new white paper, “ICD-10 Health Plans: Essential Elements for Effective Testing Strategies.”
• Healthcare Data Solutions publishes “Health System Pharmacists: 4 Ways to Solve Ethical Dilemmas.”
• HealthMedx will exhibit at the New York State Health Facilities Association Conference June 28-July 1 in Saratoga Springs.
• Iatric Systems will exhibit at the NCHICA AMC Conference on Securely Connecting Communities for Improved Health June 22-24 in Chapel Hill, NC.
• Influence Health offers “Why Mobile Should be the Greatest Priority in Your Online Marketing Strategy.”
• Healthfinch offers “Mission is Great, but Execution Matters.”
• Intellect Resources offers “Resume Writing Secrets from a Recruiter.”
• InterSystems and Intelligent Medical Objects will exhibit at the AMDIS 2015 Physician-Computer Connection Symposium June 24-26 in Ojai, CA.
• Legacy Data Access helps over 175 hospital systems comprising 1,100 facilities retire their healthcare data.
• Healthwise will exhibit at the CMSA 25th Annual Conference & Expo June 23-26 in Orlando.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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EPtalk by Dr. Jayne 6/18/15

Some days I have a love/hate relationship with social media. There are simply too many things to read and not enough time in the day, especially while I’m trying to grow my consulting business and regain my sanity after years in the non-profit health system universe. It was with great dread that I read Mr. H’s comment on Twitter upping its character limit from 140 to 10,000. I have a hard time keeping up with the current twitterverse, where people are forced to parse their thoughts. I can’t imagine what things will become. I know I had to think more along the lines of Haiku than Soliloquy when posting and that was a challenge. We’ll have to see how it flows once the change becomes real.

Crushed by alligator: W58.03XA

One of my clients is arriving at the ICD-10 dance a little late. Although they thought they had been preparing, they lost some key resources and really aren’t sure where they stand. I would bet that they’re fairly representative of small-ish physician owned practices across the country. They aren’t large enough to have dedicated resources, so ICD-10 became “other duties as assigned” for members of the practice. Once those resources moved on, they were in a bind.

I have to give them full credit, though, for realizing that they have an issue and reaching out for help. My first task was to go through the former employees’ computer files (which thankfully the office kept copies of) and identify any ICD-10 preparedness work or documentation that already existed. There was actually a decent amount of material – especially vendor documentation, a couple of partially completed assessment matrixes, and a library of vendor contacts.

I reached out to their EHR vendor and found that they were already offering an ongoing series of webinars. It’s a specialty-specific EHR that I hadn’t worked with previously, so I signed up. At first, I was skeptical because the webinar started late (normally a black mark in my book). However, my opinion started to turn when I realized that they had already placed ICD-10 under the hood of the application almost a year ago. Since it’s a hosted product, the client just has to open a support ticket to get it turned on. Whenever they’re ready, the client can start with dual coding workflows.

The conversion will occur by payer, and based on an effective date of 10/1, so it doesn’t hurt anyone to go ahead and get ICD-10 going. Once the switched is flipped, providers will see an extra column in their diagnosis grid that will hold the ICD-10 codes. Additionally, when selecting an assessment, they’ll be prompted for laterality (right, left, bilateral, unspecified) on applicable diagnoses before they can make their final selections. That all looked pretty good.

I wasn’t impressed, however, by how the providers have to modify their custom lists for past medical history and assessments to associate ICD-10 codes. This provider mapping has to be done through the practice management system. Although they have embedded crosswalks to assist, it doesn’t look like the mapping process shows the native ICD-10 descriptions but rather just the ICD-9 ones. For me as a physician, it would be difficult to trust the mapping without being able to see the native description. Additionally, when walking through the provider mapping process, some diagnoses didn’t appear to have bilateral as a choice even though right, left, and unspecified were present.

They offered interactive question and answer time after the formal presentation. The attendees were pretty quiet, despite there being a number of them dialed in. It was difficult to tell whether they had no questions because they were: a) deer in the headlights; b) confident in the workflow; or c) tuned out and just attending the webinar because someone told them to. The vendor did provide a document with frequently asked questions that was pretty solid, explaining the testing processes they’ve used and their plans for handling billing should something go dramatically wrong on October 1.

I found it interesting that in the FAQ they admitted that they had to use third-party development resources to help meet the timeline. Additionally, they said that their clearinghouse is positioned to provide additional support should there be any issues with claims submission. They also explained in the document that they’ve been using SNOMED coding all along and that is the intermediary by which they are going to transition the ICD codes. The FAQ document also made it clear that they anticipate there may be some downstream issues with payers having “varying levels of preparedness for the deadline.”

Having come from the client-server, self-hosted world, I appreciated the fact that the vendor has done significant claims testing that individual customers do not have to repeat. The vendor uses a single clearinghouse, so I’m sure that made the testing a bit easier than it might have been. I feel pretty confident this client will be OK from a technology standpoint, but am planning some face-to-face provider education as well as structured practice sessions in their test environment. I’m already looking for funny scenarios to break up the monotony of training and found this one today: Z63.1: Problems in relationships with in-laws.

What’s your favorite new ICD-10 code? Email me.

Email Dr. Jayne.

Morning Headlines 6/18/15

Fitbit raises $732M in its IPO, $37M more than expected

Fitbit finalizes its IPO, raising $732 million at a $20 per share price, for a total valuation of $4.1 billion. Shares will begin to trade this Thursday under the symbol FIT.

Congressional GOP plans to continue health law subsidies

As the Supreme Court nears a ruling on a case challenging the legality of ACA subsidies paid on behalf of seven million Healthcare.gov consumers, congressional republicans announce that they will move forward with a plan to extend those subsidies through the end of the year while they draft their own healthcare reform plan.

US Nonprofit Hospital Tax Exemption Almost Doubles Between 2002 And 2011

Health Affairs publishes a study finding that the total value of tax exemptions enjoyed by non-profit hospitals has grown to $24.6 billion, up from $12.6 billion in 2002.

Doctor On Demand Pulls In $50 Million To Continue Expansion Of Its Virtual Doctor Visit Platform

Three-year-old telehealth vendor Doctor on Demand raises a $50 million Series B funding round to accelerate the growth of its platform. The company also announced that it has signed its 200th employer-customer.