Morning Headlines 5/5/15

Imprivata Acquires HT Systems to Expand its Authentication and Access Management Platform to Patients

Imprivata acquires HT Systems, a palm-vein based biometrics vendor focused on the patient identification market, for $19.1 million in cash and $6.9 million in potential performance bonuses scheduled to be paid out over the next two years.

Athenahealth Looking Like A Very Unhealthy Stock

Forbes contributor David Trainer forecasts additional losses for athenahealth stock , citing slowing revenue and after-tax profit growth, and a 35 percent decline in stock value since its peak in February 2014.

Why Your Next Doctor’s Visit Might Be Through An iPhone

Telehealth vendor American Well launches a new telemedicine application designed to help doctors provide telehealth services to just their own local patients. The new app is designed to help doctors working through regulatory restrictions on remote consultations.

Startup CEOs and Investors: Bruce Brandes

All I Needed to Know to Disrupt Healthcare I Learned from “Seinfeld”: Part V – Yada Yada Yada
By Bruce Brandes

Most every company talks about their elevator pitch, which is intended to be a brief summation of the business to intrigue one to want to learn more. My question is this: exactly how long are the elevator rides some people are taking? More broadly, in any sort of business interaction, how to you best balance brevity vs. meaty detail?

The Webster’s definition of the phrase “yada yada” is "boring or empty talk often used interjectionally, especially in recounting words regarded as too dull or predictable to be worth repeating." Anyone still recovering from the HIMSS conference can likely recall many conversations where yada yada would have been a very welcomed interjection.

Our old friend George Costanza once dated a woman who often filled in her stories with the expression yada-yada, leaving out much of the detail. Jerry praised her for being so succinct (like dating USA Today) but not knowing the full picture drove George crazy. So opens the debate: is yada yada good, or is yada yada bad?

As discussed in an earlier column, most pitches are too long and generic. A little yada yada to help you explain your company in 60 seconds or less is very good. In calculating how to consolidate your elevator pitch, reread the Webster’s definition above and be sure to yada yada overused, now almost meaningless buzzwords like “patient engagement,” “big data analytics,” or “telemedicine.”

Instead, focus on concisely describing why your company exists, what problem you solve, and how you deliver that solution in a way that is clearly superior or more simple than the masses. Even 60 seconds might seem like a long elevator ride to your audience if you do not make a compelling initial impression in the first 15. Without the yada yada, you are not getting a first meeting.

Better yet, if your solution is as vastly unique and compelling as you may perceive, perhaps its simplicity speaks for itself. Did Apple need to yada yada when it introduced the iPad?  In his book “Insanely Simple,” Ken Segal describes the cultural foundation which led to Apple’s development of transformational products so simple and obvious that a two-year-old or a 90-year-old could just intuitively understand them.  

For real game-changing solutions, an unspoken yada yada is implicit. For example, in philanthropy, the Human Fund’s mission statement – “money for people” – enticed Mr. Krueger with its understated stupidity.

However, the buyers of and investors in healthcare technology solutions are remiss to not press for the substantive details and validation of claims glossed over by the yada yada. How many HIStalk readers been burned by extrapolating assumptions from high-level vendor assertions only to later recognize in the fine print that some important information was omitted by a yada yada?

• Q: Where does your system get all the data you are showing in your demo?
• A: Once you sign the contract … yada yada yada … we integrate seamlessly with your EMR.

• Q: How do you achieve your revenue projection of growing 20x in two years?
• A: We had meetings with people at both HCA and Ascension about doing pilots … yada yada yada …. we forecast 300 hospitals next year.

Let’s try to yada yada some of the memorable events in healthcare IT history.

• We acquired five more companies which will be integrated by next quarter … yada yada yada … we beat our forecasted revenue numbers. (every HBOC quarterly earnings call in the 1990s)
• We closed on our acquisition of HBOC … yada yada yada … our market cap dropped $9 billion today. (McKesson 1999)

• We are putting out an RFP to evaluate vendors and purchase a new enterprise electronic medical records system … yada yada yada … we bought Epic. (any academic medical center in the past 10 years)
• We are making great progress on our successful Epic rollout … yada yada yada … we are announcing major budget cuts to protect our bond rating. (that same academic medical center three years later)

I contend that yada yada is both good and bad. Mastery of this notion leads to knowing when to use the figurative yada yada to establish appropriate interest, rapport, and trust. It is equally important to know how and when to effectively press for critical information which the symbolic phrase may be concealing.  

Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.

Startup CEOs and Investors: Michael Burke

The Shifting Incentives of Startups
By Michael Burke

Mr. H asked a few startup CEOs to give his readers an “inside baseball view into a world that a lot of us will never see as employees” — the world of starting and running a startup company. In this post, I’ll try to honor the spirit of that request by describing how incentives in an early-stage startup create an environment that is simultaneously thrilling, rewarding, and terrifying. We’ll then discuss the challenge of maintaining a startup’s culture while these incentives change.

I’ll start first with a sweeping generalization:

An early-stage startup company’s incentives are more purely aligned with their customers’ incentives than any other size, stage, or structure of business.

Think about it. At this stage, it really doesn’t matter whether the founders want to build a great company, make the world a better place, or make a big pile of cash. They can’t do any of these things if they don’t focus exclusively on the success of their early customers. This singular focus is a luxury not afforded to companies of other stages. These purely aligned incentives create an environment of productivity and creativity like no other.

Does this alignment of incentives guarantee success? Absolutely not. I’ve noted in an earlier article that the odds of success for a startup are low. There are a million things that can go wrong. The alignment of incentives does, however, mitigate the risks to some degree.

Now I know that most companies of various stages consider their customers important and would assume on the surface that their interests are aligned with those of their customers. But until they’ve pledged their house and savings to guarantee a loan for working capital, they don’t know what a real incentive feels like. That’s the terrifying part.

Shifting Incentives and OPM

Incentives often change as a startup grows. The really great companies find a way to maintain the positive elements of their culture during these periods of change. It’s not easy to do.

There’s a phenomenon in the startup world that is repeated time and time again. A scrappy startup that was efficient with the little bit of capital it had gets a big chunk of money from a VC. Then they start to suffer from OPM (Other People’s Money) syndrome. They start to think that they really need those golf bags emblazoned with the company logo. They over-hire. They move away from making small, responsible bets to Vegas-style gambles. It’s not entirely their fault. Their incentives have shifted.

Because of their new outside investors (who may now have a controlling interest but almost certainly have preferential exit terms), they now have to hit a grand slam. The fund needs to generate a 10X return in 3-5 years. A base hit, double, or triple might cover the VC’s vig, but it won’t put any money in the founders’ pockets.

In order to generate this sort of return, companies are strongly incented to focus exclusively on short-term revenue growth and ignore long-term investments in people, product, and process. In a parallel universe, big public corporations often find that their incentives diverge with those of their customers when it comes to the obsession with quarterly earnings, sometimes at the expense of similarly necessary investments in people, product, or process.

Some companies manage to maintain their focus and keep their culture intact through these and other changes. As a result, they often deliver exceptional value to their customers.

Freedom and Responsibility

Most successful startups are usually characterized by a culture with freedom and responsibility at its foundation. The freedom isn’t just a cultural choice; it’s a requirement. Top-down management structures just don’t work in a startup. The glacial speed of command and control environments is absent the requisite flexibility, productivity, and creativity. Distributed, self-organizing environments are required in the early stages to learn quickly, fail quickly, and adapt quickly.

Responsibility is the opposite side of the freedom coin in a startup. It makes the selection of the startup team absolutely critical. Folks who are attracted to working in an early-stage startup seem energized by this environment of responsibility. There’s just no place to hide in a startup, and nearly every decision is important. You need folks who are willing to act and to take responsibility for their actions.

In the early days, this culture of freedom and responsibility often emerges organically as a byproduct of the nature of the work and the requirements placed on the team. As a company grows, however, it needs to be much more intentional if it wants to keep the magic going. When we were a few founders in a room, we didn’t have to worry about vacation policy. No one planned to go anywhere until the work was done anyway. Now, when we hire a new employee, we need to have an intelligent answer to the question. So our answer is: take whatever time you want. We care about results, not about punching the clock.

One of the really great things about a startup is that you get to collectively define a culture with a relatively small group of folks. That’s a very exciting and fulfilling process. Contrary to popular belief, this definition of culture doesn’t come from the top down. Don’t get me wrong — a founder/CEO can single-handedly screw up a company’s culture, but the CEO can’t define it unilaterally. A founder/CEO can be a part of the process of a company’s emerging culture, but only a part. In my view, the most influential part a CEO can play in the intentional cultivation of culture is in hiring decisions. Secondarily, a CEO can make sure the policies of the company appropriately support the required culture of freedom and responsibility. Policies are fine, but in a startup, it matters much more what you do than what you say.

No Shortcuts

The bottom line is that startups can’t focus on the finish line if they want to be successful. They have to find a way to set aside the numerous distractions and shifting incentives of fund raises and exit strategies and simply focus on building a great company that delivers great value to customers. Protecting their company’s culture is a big part of this. If they can maintain this focus, they increase their odds of long-term success dramatically.

Michael Burke is an Atlanta-based healthcare technology entrepreneur. He previously founded Dialog Medical and formed Lightshed Health (which offers Clockwise.MD) in September 2012.

Curbside Consult with Dr. Jayne 5/4/15

Jayne Goes to the Hospital

I’ve enjoyed reading the posts this week from our patient advocate HIMSS attendees. They all have interesting stories to tell from the patient perspective.

Recently I took off my doctor coat and became a patient advocate as I accompanied a coworker through her knee reconstruction process. Although she didn’t have it done at my hospital, she had it done at one that is part of a large multi-state health system that advertises its relentless focus on quality. It was eye-opening to see behind the curtain at someone else’s facility and to look at what goes on in a typical patient’s experience.

Her journey started after an ill-fated adventure vacation when she called me for an orthopedic recommendation. Since we work together, I asked why she didn’t go with one of the surgeons we know well. Her answer – privacy concerns – didn’t surprise me. She was able to get an appointment the day after returning home and was immediately scheduled for an MRI. Unfortunately, her surgeon’s office didn’t tell her she needed to schedule an appointment to receive the results, so she ended up calling a couple of days after the MRI only to be told she’d have to come in the following week.

That’s the kind of patient aggravation that’s totally avoidable. I had previously referred hundreds of patients to this particular practice as a primary care doc and never had that kind of complaint before. I did some digging with colleagues, and it turns out the practice was recently acquired by a health system that requires them to use a centralized scheduling service. Apparently the ball gets dropped a lot. It didn’t make me confident since I had referred her, but at that point, what can you do?

After receiving her results, she was scheduled for surgery at a hospital across town. I asked her why she selected it since the surgeon operates at multiple places. Her response this time did surprise me: that’s the first choice they gave her and she really didn’t consider other options. It just goes to show that no matter how much we think patients agonize over quality scores and other factors, sometimes they really don’t care.

Since she’s single, she asked if I would go with her and stay at her place the night after the procedure until she was sure she could get around the house. I agreed and we spent the night before sharing a bottle of wine and laughing about being young, sassy, and having your own personal notarized advance directive. After years of hospital work, she said she wasn’t crossing the threshold without it.

As we were leaving the house the next morning, the hospital called asking if she could come any earlier. Not likely since her scheduled arrival time was in 25 minutes and the hospital was 20 minutes away. It kind of surprised me that they’d bother calling patients to come early if it was likely that they’d already be on their way. That should have been a harbinger of the adventures we were about to have.

We arrived on time, only to find the parking lot where she was told we should park to be marked with “no surgery center parking” signs. Twice around the block and several one-way streets later, we made it to a parking garage.

The surgery center lobby was vacant except for patients and a sign-in kiosk. She registered and it took more than 15 minutes for anyone to call her up. So much for the need to arrive early!

The first question she was asked was whether she had traveled to West Africa in the last 21 days. The second was whether she was ready to pay her estimated patient portion in advance since she’d get a discount if she paid pre-op. Once her credit card was swiped, she was handed a laminated HIPAA and consent document (which had to be 8-point font) and told to “sign the signature pad when you’re ready.” There’s no way patients who are already nervous about a surgery are going to actually sit there and read it. I wonder if it would even hold up under legal scrutiny given the way it was presented.

By this point, I was totally taking notes on my phone since I knew a blog entry was likely to come out of this. The registrar asked if I’d like to receive text updates during the surgery, which I thought would be interesting to see how it worked.

With the paperwork done, we headed back to the outpatient surgery holding area. After being specifically told to keep her undergarments on (a fact which will become pertinent later, I promise), she changed into her low-fashion hospital gown and revealed the fact that she had marked her opposite knee with “NO!!!” in Sharpie. The nurse immediately jumped on this and belittled her, saying that she shouldn’t have done that because it would be confusing to the OR staff. Making a patient feel bad because they have a genuine (although humorously stated) concern about the risks of wrong-site surgery should never happen. She finished the intake process (after asking again about West Africa but never about the advance directive) and scurried off.

Luckily the anesthesiologist was a little more sensitive, kindly explaining that they have never had a wrong-site case at the facility and describing the multi-step process that they have in place to prevent it. The surgeon would meet with the patient, review the consent, sign the correct knee with “YES” and his initials, and this would be witnessed by patient and staff before the patient received any medications. They would repeat the process once the patient was anesthetized and before the surgeon started the procedure.

He was reassuring, but also stated we’d need to remove the “NO!!!” so it wouldn’t confuse the OR team. She agreed, but I wondered if the OR team couldn’t tell the difference between YES/initials and NO!!! that there might not be other issues at play.

We joked about the buffalo plaid sheets on the outpatient surgery gurneys. Our hospital has plain white, so we were snapping pictures. A second nurse came in and asked if the first nurse had finished the intake process. Um, I don’t know, since I don’t know what your intake process is. Wasn’t it in the chart? Apparently it wasn’t.

The second nurse finally logged in to see what had been charted, then proceeded to ask my friend specifically what the first nurse had done: Did she listen to your lungs? Did she use lidocaine when she started the IV? I pasted my best quizzical look on my face to see if she’d notice, but she was too busy charting another professional’s work to pick up on it. After copious clicking had gone on, the first nurse returned, asking “Oh, are you doing my charting?” and the second nurse admitted to it. I wonder what values she charted and whose login was used?

Shortly after that, the OR holding area called for my friend, so they got ready to wheel her off. The problem was the surgeon hadn’t come by yet. The nurses also realized they hadn’t completed some of the pre-op orders, but didn’t want to mess up the schedule, so off they went. I was given the option of carrying her bag of clothing with me or putting it in a locker – of course I chose the locker. I walked with her to the doors of the OR holding area and crossed my fingers that they would write on the correct knee.

The hospital has the same waiting room for the inpatient and outpatient surgery areas, but there was no one at the desk. I selected a seat close to an electrical outlet and started catching up on some work. A few minutes later, I received a text that she was “now in the operating room.” A few minutes after that, a staffer in scrubs and a cover gown arrived and asked for the “Jane Doe Family” and I raised my hand. She walked over and handed me a clear Ziploc bag stating “she forgot to take off her underpants” in a loud stage whisper. Luckily the rest of the room couldn’t hear her over the Shark vacuum infomercial that was playing on the communal TV, but I know my friend would have been horrified.

As she left, a hospital volunteer arrived to staff the desk and explained the monitor they have on the wall that shows the patients’ initials and a color-coded bar that says where they are in the grand scheme of things – pre-op, OR, procedure in progress, procedure complete, recovery, post-op, etc. I liked the idea and I liked even better the family member that interrupted, asking for the remote control. They found an episode of “Gunsmoke,” which was much more appropriate for this particular waiting room demographic.

I received a “procedure has started” text and set my timer so I could plan the rest of my afternoon. I was able to accomplish a massive email cleanup with very few distractions from Marshal Matt Dillon, then took a break for lunch.

The cafeteria was chock full of motivational posters for staff as well as banners celebrating their “Top 10 Hospital” recognition from an organization I had never heard of. Regardless, it was nicer than my own hospital and the food was better, so I gave the experience a 10 myself. I continued to receive “the procedure is still in progress” texts every hour or so. Once I returned to the waiting room, I also received hourly updates from the waiting room volunteer who actually said, “She’s still in surgery – whoop de do, I know” at least twice. It has to be boring saying the same thing all day and she was sweet, but nevertheless I doubt the hospital would appreciate it.

Once I received the “patient is now in recovery” text, I found a good stopping point and packed up my laptop. The surgeon came out (wearing rubber rain galoshes with his scrubs, which was a new one for me) and went through her surgical photos with me. I have to say, the innards of her knee looked pretty ragged in the “before” photos and much more glamorous in the “after” shots. He told me she’d be “going home on crutches” and that he’d leave a script for pain medication.

I knew he was straight out of fellowship, but he looked even younger than expected. Despite feeling old, I figured that being proficient in the latest and greatest techniques outweighed any concerns about duration of practice – I wasn’t even aware the procedure she was having existed before she told me about it.

The volunteer stepped away and asked that someone answer the phone if it rang. It did, and I was told to “go back to the outpatient holding area.” I went back to the outpatient surgery lobby and it was closed with a sign directing me to the front desk. I figured going to the front desk would be more hassle than finding my way to the holding area, and made it there after only two wrong turns. My friend was in a holding bay and awake, so I stepped to the bedside and immediately received a look of annoyance from the nurse. “She just got here. We’re not ready for you yet.” I apologized and told her that I had been instructed to come up and backed away. They didn’t tell me where to go, so I just stood there feeling stupid.

Once I was allowed back at the bedside, my friend was still pretty doped up. The staff offered the ubiquitous eight-ounce can of Sierra Mist and her choice of Cheez-Its or pretzels. Another nurse yelled, “We’ve been out of Cheez-Its for months,” which set the stage for our tour through the post-op process. The staff printed her discharge instructions and went through them with me, explaining that she had received two nerve blocks in her leg and they would last for at least 18 to 24 hours. That was news to both of us! I started wondering how I was going to get her out of the car and into the house since managing stairs, a tall lanky athlete, and a dead leg might be quite the trick.

As we went through the instructions, we found several conflicts on dressing changes and showering. I had questioned the “leave dressing on until showering” and “shower after seven days,” which resulted in a call to the OR to clarify with the surgeon, who had started his next case. Next was a search for the prescription, which the nurses assumed I had been given in the waiting room. A call to the OR revealed the surgeon had taken it with him. Last, there were no instructions for how often and how long to use the high-tech ice water therapy machine he had ordered for her (which incidentally insurance didn’t cover, but we have enough mutual friends with sports injuries to scrape one up from someone with better coverage). Yet another call to the OR. I can only hope that as a young surgeon, he’ll learn to double check things or develop a process, because three calls to the OR to clarify orders is too many. On the other hand, maybe his hospital’s $200 million EHR might have an order set?

Since she had been drinking fluids, eating solids, and not feeling nauseated, the nurses announced she could get dressed and go home. That was when my radar went up. In my post-op universe on the other side of town, we want to have a patient complete some critical functions (such as emptying the bladder) after they’ve had general anesthesia and a bladder catheter. I didn’t consider three pretzel sticks to be “eating solids” and my friend was still pretty dopey, not to mention completely unable to move or even feel her leg. I asked about the crutches since the surgeon said she’d be going home on crutches and they said he didn’t order any. I gave the quizzical look again and she said that even if they had an order, they couldn’t dispense them because it was after 4:30 p.m. and the physical therapists had gone home, so no one could do crutch training. Then she added that I could rent them at the pharmacy if I wanted them.

I reminded the nurse that my friend had zero control of her leg and I had no idea how I was going to get her out of the car and into the house. What did they suggest? Another nurse chimed in and said, “I don’t think crutches are a good idea anyway. They’re not stable. She really needs a walker.” I asked if we had an order for that. She said no, but they had a walker she could try. I suggested that maybe we try the walker on the way to the bathroom since she hadn’t been yet.

She barely made it the 20 feet to the bathroom since her toes were dragging and she had to lift the leg from the hip to get it to swing through as she advanced the walker. I couldn’t believe that as a facility that does this every day, they had no plan for this. I guess maybe all the other patients bring their own crutches or walker. I took the opportunity while she was in the bathroom to start calling septuagenarian relatives who have had knee replacements to see if anyone had a walker I could pick up on the way home. I was grateful for success on the first attempt.

While she was in the bathroom, she figured out that she was missing some clothing she had been wearing pre-op. She asked where it was and was not amused by my answer that they brought them to me in the waiting room. I dug them out of my laptop bag while we strategized on getting her dressed. She wasn’t keen on having the nurses assist, so I helped her wrestle the dead leg (with its huge bulky dressing and rigid brace) into her clothes. While the bay curtain was closed, we overheard the nurses buzzing around since someone had taken their specialty wheelchair that is set up for a patient with their leg locked in an extended position. One never wants to hear, “We’ll just have to rig something” when you’re being discharged from the hospital.

Being out of the hospital gown (and also free of mind-fuzzing medications) must have been empowering because my friend started to let the staff know how much she was not amused by the discharge process, the multiple order conflicts and omissions, and the apparent lack of a plan for what is likely a common set of events. A supervisor stepped in and I slipped away to get the car, knowing she could handle herself. I pulled into the circular drive as instructed and discovered it was full of cars left for the valet but not addressed. I had to double-park in the traffic lane and go back in, where I found the nursing supervisor offering her best service recovery tactic. It involved (no kidding) a “XYZ Hospital” mug with a can of soup, tied up with cellophane and a bow. I actually laughed out loud at this point.

Soup in hand, our patient announced she was ready to go and the supervisor wheeled her out, taking a route which required me to manually open two doors on the way so she could wheel the patient through. I guess there is no way to take a patient out in a wheelchair that either uses automatic doors or assumes the family will be there to open them. What if I was out waiting with the car? It’s a small thing, but if there’s anything that the events of the day proved, the small things count.

Our patient immediately became nauseated upon trying to get into the car, resulting in a frantic run by the nurse. Luckily we avoided any actual vomiting, but I guess it’s something the family should be ready to handle.

We headed into the sunset to pick up the walker, drop off the prescriptions (couldn’t she have been given the script at the pre-op appointment when she scheduled the surgery?) and wrestle the dead leg into the house. Luckily she’s an athlete and was able to do some kind of parallel bars lift and twist maneuver to handle the steps, but I worried about her banging the dead leg around. She made it to the sofa and we fired up the ice therapy machine. I ran out to pick up her prescriptions and provisions. Three bags of ice, 90 Percocet, two Red Box flicks, and a medium pizza later, we were stocked.

The night passed uneventfully, although I couldn’t resist snapping photos of her wearing compression stockings with her walker. Some day when we’re of “Golden Girls” age, we’ll look back and have a lot of laughs. The dead leg started waking up after 8 a.m. the next morning but it was more than 24 hours before she could really move it. I violated the post-op orders and changed her dressing the next day since they had three battlefield dressings on there. It was so thick I didn’t think the ice therapy was making it anywhere near her knee. and once she was no longer numb, it was confirmed.

After two days. she ditched the walker for crutches (borrowed from the high school basketball player up the street) and started physical therapy a few days after that. Her overall prognosis looks great and I have successfully resisted the urge to ask her if I can examine what has got to be a seriously rock solid knee. It will be a while before she’s wearing stilettos again, although if there’s anyone who could manage them on crutches it would be her.

I still wonder though what other people do in these situations. Do they really leave a grapefruit-sized dressing on for seven days? Or do they just call the office? Do they bring their own crutches to surgery? Do they know to ask for the post-op prescriptions in advance? Do they know to bring something for possible carsickness? Are they savvy enough to take off all their clothes even when told to leave some of them on?

I wasn’t the patient, but for a healthcare system that increasingly demands quality, the whole process was certainly something. The next time I am asked to review post-op order sets or pre-op protocols, I’m going to look at them with a new perspective.

What’s your patient-side story? Email me.

Email Dr. Jayne.

HIStalk Interviews Jeremy Bikman, CEO, Peer60

Jeremy Bikman is founder and CEO of Peer60 of American Fork, UT.

Tell me about yourself and the company.

I used to be at KLAS, running research sales strategy for seven years. Now I am in my apology tour, doing atonement to the industry with Peer60.

Our whole goal with Peer60 is to enable companies to get whatever data they need from customers and the market directly, with no one in between besides the platform. This lets them get tons of data a lot faster and hopefully have all the control they want from the information.

Why can’t vendor executives talk to their customer counterparts directly instead of hiring somebody else to do it for them?

I was talking with someone at my company yesterday about the management consulting thing. The cliché is, "All they do is interview people at the company that they consult with, then just repackage the answers." When I used to do some consulting, I would think the same thing. I would go, geez, all of the strategy for what this company should do is already contained in the minds of its own people, so why don’t they just go talk to the people?

I always wonder if it’s simply because it’s almost like in a war — everyone is in a foxhole and bullets are going overhead, so they can’t really step back and think strategically. Is that part of it? Is that just what happens? Do you need a third-party consulting firm or just a different set of eyes to look at it? Is it a case of “measure twice, cut once?”

That may be the reason why there are so many research firms out there. Maybe they have the connections. The companies don’t have the expertise themselves, or  the time or the know-how to actually go do it, so they turn to that.

Is it a case of everybody loves being ranked? People obsess about, "Where I fit in comparison to everyone else?" I think everyone does that in life — we are always comparing ourselves to each other. Is that natural thing now happening and the research companies just leverage that to pump up a lot of interest to be able to sell? I know when I was at KLAS I took that angle. You’d say, "Here is where you are and here is where your competitors are, and hospitals are using it for this." It would generate a fervor that would build on itself. That’s how I would sell in some cases. Some of that still permeates.

Along those lines, are companies just looking for a customer-friendly "you’re doing a great job" validation or are they really looking for things they need to improve?

It depends on who you are looking at. Typically when you are talking to people who are in sales — and I’m a former salesperson, so I’m indicting myself in some aspects with this statement — those people are usually pretty tactical, where I’m thinking in the moment, "How can I get something done?" and I run off.

You have some exceptions out there. Some of the salespeople at Epic are exceptionally aggressive. I think Judy’s mandate was, "Just don’t lose a deal." They really get into it and they think strategically. There are obviously some other salespeople that think like that.

Within the organization, there are some people who care about the data, who care about the feedback. A lot of them also say, "I just care where we rank. I don’t care how truly accurate this information is. Is this statistically significant? I don’t care. I don’t care what this company’s research methodology is — look where we sit." Of course they take it and market it like crazy.

Is that accurate? No, but people are acting on it. My grandpa used to say, "Never confuse what should be done with what, frankly, is being done."

Do KLAS rankings and awards mean anything?

I think they do. KLAS does their best. Their data is not remotely statistically significant. When you go out and you’re talking to 15, 20, or 30 of someone’s customers over a 12-month period, that’s not relevant, but it is the voice of the customer. That is one thing that they are gathering. Those 30 or 40 hospitals they talk to for GE or Allscripts or anybody else — that is legitimate information, but is it a highly accurate rank about what is actually happening? Not necessarily.

It’s not just KLAS – it’s Black Book or anybody else who comes out with it. They are asking questions to CMIOs that CMIOs don’t know, such as work flow, and lower-level IT where their IT analysts can’t answer it. They’re also asking CMIOs some hardcore interoperability questions and maybe security that they may know in a secondary and a cursory way, but not primary themselves. A lot of its “opinuendo,” but it’s not just KLAS — it’s pretty much every research firm out there. That’s how they do it.

The most important information that you don’t see is who they’re talking to. If I want product-specific information, I’d want to talk to the person who works with it every day. But if I want to know from a marketing standpoint, “Is my customer going to fire me?” I’d want to talk to the person who has the clout to make that decision. Do they talk to the right people?

It’s obviously too much of a mix. Again, I just need to make clear that it’s every research firm. I haven’t come across a research firm that really does it right. But it’s part of the model, too. If KLAS, Black Book, MD Buyline, or anyone else were to say, "We have to segment our questions. Operational finance questions go just to people who are in operations and finance, IT questions go only to IT people and clinical workflow questions go just to those clinicians." They would have to do so much research that their cost would go through the roof.

People complain about how much KLAS costs right now. That’s nothing if they had to get a lot of data per user per that specific context that you really should be talking about. Like I said, operations questions to operations people, just limit it to that. It would be very, very difficult.

If you look in the fine print with KLAS, it says, “This is overall just the voice of customer.” They have little things in there, like confidence level isn’t with a C, it’s with a K. If you read the fine print — and they’ll admit it — this is voice of the customer. For the most part, the KLAS rankings do a pretty good job. Is it perfect? It is completely accurate? No way. No research I’ve seen out there is. It’s one the reasons why we started this platform.

If a company wants to go out and get feedback from the customers or the market in Europe and North America, they’re getting hundreds and sometimes thousands of responses within a week or two. In that, stats mean something. The questions get very specific. IT to IT people. Operations to operations people. Finance to finance. Of course, this is their data, it’s not going in the market.

We’re producing these free reports just because it’s so easy for us to get the data. We did this clinical purchasing report. We got 25 percent of the hospitals in the US in three weeks. It’s very fast and easy for us to get the data. You’ve seen our reports. They’re pretty basic. Just, “Here’s the data.” We don’t really do much analysis. We’re not into the vendor rankings. Just, “Here’s interesting information.”

Our customers use that to get far more information far faster. Then they can do whatever they want at that point. We hope that they do it to improve, but we’re never going to rank vendors. That’s not who we are.

The source that I liked most, at least of those who provided their information without requiring payment, was CapSite.  HIMSS Analytics bought them. How do you see HIMSS Analytics fitting into the market research world?

You know what I always wanted someone to do? I talked to HIMSS a couple years ago. They’re just too big. They can’t get out of their own way. Their data is pretty reasonably accurate to some extent. We buy it sometimes to make sure we have demographics for hospitals. Definitive’s doing a good job there, too.

I always thought some of these guys should go out and do what’s called an "ideal fit." You have a report come out that bashes Meditech from somebody, but Meditech is still selling. What about those smaller hospitals that don’t have very sophisticated IT environments? They don’t have much budget. They’re not going to sell out to one of the big IDNs or to a health plan or something like that. Meditech is a really good fit for them, but you don’t get that in “one size fits all” research. I remember telling HIMSS, "I know you guys are really trying to get more into this primary research, more away from just demographic information. Why don’t you go that direction?”

I hope someone does it. That would be way better for the market to rank vendors on where they actually play well. Why in the world are we comparing Meditech to Epic in a large hospitals? That doesn’t even make sense. That’s not where they play. They get crammed in and it does a big disservice to the market.

It would be like Consumer Reports saying that the best car is Rolls Royce and just leaving it at that. Healthcare has a list of best products and another list of all the types of hospitals — maybe the job of consultants is to arbitrage the information by matching them up.

That’s very good way to put it, actually. There are some consultants that can do that, real domain experts. They’ll take available data that’s out there. They’ll get a KLAS report, MD Buyline, whatever. Then they need to do primary research themselves. The hospital does, too. No hospital will go, "Oh, they rank #2 in this report – done. We’ll do it." They’re going to do site visits and they’re going to do calls. They have to go through their normal decision-making process. Money still means something. How much money do we have? Our internal capabilities still mean something from an IT and informatics perspective, biomed. These things mean things, so they will factor that into it. The “one size fits all” report does not do that. It lumps everybody together.

Just because of my background in working for a major research firm, every meeting I had at HIMSS, and I probably had 50 meetings, every person would go, "I hate this report. What do you think about this report?" I said, “I don’t really work there any more and I don’t really know that other research firm, but you have to quit trying to take these reports” … everyone is coming at it the wrong way. They anticipate that this should be an apples-to-apples comparison. They’re not apples-to-apples comparisons. You have to get that out of your head. The lens through which you view this has to be that there are both fruits or vegetables. It’s an apple to a kumquat or it’s like a fruit salad. That’s really what these reports are. Obviously there needs to be way more analysis that’s done and it’s probably like you said — that’s probably a time where some consultants need to step in and they can probably add real value.

f you’re talking to someone on the provider side who doesn’t really understand the vendor world, how would you describe what market research means to a typical healthcare IT software vendor?

It’s a crutch. Buying reports is a crutch. It’s an easy way out. Is that inflammatory enough? [laughs]

If you’re a vendor trying to formulate a market strategy, how important is market research? What else goes into that mix of saying, "What do we do for the next five years?"

Market research is great, but you need to it yourself. It needs to be primary. You don’t want it filtered.

There’s a saying that I’ve heard before. "If you drink from a stream, get as close to the source as possible." When you’re getting it filtered through a research firm and it’s anonymous, you have no idea who said what or anything like that. You’re getting an inherent bias coming from the research firm. No matter what they try to do — and you can read all the philosophy of Immanuel Kant and those other ones out there that talk about this, those German philosophers — there can’t be anything truly objective.

It becomes far less objective when it’s filtered through somebody else. Someone else made the calls. Someone else is now analyzing the information. They’re trying to keep it as pure as possible, but they’ll see some phrases and the natural tendency is to try to clean it up. It’s like the Bible. the Bible has been translated how many different times? From Aramaic into Greek, into Latin, into German, into whatever. How much stuff gets lost in that translation? Same thing happens.

Market research is absolutely critical. Research and getting data from the customers is critical. But get it directly from them and get a lot of it. Get it repeatedly. Make it easy for them. That’s the reason I say market research reports are a crutch. Hiring a research firm to do custom research for you is a little bit better than that, but still you are ceding control to somebody else.

It’s as if you hired someone else to do this interview and they didn’t give you a direct transcript. They’re going to change it. That’s the way research works. You get it and go, "This is interesting," but you can tell it’s bland. You can tell something’s have been changed rather than getting it unfiltered.

You talked about Epic’s sales and marketing. They claim they don’t do marketing and they don’t ever talk about their sales. Does Epic do sales and marketing?

Oh, my gosh, they are the best in healthcare. It’s brilliant.

Have you seen the show “Usual Suspects?”  It’s a brilliant show. There is a guy Verbal Kint played by Kevin Spacey. The main villain is this guy named Keyser Soze, this super evil global Mafioso boss who no one has ever seen. Verbal says, "The greatest trick the Devil ever pulled was convincing the world he did not exist.”

It’s brilliant, that line. Every time someone says Epic doesn’t sell or market, I laugh about it. They are brilliant at it. By virtue of saying they don’t market, that is different. It sets them apart. What is that? That is marketing. You just established a brand.

They’re not traditional though. They’re very thoughtful. They’re very extremely aggressive, but they do it in a very calculated way that’s not offensive and doesn’t feel like sales is coming across. They’ve earned a lot of it, too.

I want to preface that out front. When you have companies like KLAS ranking them constantly and other publications are constantly publishing the rankings, you are using that to your advantage. When other people market for you, that is way better than when you’re doing it yourself. 

Epic absolutely markets. They just do it in the early Silicon Valley way. The rest of healthcare needs to catch up, which is have other people market, be almost counterculture. That is really Epic. They are just brilliant at it. Absolutely brilliant at it.

Epic somehow always seems to slide across from being on the other side of the table to their customer’s side. The customer feels that Epic is their partner and defends them. How would you create something like, that where both contractually and morally, the customer feels the imperative to be their vendor’s advocate?

You see that in Silicon Valley. Look at Apple. I like Apple just because it’s stable so I don’t really care, but people are violently defensive of Apple. Epic does the same thing. It’s not about the solution. 

When I was at KLAS, people would complain, "Epic can’t get this — they have older technology." I would say, “Yes they do — it’s not about the technology.” As long as the technology is stable and does the basics, it’s all about the people. It’s the the relationship and the feeling. My dad used to say, "Son, you only sell two things in life — solutions and good feelings.”

That’s correct. Epic solves a problem. Companies solve problems and how you feel about that. Epic is really good, like you said, at getting themselves on that same side of the table. They don’t talk about their tech a lot — they talk about the problems they are solving and the benefits they are providing. Apple did that. Steve Jobs always talked about “why we do what we do,” not all the features. Those will come later. They would build this whole culture. That is really what Epic has done.

Can another company do it? I don’t think they can if they don’t start out that way. You’d have to do a scorched earth. Before Siemens got bought out by Cerner, to turn it around, John Glaser would have to come in and say, "I’ve got to fire everybody. Anyone that’s been hired here previous to two years that doesn’t have a lot of neural plasticity, doesn’t have a lot of bad habits — we’re just going to get rid of everybody. We’re going to start from the ground up.“

I don’t know how a company pivots. I haven’t seen a company pivot like that. Maybe you have, I just haven’t seen someone. You have to start out like that. You can obviously improve, but you also need to be yourself. Epic is Epic because of Judy and Carl. You don’t have to be like that. Cerner is highly successful and you wouldn’t really say their culture is very similar to Epic.

What are the most interesting trends you took away from the HIMSS conference?

The most interesting trend that I’ve seen — this is a bit tongue in cheek — is how fast marketing moves. Products move at glacial speed in comparison to marketing. I am absolutely blown away that pretty much every company out there can do accountable care, care coordination, population health management, patient engagement, and data analytics. It’s amazing. It was like a forest just crept up over the last two years.

I may be underselling everybody, but their marketing departments are in full bloom. I’m not sure the R&D is there. I spent so much time just meeting with people. It was hard. That was just one of my takeaways, "Wow, everybody does everything and nobody is standing out because of it."

In our 2011 interview, you predicted that Epic and Cerner would lose some dominance, best-of-breed would make a comeback of sorts, and smaller vendors would upset the apple cart. Do you still think that will happen?

Because the government is in, no, I don’t. I was wrong.

The big are going to get stronger because what the government has done is going to enable it. It makes it tougher. When you have government-required mandates that somehow map well to the “one size fits all” big integrated vendors, how do you fight that?

Imagine if you are in Silicon Valley and all these B2C companies. The government came in and said, "Here are all the different mandates you have to do." How many new startups could crop up and really be successful? 

I underestimated the impact and the staying power of what was enacted through HITECH legislation. When it comes to enterprise, maybe in 10, 15, or 20 years, but nothing soon. The governments has enabled this to happen and smart vendors like Epic and Cerner absolutely jumped on it and have done exceptionally well. It’s not like they haven’t done a good job anyway, but there is no doubt it certainly helped.

In that regard, is there irrational exuberance with mobile health and the unprecedented amounts of money being invested in innovative companies?

I love the energy. When you have a lot of companies coming in and competing, hopefully you can get to something that is really usable, specifically for patients, that really engage them without having hospitals having to do the heavy lifting, which is happening now. What if the government steps in there and starts putting all these mandates around that? It is just going to empower the incumbents. That still isn’t good for innovation or for patients. I hope that it stays the Wild West for a while.

What will the health IT market look like over the next five years?

Big getting bigger. You are going to see a lot more consolidation. There are some pretty cool startups and a lot of cool companies. You are going to see a lot more consolidation. I don’t think that Athena and some other guys are even close to being done, snapping up different companies and rounding things out. Salesforce is coming in in a big, big way. Amazon is coming in. I just got an email from a guy at a major IDN saying, "Hey, you’ve got watch out for Amazon — they’re doing some amazing things. They are moving stuff to the cloud and are starting to bring all these different apps no one is even talking about.”

I kind of love that, but I don’t know if they are going to stick around. We’ve seen the hokey pokey dance go on in healthcare for decades, where guys jump in and jump out. I’m sure hoping that a lot of these guys will stick in – Salesforce, etc. — and really help out. An argument could be made that guys like Salesforce need to be in there. If you are really going to engage patients and you’re really going to manage populations, CRM-like technology may be absolutely critical. Can the big incumbents in healthcare really develop a CRM? I don’t know. I don’t think so, but they certainly could.

Did the FDA really come look at your fake crack booth giveaway at HIMSS?

They did. Did I tell you my marketing guys didn’t take a picture of it? They did a great job. I said, I’d have given you an A+ because it was such an awesome event, the booth, everything, the traffic, but the FDA came by after hearing, "What’s this? You guys are giving away dime bags?" Do you really think we are giving away illegal substances at a trade show? Besides, it would be cheaper for us to give away iPads. We should have gotten a picture.

Morning Headlines 5/4/15

Former HealthCare.gov IT program manager Chao retires from CMS

Henry Chao, CMS deputy director of the Office of Information Services and program manager of the troubled Healthcare.gov rollout, retires after 21 years of government service.

Almost half of Obamacare exchanges face financial struggles in the future

The Washington Post reports that nearly half of the 17 state-run health insurance exchanges are struggling financially. Some are considering increasing fees imposed on insurers, while others looking into cost sharing arrangements with other states or shutting down completely and migrating exchange services to Healthcare.gov.

athenahealth’s (ATHN) CEO Jonathan Bush on Q1 2015 Results – Earnings Call Transcript

Athenahealth hosts its Q1 earnings call, with CEO Jonathan Bush providing his own style of commentary on the company’s recent performance and projects. This quarter the company added 2,300 providers, and sold a number of new inpatient systems through its recently acquired EHR RazorInsights.

Erlanger Chooses Epic Software For New $100 Million Electronic Medical Records System; CEO Judy Faulkner To Visit Chattanooga

Erlanger Health System chooses Epic as its next EHR vendor, beating out Cerner as the other finalist. The system will be implemented over a two-year period and will cost $100 million.

Monday Morning Update 5/4/15

Top News

Henry Chao, the CMS CIO and deputy director who led the rollout of Healthcare.gov, has retired. He was little noticed until a September 2014 House report on the site’s failure, which quoted emails from former HHS CTO Bryan Sivak that characterized Chao as being in way over his head to the point that HHS plotted to hijack the project to try to salvage it. Chao reported to CMS CIO Tony Trenkle, who hightailed it for an IBM federal IT executive job just a handful of weeks after the site went down in flames (of taxpayer money).

Reader Comments

From Not So Lucky: “Re: McKesson EIS division. Big layoffs Friday.” Unverified.

HIStalk Announcements and Requests

Around 17 percent of poll respondents think that HIT vendors intentionally stack the executive deck against women and unstated minorities, but most of them feel that companies have simply chosen the best people for the job and possibly only need ongoing reminders of the desirability of diversity. Some readers commented that perhaps companies can’t even see the benefit of executive diversity because they’ve never practiced it, while others commented that the “mommy track” may present a more attractive option for women who aren’t very interested in the never-ending hours, travel, and relocation required to move up the executive ladder. Cerner Europe GM Emil Peters referenced the poll on Twitter, saying, “Personally I think it’s a travesty. And I’m going to do what I can to fix it. However, I don’t think it’s by design.” New poll to your right or here: within the past two years, have you had to pay a medically related bill that created at least a modest degree of personal financial hardship?

Here another poll that interests me since I see a lot of people playing around with media in ways I don’t quite get: which would be the most attractive way to catch up on a weekly health IT news summary? I personally have never listened to a podcast and don’t anticipate a time that I ever will, so the results will help me figure out if I’m in the Bell curve hinterlands.

Check HIStalk Practice for the Population Health Management Weekly Roundup.

I bought Regina Holliday’s brand new book “The Writing on the Wall” from Amazon and became so engrossed that I read it nearly straight through this weekend. My expectations are modest for healthcare IT-related books given some fairly lame ones, but this one is among the most moving things I’ve ever read, more of a story about love and family, overcoming adversity, and standing up for what’s right than the usual preachy, recycled facts about technology coming from someone who thinks of patients as people and/or customers different from themselves (the big secret: we’re all frightened, marginalized patients at one time or another). If your blood runs above room temperature, I predict you’ll laugh, cry, and get fighting mad at the very system you work within as you read about her life and the untimely death of her husband, but you’ll also find it uplifting and empowering. It would be a great read even without the IT connection. I’ll most likely write a full review shortly since to do less would be a disservice to people who either want or need to peruse it, but here are some excerpts that got me as I learned that Regina’s art is not limited to the visual variety:

We come into this world screaming and owning nothing. We grow and change. The years pass by and we fill with life experience as our homes fill with possessions. Time rolls on and on, but for all of us there is an end. Some will meet their end on highways and some in hospitals, but for most of us the end is the same. We are patients in the end. We pluck at cloth hospital gowns, left with only a few possessions: our watches, rings, and wallets … Hospitals can deconstruct a person as assuredly as I could lay bare a jewelry box. Take any professional adult and remove their clothes and their accessories. Dress them in a threadbare gown that is faded by thousands of wash cycles. Give them a number rather than a name. Confuse them with jargon while applying copious amounts of medication. Then watch them try to navigate the maze of care … I felt like a bright blue inconsequential bird in my Easter dress as I fluttered among the forests of polo shirts, hoodies, and business suits. Conference attendees in the world of medicine have a uniform look. You were welcomed if you wore a suit, tolerated if you wore a hoodie, and ostracized in a church dress. I was not wearing the correct uniform, but I took a deep breath and introduced myself. I would say, “Hello, my name is Regina Holliday. I want to paint about healthcare to improve health policy for patients.” I’d then say that I was inspired to paint by my late husband who very recently died of kidney cancer. I would give them my slip of paper masquerading as a business card. Then tell them to reach out to me via social media or email. Then I’d share the horrific things we had experienced during my husband’s 11-week hospitalization at five different facilities. I would see them step back from me with a brief condolence. A nervous half-laugh would often escape their lips. I was a widow fresh from the graveside asking questions that affect the lives of us all. I was not supposed to be there. They were having a ball and I was death walking among them.

I’ll have more DonorsChoose project updates later, but here’s a photo from Ms. Classen’s intervention algebra class using the calculators we provided. She says, “What we’re able to do now with these calculators is amazing. Many more students are going to get the practice they need to graduate high school and learn to solve difficult problems thanks to you all.” 

Here’s a photo of Mrs. Rowe’s third graders using the six iPad Minis we bought them for math study.

I was thinking about how hospital patient rooms often resemble hotel rooms in being littered with previously popular but now-useless technology components, which in the hotel’s case often includes iPod docking stations and dial-up ports that get used rarely and never, respectively.

Last Week’s Most Interesting News

• CMS releases a gigantic Medicare Part D prescribing database for 2013 that includes details on $103 billion of drug spending.
• Teladoc announces IPO plans and files an antitrust lawsuit against the medical board of its home state of Texas for requiring prescribers to see a patient at least once in person before issuing a prescription.
• Anthem books $865 million in Q1 profit, up 25 percent despite its massive data breach during the quarter.
• Imprivata acquires palm vein scanning biometric vendor HT Systems.
• The chair and ranking member of the Senate’s HELP committee follow through on HHS Secretary Sylvia Burwell’s request for help identifying pressing but easily solved EHR-related issues.
• A Brookings Institution report questions why patients are charged significant and inconsistent prices to receive copies of their own electronic medical records from providers.
• CareCloud announces $15 million in additional funding and a new CEO.
• Validic receives another $12.5 million in funding.
• Vanderbilt University Medical Center announces that it will replace McKesson Horizon, some of which was developed internally by Vanderbilt, with either Cerner or Epic.

Webinars

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

Acquisitions, Funding, Business, and Stock

Startup MORE Health receives $3 million in Series A funding for its multi-language EHR that connects doctors and patients in China with US specialists.

From the Athenahealth earnings call, which followed Friday’s expectations-beating earnings report that for some reason triggered a 7.4 percent share price drop:

• The company added 2,300 providers in the quarter, raising its total to 64,000.
• The RazorInsights team has been moved into the Atlanta office and the company has made RazorInsights sales, cross-sold AthenaOne to a RazorInsights client, and sold both products to a new client.
• Jonathan Bush says the urgent and convenient care market is the most important to him because it’s growing fast and is managing “worried well” lives.
• Bush says of big, non-academic health systems buying Athenahealth, “These guys have done their homework, gotten out their protractors and done the math on the arc of their flight, and they see it not clearing the tree tops. Not clearing the tree tops due to lack of profit is a great way to make you for-profit … They know that they can’t put the kind of obscene amounts of capital against or manage internal IT systems in the way that the fancy pants universities can afford to do and they’re slowly coming around to us and it’s exciting.”
• The company says it won’t talk about individual hospitals or sales of RazorInsights, but “When we look at our growth, first of all, we’re starting with a very new company with a small base, so it’s relatively easier to grow a lot on the small base. We don’t intend to talk specifically about the number of individual Razor deals or that sort of thing. We really bought RazorInsights as a strategic asset along with WebOMR to build out our full inpatient solution over time.” Bush added that RazorInsights got its clients to Meaningful Use but “the billing needs a lot of work, like a lot” and says by year-end Athenahealth will offer a full-service revenue cycle program to RazorInsights users.
• In justifying the $40 million paid for RazorInsights, Bush says Athenahealth got the best deal it could since the VCs who owned the company were either going to re-fund it or step out, so he sees it as an “acqui-hire” play in buying a product, a founding team, and brave early customers, adding that he’d like to do more of that.
• Bush responded to an analyst who asked how bookings revenue drove operating income improvement, “If you’ve been following us for a while, you’re following a caterpillar, right? There’s sometimes where the nose of the caterpillar doesn’t appear to be moving at all, but back in the ass, it’s building up potential energy which will turn into a great nose stretch. ”
• Bush said of ICD-10, “Never has a Bush felt so longing for more federal mandates as I have felt since the dying down of Meaningful Use and ICD-10 and PQR and ABC and do-re-mi. It is so easy when some fearful group of federal apparatchik are going to come for your prospect if they don’t buy. We are currently in a period where there are no apparatchiks coming … if ICD-10 tightens up and actually looks real later in the year it will help our close rate. I will feel sheepish about it because it seems a silly reason to make a free market move. But it’s true that right now our close rates are lower and that the specific reason we can attributed to it is no urgent federal mandate to buy.”
• Bush said that Athenahealth’s connection to CommonWell is in beta and that he’s OK with making EHRs interoperable via other methods because “otherwise we’re all going to be on some federally mandated ridiculous EHR.” He adds, “CommonWell could have been perceived as sort of a PR smite against Epic, which I assure you I would never want … I want to be anything that Epic’s in as well, even if we have to double pay. This is not the solution for interoperability by any stretch. This is just a service so that a patient can get their freaking chart and have the same patient match to all the different systems that their chart is in. So I don’t think you guys should think of CommonWell as some sort of silver bullet that fixes everything … I don’t think it’s a solution to the real challenge, which is the B2B interoperability … that’s kind of the new frontier that we’re doing most of our work on.”

Sales

Erlanger Health System (TN) chooses Epic in what the local paper says is a $100 million deal.

CoverMyMeds will use state-specific electronic prior authorization requirements information from Point-of-Care Partners.

People

Valence Health hires Michael McMillan (Cleveland Clinic) as SVP of strategic solutions.

Announcements and Implementations

CVS says in its earnings call that its Epic rollout is on schedule and will be completed by mid-year.

Government and Politics

A Washington Post review finds that nearly half of the 17 health insurance exchanges created as alternatives to Healthcare.gov are struggling with high technology and call center costs along with less-than-expected enrollment numbers. They’re considering raising fees charged to insurance companies, sharing costs with other states, asking for state money, or shutting down and using Healthcare.gov instead.

Technology

Consumer personal health record vendor LMG 3 Marketing and Development Corp. sues Apple, claiming that its Health and HealthKit apps violate its patents for technologies that it claims to have licensed to retailers such as Target. I found the original 2012 patent, which is a vague and seemingly unrelated description of a personal health record on a thumb drive. The primary inventor is Mike Lubell of Raleigh, NC, who developed MyPMR in 2000 while creating an EMR/PM business unit  for Canon Business Solutions. LMG 3 apparently still offers MyPMR for $34.95.

Other

Former National Coordinator David Brailer, MD, PhD says in a Wall Street Journal opinion piece titled “They’re Your Vital Signs, Not Your Medical Records” that Congress should ensure that individuals have unqualified ownership of their health information and be given legal control over who sees it. He adds that patients should be allowed to designate an “infomediary” who can manage their information on their behalf. He warns that EHR vendors and providers block interoperability to gain a competitive edge and because “whoever controls health information will dominate the healthcare marketplace and its vast profit pool.”

Intermountain Healthcare CHIO Sameer Badlani, MD lists his favorite apps for reference guides (DynaMed, UpToDate, ACP Smart Medicine); drug reference (Epocrates, Lexicomp, and one listed as Medimex that I assume is supposed to be Micromedex); clinical calculators (MediMath, MDCalc, and one I haven’t heard of, OxCalc); and antibiotic guides (Johns Hopkins Antibiotics Guide, Sanford Guide).

UnitedHealthcare will offer 24×7 video-based virtual physician visits to members enrolled in self-funded employer health plans, expanding availability to employer-sponsored and individual plan participants in 2016. It’s working with Doctor On Demand, Optum’s NowClinic, and American Well, with access through its Health4Me app. 

A Phoenix TV station profiles the local neurosurgeon who in 2008 developed The Medical Memory, which provides doctors with video recording equipment for recording patient encounters and posting them securely online for reference and sharing. I checked out the video link from the site showing his overview, but was kind of turned off that he got rather curt with whoever was running his slides (he’s a neurosurgeon, after all). It’s fascinating to me that on at least half a dozen occasions recently, I’ve had email or telephone conversations with healthcare IT people who came across as rude and clueless, leading me to question: could they possibly be that unlikeable in real life, or do they just come across poorly online without realizing it?

I’ll go out on a limb with this story: a Florida man sues a hospital for discarding his amputated leg in the trash, which he discovered when homicide detectives knocked on his door to inquire about what it was doing there.

Sponsor Updates

• The SSI Group will exhibit at the Louisiana HFMA meeting May 3-5 in Lafayette.
• Streamline Health will host the 2015 NEXT Summit Client Conference May 3-5 in Atlantic Beach, FL.
• VitalWare shares “Five More Facts about ICD-10.”
• Versus Technology recaps its HIMSS15 presentation on “Transforming Process Improvement through RTLS Data.”
• Huron Consulting Group will sponsor the 2015 Cristo Rey Viva Event on May 7 to support the students of Cristo Rey Jesuit High School in Chicago.
• Verisk Health offers“How Dollars Flow to Fight Medicaid Fraud.”
• Sunquest Information Systems will exhibit at the Pathology Informatics Summit May 5-8 in Pittsburgh.
• T-System President and CEO Roger Davis weighs in on EHR interoperability.
• Team Hackasaurus Rex wins TransUnion’s first Hackathon, held at California Polytechnic State University.
• Truven Health Analytics will host its Advantage Conference May 4-7 in Boca Raton, FL.
• Valence Health will exhibit at Becker’s Review and Annual Meeting May 7-9 in Chicago.
• ZirMed CEO Tom Butts shares his thoughts on IT trends and challenges, hospital CFOs on preventing claim denials before they happen, and ICD-10.
• MedData exhibits at the MGMA Anesthesia Administration Assembly through May 1 in Chicago.
• MediQuant President Tony Paparella is interviewed as part of the #TalkHITwithCTG podcast series.
• Navicure exhibits at Centricity Live through May 2 in Orlando.
• New York eHealth Collaborative will exhibit at the Crain’s Health Care Summit May 5 in New York City.
• Nordic Consulting releases the fifth episode of its “Making the Cut” video series on Epic conversion planning.
• NTT Data offers “It’s Beginning to Look a Lot Like Christmas … Thoughts on the Apple Watch.”
• Oneview Healthcare will exhibit at Digital Health Live 2015 May 5-7 in Dubai, UAE.
• Orion Health, Patientco, and PDS reflect on their HIMSS15 experiences.
• PMD offers “There’s More to Health Than Being Happy: What a Patient Satisfaction Score Really Means.”
• Qpid Health will exhibit at the Medical Informatics World Conference May 5 in Boston.

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 5/1/15

Medicare Provider Utilization and Payment Data: Part D Prescriber

CMS publishes a new dataset containing Medicare Part D prescription details for 2013, representing $103 billion in drug costs.

athenahealth, Inc. Reports First Quarter Fiscal Year 2015 Results

Athenahealth publishes its Q1 results: revenue is up 27 percent to $206 million, adjusted EPS $0.24 vs. $0.12. Epocrates-related earnings remained flat at $10 million. Athena shares are up 20 percent over the past year.

Former hospital CFO ordered to pay $4.4 million restitution

The CFO of a small network of rural Texas hospitals is ordered to pay back the $4.4 million in payments his hospital received after fraudulently attesting to MU Stage 1. He is also facing criminal charges that could result in up to seven years in jail.

Premier statement for the record on 21st Century Cures legislation (PDF) 

Premier applauds the legislative work being undertaken by the House as it drafts the 21st Century Cures bill, and lobbies for increased interoperability requirements through a unique patient identifier, national interoperability standards, and APIs. Premier calls on ONC to include the requirements in its EHR certification criteria.

EPtalk by Dr. Jayne 4/30/15

One of the hot topics in the physician lounge this week was the provision in the recently-signed SGR bill that ends the use of Social Security numbers on Medicare cards. Medicare is authorized to spend $320 million over four years to make the change. The first $50 million is in the 2016 budget. Other interesting facts in the article: more than 4,500 people enroll in Medicare every day; total enrollment is projected at 74 million by 2025; and the push to end use of the SSN in healthcare has been going on for more than a decade. Other than the number being “randomly generated,” there aren’t many specifics about how patients will be enumerated moving forward. Based on how providers have been assigned UPINs and now NPI numbers, it’s not likely to be quick. Additionally, vendors will have to update systems to handle the new numbers.

Another hot topic was the recent CMS report that half of the professionals eligible for the PQRS program didn’t participate in 2013 and are therefore subject to penalties this year. More than 98 percent of those being penalized didn’t even try to participate. In my book when half the candidates don’t even try, that makes a statement that either they’re not interested or have other priorities. Unfortunately it has fallen on deaf ears as the move to new payment models continues. Very few industries have the “pay-for-quality” construct like we now have in healthcare. I recently had to deal with a legal matter involving a law firm that was not exactly with the program. Too bad they weren’t on a pay-for-performance plan because they’d likely be looking for a new line of work.

JAMA online offers a nice profile of our new Surgeon General, Vivek Murthy. It feels a little odd to have people in my generation filling major roles. At 37 years old, however, he is not the youngest to hold the post – he mentioned to the interviewer that the first two appointees (by Ulysses S. Grant and Rutherford B. Hayes) were younger. Like Murthy, I remember first hearing about the Surgeon General when C. Everett Koop held the post. Seeing him on TV was probably my first view of public health. Murthy is a fan of social media and digital platforms, and I have to say I’m somewhat jealous of his public service announcement with Elmo. If Sesame Street is ever looking for an average family physician, I hope they look me up.

The AMA continues to nauseate me with their congratulatory focus on the SGR bill. AMA President Robert Wah cites “Five ways health care will look different in the post-SGR era.” Number four is that health outcomes will be improved and he names the idea of Medicare payments for care management of chronic disease patients as the reason. The devil is in the details – our practice investigated using the new Chronic Care Management codes that went into effect in January. The fact that the patient has to consent and agree to pay a 20 percent coinsurance is a huge barrier. Patients are reluctant to put their nickel down on something that feels unproven, especially if they are on a fixed income. Additionally, it’s first-come, first-served, so if other specialists charge it before the PCP does, they win.

I got a chuckle while reading Mr. H’s news feature mentioning a new referral management software vendor named Fibroblast. For those of you who may not have had to sit in the dark through dozens of hours of histology slides on carousels in medical school, a fibroblast is a connective tissue cell. It also does a lot in wound healing. If there is anything that the completely dysfunctional healthcare referral process needs, it’s something to help heal it. Good luck to Fibroblast in their work.

From Eager Reader: “Re: Dr. Jayne, I enjoyed your fashion commentary from HIMSS, especially since I couldn’t be there this year. What do you think of this article about people who wear the same thing every day?” I have to admit, I wear a modified “same thing every day” wardrobe myself. It’s kind of like Garanimals for adults, only without the matching labels that allowed even the most fashion-challenged to put together a workable outfit. When I was a kid, as long as you had the lion-tagged pants with the lion-tagged shirt, you were good to go. I’m pretty sure my brother had the outfit above, but I remember him wearing it with a wide white belt. Although the article cited Steve Jobs, Mark Zuckerberg, and Albert Einstein as devotees of simple dressing, there might be another famous fan in the wings. The parent company of Garanimals is now owned by Berkshire Hathaway. I’m going to start the Warren Buffett style watch in the morning.

What’s your favorite work uniform? Email me.

Email Dr. Jayne.

News 5/1/15

Top News

CMS releases a Medicare Part D prescription database for 2013 that includes details down to the individual prescriber for $103 billion in drug costs.

Reader Comments

From Ortho Doc: “Re: Meaningful Use. The ‘we can’t tell what the numbers mean yet’ for MU2 rear their ugly head in an Advisory Board report. Only 38,472 EPs have attested for MU2 to date. My guess is that only about half actually did Stage 2 as there was the Stage 1 reprieve. Even so, only 18 percent have successfully attested, which is a complete failure of MU. Someone ask CMS and ONC the tough questions, please. Now what are they going to do?” I’ve lost what little interest I had in MU – it’s a distraction to the real work that needs to be done, it encouraged providers to impulsively buy the same old EHRs they wouldn’t spend their own money on, and it put the federal government’s fingers in what should be private business practices and the patient-physician relationship. I’m actually encouraged that providers are bailing out since maybe they will refocus on what’s important.

From Dan: “Re: DonorsChoose. We’ve noticed the recent activity on HIStalk and would like to participate. Your effort is very well aligned with our philanthropy and community involvement objectives, especially around STEM (science, technology, engineering, and mathematics). It’s great that you’ve topped $10,000 towards the effort and we’d love to make a $5,000 contribution. We’d also like to keep the contribution confidential – I’m simply reaching out on behalf of others who feel strongly about this topic and have worked to approve the funding.” I never disclose sources, but I’m making an exception this time because Cerner’s generous donation should be acknowledged (I warned Dan that I would probably name the company). I also suggested an interview with one of Cerner’s female engineers who mentors local girls about technical careers, so that’s coming soon. Thanks to Cerner, I’ll be funding another $5,000 worth of DonorsChoose projects with an emphasis on those related to STEM, which is vital to our global future as we fall behind countries that emphasize those subjects more than we do. Kudos to Cerner for stepping up with no expectation of recognition. 

Speaking of the DonorsChoose project, donating $500 for some time with Centura SVP/CIO Dana Moore is Holland Square Group, which provides contract help to Centura.  

From Ockham: “Re: Judy Faulkner. A rare panel appearance at the World Medical Innovation Forum put on by Partners HealthCare. I attended Day 1 and I was very impressed with the speakers. I also found it fascinating that even though the conference was on neurology, every panel and speaker ended up talking about genomics and how it is going to transform medicine. Unfortunately, I couldn’t be there for Judy. Epic clinicals and everything go live at Brigham and Women’s in 30 days. Boston should feel like a home town to Judy with almost all but BIDMC soon to be live on Epic.”

From Soul Survivor: “Re: Medfusion. 20 percent payroll downsize.” Unverified.

HIStalk Announcements and Requests

This week on HIStalk Connect: Teladoc files IPO paperwork, and simultaneously sues the Texas Medical Board for antitrust violations. Scanadu raises a $35 million Series B to fund clinical trials of its Tricorder-like Scanadu Scout. Validic reports strong Q1 results and raises a $12.5 million Series B that will be used to ramp up operations and meet growing demand for its personal health data interface engine. White coat hackers demonstrate a number of security vulnerabilities found in tele-operated surgical robots.

This week on HIStalk Practice: CareWell Urgent Care goes with Athenahealth. PatientlySpeaking integrates with Aprima. Iora Health CEO details the delight of developing a homegrown EHR for primary care. IOM rebrands. ICD-10 study shows physicians have their heads stuck in the sand. North Florida Women’s Care goes with Keona Health. Telemedicine price wars escalate. Tattooed community up in arms over Apple Watch’s heart rate sensor sensitivity. Sherpaa bypasses "old school" video for more effective text message consults. Thanks for reading.

Webinars

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

Acquisitions, Funding, Business, and Stock

Dallas-based video doctor consultation vendor Teladoc will file an IPO. The company also files an antitrust lawsuit against the Texas medical board for passing a new rule that requires doctors to meet a patient face to face before prescribing medication.

MedAssets announces Q1 results: revenue up 9.9 percent, adjusted EPS $0.31 vs. $0.32, beating expectations for both. Chairman and CEO Halsey Wise said in the earnings call that he’s not happy with the company’s financial performance and announces plans for a “data-centric future” as customers ask the company to offer more services than just group purchasing as health system emphasis partially shifts from inpatient to ambulatory where MedAssets has minimal presence. The company plans to combine its supply chain and revenue cycle data with insights from its Sg2 analytics group (acquired in August 2014 for $142 million) to provide customers with deeper analytics. Above is the one-year share price chart of MDAS (blue, down 3.8 percent) vs. the Nasdaq (red, up 20.7 percent).

Care, quality, and compliance software vendor MedHOK acquires Continuum Performance Systems, which offers Medicare process management software.

Anthem shakes off its January 2015-reported data breach in booking Q1 profits of $865 million, up nearly 25 percent from a year ago, mostly due to increased Medicaid plan membership.

Athenahealth reports Q1 results: revenue up 27 percent, adjusted EPS $0.24 vs. $0.12, beating estimates for both. ATHN shares are up 20 percent in the past year.

Imprivata acquires HT Systems, which offers the PatientSecure biometric identification system, for $19.1 million in cash plus performance incentives worth up to $6.9 million. The company’s palm vein scanning patient ID system is used in 324 hospitals.

Sales

Community Health System (IN) chooses Allscripts dbMotion for its clinically integrated network.

Announcements and Implementations

Surescripts expands its CompletEPA prescription electronic prior authorization coverage to nearly 100 percent of US patients by partnering with PDR.

Boston Scientific will integrate analytics software from TogetherMD into its cardiovascular products.

IBM, Apple, and Japan Post Group will deliver iPads to up to 5 million senior citizens in Japan by 2020. The IBM-developed apps include medication and lifestyle reminders, community services access, and electronic monitoring that extends Japan Post Group’s fee-based home visits.

Apple revises its App Store review guidelines to require ResearchKit developers to obtain institutional review board approval for studies involving human research. The previous language recommended but did not require IRB approval.

New York-Presbyterian Hospital launches the self-developed NYPConnect staff communication app.

Athenahealth connects the lab hub of Liaison Technologies to its network.

Government and Politics

Former Texas for-profit hospital chain CFO Joe White is ordered to pay $4.4 million in restitution for filing false Meaningful Use attestation reports, adding to his previous sentence of 11 years in prison for healthcare fraud. He also falsified the entries using another employee’s ID and faces up to seven years in federal prison for identity theft in his May 27 sentencing. Chain owner Tariq Mahmood, MD was sentenced to 11 years in federal prison a couple of weeks ago for Medicare and Medicaid fraud, with the US attorney cheering the decision by saying, “What we do not need is providers like Tariq Mahmood who masquerade as physicians and pretend to care about American healthcare but actually are determined to loot the Medicare Trust Fund.”

Premier comments on the House’s 21st Century Cures, urging ONC to help liberate data “locked in proprietary software systems” by developing standards (including patient identifiers, security, and APIs) and publicly reporting measures of interoperability via ONC’s certification program. Premier’s comments are valid, but as an organization representing providers, it places the blame on vendors rather than providers who are neither demanding or using interoperability capabilities due to competitive concerns.

Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) of the Senate’s HELP committee make good on their promise to help HHS Secretary Sylvia Burwell with ideas for EHR improvement by inviting their Senate colleagues to join a working group that will identify ways to improve care, interoperability, and patient access to their own information.

Privacy and Security

A security guard at Mercy Health Saint Mary’s (MI) apologizes for looking up the EHR record of a 19-year-old female patient and then sending her a Facebook friend request.

Innovation and Research

Sensiotec wins an innovation award from the Technology Association of Georgia and the Southeastern Software Association. The company’s Virtual Medical Assistant offers FDA-approved, non-contact patient monitoring for post-acute care patients, with a monitoring panel placed under a patient’s bed or chair to continuously stream biometric information to the cloud.

Technology

Ron Kloewer, CIO of Montgomery County Memorial Hospital in Red Oak, IA, sent over a link to a Verizon story about the hospital’s Heartland Mobile Health unit, which connects the mobile exam room by 4G LTE to the hospital’s EHR.

Microsoft releases a software development kit for its Band smart watch that providers app developers access to its body sensors and notification tiles.

Other

Sitka Community Hospital (AK) says one of its top priorities in trying to survive financially is to fix its software problems, especially those that are causing delayed billing. Googling suggests that the system they installed last year is Healthland.

Deaconess Health System (IN) will install and maintain Epic for Good Samaritan Hospital (IN) via the OneCare ACO. I believe the system getting replaced is McKesson Horizon, which Good Samaritan bought in 2007.

Sensationalistic US news sites love crises that keep eyeballs coming back, milking the latest plane crash, natural disaster, or civil unrest for all it’s worth. Good news doesn’t sell in the “if it bleeds, it leads” style, so here’s a counterpoint: the folks at Baltimore-based Salar were at Inner Harbor Wednesday handing out food to whoever was around – National Guard, police, locals, and visitors. Scour the web and you’ll find pictures everywhere of locals helping looted business clean up, protecting police from those intending to harm them, and reminding opportunistic criminals that torching a CVS and stealing lottery tickets hurts rather than helps.

Sponsor Updates

• Microsoft announces Office plug-ins for DocuSign.
• Mobile charge capture vendor pMD will become a PQRS registry for 2016.
• Extension Healthcare offers “Reducing Clinical Noise and Solving the Challenge of Interruption Fatigue – A Nurse’s Perspective.”
• PatientSafe Solutions hosted a 40-participant HIMSS15 breakfast event discussing smartphone-based clinical communication and collaboration.
• Galen Healthcare offers part 1 of “Management-friendly policies we’ve taken to improve information security … and why you should too.”
• The HCI Group interviews ERP Practice Director Lane Tucker in its latest blog.
• ZeOmega hosts its client conference May 4-6 in Plano, TX.
• Healthcare Data Solutions unveils a new brand and website.
• First Databank adds natural health products to FDB MedKnowledge Canada.
• Holon Solutions will exhibit at the National American Hospital Association Meeting May 3-6 in Washington, DC.
• Influence Health will hold its Influence Client Congress May 3-6 in St. Louis.

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 4/30/15

The Evidence Shows IOM Was Right on Health IT and Patient Safety

ONC publishes its first of four planned reports on health IT and patient safety, titled Recent Evidence That Health IT Improves Patient Safety, the report cites a group of studies to support the argument that health IT has reduced medication error rates, enhanced capability for disease surveillance programs, and increased adherence to evidence-based medicine.

Your medical data: You don’t own it, but you can have it

A Brookings Institute report calls into question the need to charge patients for copies of their medical records now that EHRs have essentially eliminated the overhead cost of producing them incurred by hospitals and practices.

Teladoc plans to file for IPO, sues to stop Texas Medical Board rule

Dallas-based telemedicine vendor Teladoc files confidential IPO forms with the SEC in preparation for a public stock offering. The company also filed an antitrust lawsuit against the Texas Medical Board, claiming that the board is trying to unfairly limit competition by mandating that consultations happen in an in-person setting.

KLAS names Epic, athenahealth, Medfusion most effective in driving patient portal adoption

KLAS releases a report on patient portal vendors, finding that Epic, athenahealth, and Medfusion are leading patient engagement efforts. Customers of these three vendors report that at least 20 percent of their patients have accessed their portal.

HIMSS15 Patient Advocate Recap–Melanie Peron

How do I sum up the HIMSS tornado I lived for three days with my new advocate friends? It is quite difficult, but it’s time that I did it!

Almost four years ago, I decided to act and founded a social enterprise called l’Effet Papillon (The Butterfly Effect) in my home of France. It is dedicated to bringing a greater welfare to patients and their families. Since September 2011, we have organized 20 shows in patient hospital rooms (oncology services) and over 1,000 patients and family members received visits from musicians and storytellers. With the supportive care we provide to hospitals, charities, and socio-medical structures, 500 patients participated in individual or collective sessions.

It is incredible to see the power of this non-medical approach. Less anxiety, less feeling of social isolation, less consumption of antidepressants, and fewer relapses. This idea was born after being a caregiver for 18 months and after being very shocked by the social isolation of patients and family.

After being in contact with Regina Holliday for three years thanks to social media, I became a proud member of The Walking Gallery when she painted my jacket, “Butterflies.” When she suggested I apply for the patient advocate scholarship she created with HIStalk to attend at HIMSS15 in Chicago, I was surprise because I thought I was too small. I applied, thinking I had nothing to lose and that maybe I could be one of the lucky, happy, few patient advocates.

A few weeks after, I learned that I was one of the five winners. When I discovered the four other winners, I was very honored to be a part of this incredible team of rocking ladies. I also noticed that I was the only non-American patient advocate. Me, little social entrepreneur from France who struggled to provide supportive care and greater wellness to people, I’ll attend this huge event. I was thrilled!

For my trip to Chicago, friends and family wanted to be part of this journey, and in a way, they were with me. A friend of mine, Geraldine, took time to help me with the English version of the website. She also coached me for presenting my project. Another friend, Richard, helped me with the English version of the website of l’Effet Papillon. My friend Sonia lent me a beautiful couture dress of her atelier GLM fashion.

I arrived a few days before because I wanted to acclimate myself to the time zone, to the city, and to the language. I was a little bit worried to take part to this event and not to be able to speak like I did in French. HIStalk and Lorre organized everything very well before my arrival. Thanks to FormFast, I had the chance to stay in a very lovely and nice hotel during the event. Sunday evening I met Lorre for the very first time for real at Maggiano’s Little Italy at the HIStalk sponsor event and we met very nice people from Health Catalyst attending HIMSS as vendors.

I arrived at McCormick Place on Monday with the shuttle. Even though I heard it was a big event, I was impressed by the crowd. I searched for the HIStalk booth with a great excitation to meet Regina, Lorre, Jennifer, Amanda, Tami, and Carly. I was searching a lot because HIMSS is so big. Even in the biggest stadium when I went to see my favorite rock bands, I never felt so lost!

Finally, after a little time, I found the HIStalk booth and Regina. She was painting the jacket of Gabriela Wilson, a very nice person who I will meet the day after. Meeting Regina in real life is like meeting someone you waited for a long time. Quickly after this very happy moment, I met Carly, Tami, and Amanda and the team of patient advocates that was there. Sadly at the last minute Kim Witczak, our fifth winner of the scholarship, couldn’t come because of her job.

Monday was the first day of meeting in real with all my Walking Gallery friends and I passed all my day with them. I wanted to take the time to know them, to share our experiences, and to be with them, so I didn’t see a lot of vendors. The Walking Gallery of Healthcare members are so inspiring! You can’t imagine how wonderful and shining they are!

Regina organized a gathering of the members and I met E-Patient Dave for the very first time. I was so happy! It’s thanks to a talk of Dave that I discovered him and Regina. I had the feeling to meet one of my favorite rock stars! And Dave is so nice! He gave me a badge for the Society for Participatory Medicine and proposed me to be a member of this society because they need of the participation of patients to move forward with the care and the treatments of patients. I would love to have the same kind of organization here in France.

Monday night was the HIStalkapalooza event, a VIP event that is the place to be during HIMSS. As a fan of music, I was delighted to go to the House of Blues and share this lovely moment of music and happiness with my friends. For this special occasion, I wore my French couture dress and everyone loved it! I even receive the “Mr. H’S Secret Crush” sash. I think I succeeded to make a good representation of my friend’s work and talent!

Tuesday, we went to visit vendors with Tami. They welcomed us well and I think they were a little surprised to discover patient advocates. Finally, they all told us it was a great idea to have patient advocates in this event. I’m deeply convinced that everyone will take advantage asking patients their needs. How can we imagine being efficient toward the users of the healthcare system while ignoring them?

Unfortunately, I didn’t have the time and the chance to meet the cancer centers who were at HIMSS and I came through a lot of trouble with the WiFi. If some of them read this post, I’ll be happy to have a talk with them on Skype!

Tuesday afternoon was the CGT live interview and I was a little scared about it. As you know, English isn’t my mother tongue. I make a lot of mistakes and it’s very frustrating to not be able to express your thoughts like you can in your native language (French for me). With the help of the two kind interviewers and the support of Tami, I came through safe. I tried to give the voice and the needs of the people who aren’t heard, who are voiceless — the patients. I hope the message is understood and empathized by many.

After the interview, we had another gathering with the walkers. I had the privilege of meeting Kym and Ross Martin, two lovely people who know very well how important support and the well-being are both for patient and caregiver. Kym is a three-time cancer survivor and she is as shiny as the sun. Ross loves music and he founded The American College of Medical Informatimusicology and Ross named me fellow for France! I’m very proud to be part of it when you know how important music in my life and in my work is. That’s how l’Effet Papillon began, with music and the meeting of the French singer Benabar.

When you’re a lucky patient advocate invited thanks to HIStalk patient scholarship, you are invited to very nice events and a lot of people want to talk and share your thoughts about patient’s needs with you. Tuesday evening, we had two events where we were invited. The first was the Speakeasy party organized by Medicity. The second was the social media healthcare leaders in Gino’s. It was very nice and Tami won a Chromebook!

I began Thursday with a session about physician tools for patient engagement and it was very interesting. I learnt that 72 percent of Internet users look online for health information within the past year (2012 survey) and research indicates informed patients are more likely to comply with physician-recommended treatment, more willing to take an active role in their own health, less likely to make unnecessary health visits such as to emergency room, and more likely to have better health outcomes. About the topic patient-centered vs. patient engagement, they told us that patient-centered care is about the actions of the physician and other care providers and patient engagement is about the action of the patient regarding their own care. I have the dream that all physicians share the same goal and so the healthcare system!

Little after, I did a demo of Bliss in a Starbucks for Tami.

After that I had a nice meeting with Bewatec. This company offers multimedia communication solutions for hospitals. I thought it could be interesting for them to see Bliss, the social network of l’Effet Papillon I imagined and designed to answer to the social isolation of sick people. I have to keep in touch with them because we did not have a tablet version for the moment.

Because of the awful WiFi, I heard very late about Carly and the fact that she was in the emergency room of a Chicago hospital. She did so much for the patient advocacy during the event that her body stopped her with a huge migraine. With my daily headaches and the huge migraines I have quite often, I understand very well this kind of problem. When you give a lot and you don’t rest enough, your body stops you. And Carly, as a chronic patient with Crohn’s disease, knows that much more than me.

On the afternoon, I met Medfusion and they did a demo of their portal of portals for me. I’m not used to applications like that and I was surprised to find it quite easy and user friendly. They told me they asked for patients’ thoughts and needs when they were creating their app. The solution manager gave me an invitation code to download the app and try it, but unfortunately it’s not supported by my HTC One mini 2 so I am unable to review it.

At the end of the day, we had the last gathering of The Walking Gallery.

Thanks to HIStalk for this scholarship opportunity at HIMSS, I lived one the very best moments of my life. It was one the most incredible experiences I have had since the beginning of l’Effet Papillon. I met amazing and lovely people, people who inspire the change, people who dare, people who try and a lot of DOERS! With Amanda, Tami, Carly, Regina, Lorre, and Kim (you were there in our thoughts), I found incredible new friends.

I have never been so well received and listened to. In 2011, when people asked me, “Why do you want to create something which doesn’t exist? If a structure dedicated to bring a greater welfare for sick people doesn’t exist, it is because it’s not possible,” at that time, I discovered those crazy people like me are called social entrepreneurs. In 2015, thanks to HIStalk and Regina Holliday, I discovered that I was a patient advocate and a change maker.

One day, I’ll hope to bring wellness and happiness in the US too and I think Bliss could be a lovely way. I met so nice people there! The butterfly wants to fly and bring bliss actions everywhere.

I hope I will have the chance to live again those kind of moments and to attend to other events like that with patient advocates. Don’t forget about Carly’s challenge for HIMSS16: bring at least one patient to each booth!

Again, a huge thanks to Regina Holliday with The Walking Gallery of Healthcare and HIStalk who allowed me to be part of this journey.

If you want to stay in touch, feel free to contact me, I’ll be happy to talk with you by website, email, Twitter, Facebook, or LinkedIn.

HIStalk Interviews Jake Morris, Managing Director, McKinnis Consulting Services

Jake Morris is managing director of McKinnis Consulting Services of Chicago, IL.

Tell me about yourself and the company.

I started out as part of a healthcare family in healthcare finance and compliance. I think I was pre-destined. I started out an internship out of college and got involved in big rev cycle companies. I was fortunate to be staffed in early engagements on big transformation engagements, one locally here in Chicago where they were rolling out the Epic technology back when they used to do design, build, and validate.

I was very fortunate to see all the bells and whistles of rev cycle. What people are trying to accomplish, best practice, and getting involved in the nuts and bolts of how these next gen systems behave and how integrated they are in nature. I was able to take that learning, go client to client, and start to pinpoint where these challenge points are in conversion, but more importantly, what you could do in rev cycle with this next gen technology to eliminate costs, promote efficiencies, and make sure that the process and people independent of the technology were set up for that integrated nature to take the next step and to performance within rev cycle.

How has the Affordable Care Act impacted the revenue cycle?

It has really impacted the front end of the rev cycle. Pre-service centers, pre-registration, insurance verification, and identification of Medicaid populations have always been prevalent in a rev cycle. This just highlights the importance of those processes up front, which often gets neglected in rev cycle because it’s such a focus on the back end.

With segmentation, you’re having what used to be “true self-pay,” where historically you would get maybe 1 to 2 percent yield on a collection standpoint. That is now being blended into the “balance after,” which traditionally got 40 to 50 percent. Why that’s important is propensity to pay scoring. It’s becoming even harder to segment that population and balance after to understand what my collection efforts should be.

This has highlighted the importance of patient liability estimation functionality. It’s highlighted the importance of payment plans, processes, identification of. Then also because of the Affordable Care Act, a lot of the young demographic population are the ones going to the markets, getting these high-deductible plans. They’re used to using technology and Internet, so making sure that these online portals are set up for success and you can leverage that is of the utmost importance right now.

Are hospitals struggling to get that patient responsibility portion paid now that their chunk is bigger?

I think so. There’s leading indicators right now that there’s more process improvement up front. We have all the self-pay strategies on the back end with the dunning cycles and the outsourced vendors and those are important. But we’ve always struggled as an industry in rev cycle to get point-of-service cash collections lifted on the front end.

The Epics of the world now have this technology, the robustness, and the transparency to promote it. Now we just need to make sure with the information we have that we’re leveraging the technology to actually help with that segmentation and making sure that we’re leveraging all the functionalities in front of us to promote that type of behavior.

I’ve read interesting case studies showing that it’s not so much that patients are unable or unwilling to pay, but that providers have made it too difficult for them to do so. Do you agree?

I think that is the case. It’s always been the case, even in point-of-service cash strategies in the past independent of these next gen systems. It’s always a struggle. Part of the struggle was less to do with technology and more to do with the willingness and a culture of asking. Also, with the data we have, what are we doing to interpret it and have strategies in place for that appropriate segment based on the propensity to pay?

We can have in a vacuum finance in the back end and an analyst doing mining, but if you’re not getting end users up front bought into the process, if you don’t have the leaders up front bought into the process, and there’s not an accountable metric-driven process to promote this, then it’s never going to launch no matter what technology you have.

How hard is it for hospitals to walk that line between trying to collect from patients who aren’t paying their bills but who also fill out satisfaction surveys?

What I’m talking about right now isn’t even collections. On the front end of it, when you have the patient in front of you, like in pre-service, it’s not even a collection strategy. It’s more about helping to educate the patient on their balance, how their insurance works, and when this is going to happen. Then educating them on all the different strategies, policies, and processes that we have to help promote getting that payment.

I had mentioned payment plans and making it easy with all the different partners that exist out there that can help get the prepaid credit card or online payment portals. You’re making it easy for them so they understand what they owe.

Once you understand something and it doesn’t seem complex, you’re more prone to pay. In healthcare, unfortunately, sometimes statement design makes it really hard to understand what I owe. That creates a lack of confidence in that amount, and therefore, I’m less prone to pay it.

It’s engaging that individual to educate, to help create a comfort, to then allow for that patient to make the payment. I think most people have high integrity in what they owe.

Are insurance plans that people are buying via the online exchanges harder for consumers to understand or do they contain terms that are less favorable to providers than commercial insurance plans have typically been?

You see the ads from the bronze plans in California, Minnesota, and others that have up to a $5,000 deductible. Making sure the patient understands that. Also, the insurance cards don’t really look that much different. You could have Blue Cross Blue Shield or you could have a bronze plan and it might be hard for the registrar to interpret the difference between what those cards look like. How do I identify those? Because it matters in terms of what the patient liability is based on those plans that have high co-insurance and high deductibles.

What are hospitals doing to address plans with narrow networks?

From our experience, it’s a work in progress. The first step is understanding your population, having the data to create a strategy to attack, and making sure you have that segmentation.

What typically goes wrong when a big health system has financial stumbles after implementing Epic or Cerner and what has to be done to fix the problems?

The Epics and Cerners of the world are fantastic. The whole reason we’re doing business the way we’re doing is because of this type of next gen system. It is integrated and transparent.

People underestimate the work effort. There’s an assumption that because I went live this next gen, ROI is going to come. When in reality, what we often tell our clients is that the rev cycle is always going to be the revenue cycle. Environment dictates how I attack revenue and how I attack cash.

In a conversion environment, it’s much more a mitigation tactic than it is attacking it upside, but you have to have the vision for both. You have to respect the conversion and make sure that you’re taking the right approaches to hunker down and manage possible loss. A buzzword you hear in the industry is “optimization.” You’re always supposed to be optimizing your rev cycle. It’s cyclical. It’s an assembly line. You always have to be analyzing how am I doing in that process.

A conversion is no different. I have to be much more conservative in my approach. If I do that right, I could be on the path to gains in the future faster. I think people put too much emphasis on immediate ROI from a conversion. What they need to put more emphasis on is, what are the leading indicators for successful conversion that will allow me for continued investment for future growth opportunities?

Do CFOs think those big-ticket conversions are worth it in general?

If done right, yes. People see the absolute value in these technologies. The CFOs seeing that hold their rev cycle teams accountable equal to the system the process and the people. Are we integrated, in fact? Are we an integrated health system? Are we transparent? We have a system in place that’s promoting change — the clinical departments can be involved. Are we building a structure that will last to engage them in resolution so that way we don’t just have an uptick temporarily, but we have a model for sustained performance?

People that do that and treat conversion as a catalyst for culture enhancement — those are the people that are saying, this is great, this is fantastic. These are the same people that in their optimization plans or transformation are looking to get more out of their platform as opposed to go out to market and bring bolt-ons, which we should be trying to eliminate.

Are there any technologies coming in revenue cycle that will have health system impact?

There’s some cool payment plan processes and technologies that are coming to fruition. That is going to be critical in helping with the ACA impact. The online portals have come a long way. A lot of front-end technology is making some good strides. A lot of the host systems themselves are doing a great job hearing customer feedback and trying to build those within, so you have one-stop shopping and you get the most out of your host system. I think that’s a really cool development and that’s something that our firm’s backing up — making sure that you’re getting the most out of your capital spend. I think you can.

Now more than ever you can’t separate business and IT. You have to have equal component understanding of what my IT platform can be capable of. I also have to know what am I trying to achieve from a business process standpoint? I think historically to look at rev cycle support systems, even the bolt-on technologies, that model is true. Whether it was a charge capture bolt-on, whether it was a denial management bolt-on, so on and so forth, in order to build those bolt-on technologies, the author had to understand what they were trying to accomplish in outcomes, understand the complications of the process, and ensure the system was built to that.

What we’re seeing now is that same skill set is required. However, you need to be able to do that in the host system as much as you possibly can, because they’re capable of doing it. By doing that, you’ll promote greater efficiencies and better end-user acceptance to using those work flows.

Do you have any final thoughts?

This is an exciting time to be in healthcare. That’s why you’re seeing such an interest from existing healthcare companies and also companies wanting to get into healthcare. 

What I would say to buyers out there and organizations that are looking to continue to improve their overall experience, especially in the rev cycle arena, is making sure that you’re building in the time to  get the most out of your current spend. Not have additional costs to your solution, but to challenge your business owners and your IT owners to budget the time to get together to have a strategy that aligns to your organization’s budget, to the industry trends and vision, and to get together and partner to maximize what’s going. 

Making that part of their everyday existence. Not just one time, but making it hardwired like an audit process. Always evaluating your accountability structures. Always evaluating the productivity and efficiencies that you’re supposed to be gaining. Always evaluating how I can take these efficiencies, reduce cost, or repurpose cost to always be on the cutting edge of what the industry is doing.

If everybody focuses on that,  you’re going to get a lot out of this wave of the technological boom that you’re seeing for this next gen. I’m excited to be a part of it and I’m excited to see what the results are in the next few years.

Morning Headlines 4/29/15

Vanderbilt to replace clinical IT systems

Vanderbilt University Medical Center announces that it will replace its current McKesson Horizon system with either Epic or Cerner.

CareCloud announces new CEO, $15M in funding

Cloud-based ambulatory EHR vendor CareCloud replaces its CEO Albert Santalo and announces that it has raised a fresh $15 million in VC funding, bringing its total raised to $70 million.

What Health Care Will Look Like in 2030. Maybe.

Former National Coordinator for Health IT David Blumenthal, MD publishes an article in the Wall Street Journal imagining the future of healthcare in a world where patients are monitored, alerted, and triaged by smartphone apps. To help usher in this reality, he calls for improvements in EHR interoperability and data security.

Validic Tracks Down $12.5 Million to Gather Medical Data

Raleigh, NC-based digital health startup Validic, which sells an interface engine that captures patient-generated health data from fitness trackers and medical devices, announces a $12.5 million Series B funding round. The company recently announced commercial agreements with both Cerner and Meditech.

HIMSS15 Patient Advocate Recap–Amanda Greene

When I first heard about the opportunity to attend the 2015 HIMSS conference in Chicago as a HIStalking patient advocate on Regina Holliday’s blog, I knew I had to apply even if I didn’t earn one of the coveted scholarships. I wanted to be a part of the incredible opportunity that invited patients to be a part of the largest health IT conference of the year. I was thrilled when I found out that I was going to be one of five patient advocates selected by Regina and the HIStalk team.

"LA Lupus Lady" in The Windy City of Chicago at HIMSS15.

After weeks of planning and preparations, taking a trip when you manage a chronic illness is more than packing your suitcase — it involves strategy and planning for all contingencies. Traveling to Chicago, checking in to the hotel, and adjusting to Chicago time is for most people the extent of travel stress. For me, the seemingly endless walk to the departure gate and retrieving my luggage was a virtual marathon, yet my adrenaline and excitement pushed me with a sense of excitement. I made it to the shuttle and arrived McCormick Place with eagerness and anticipation.

There was a small registration situation, but soon I found myself meeting Colin Hung (@Colin_Hung of #hcldr) for the first time. I love meeting my friends from social media in real life and had been looking forward to hugging Colin at HIMSS. Thankfully Colin had access to an extra HIMSS pass and shared his access with me.      

Strolling the streets of Chicago was one thing but walking the aisles of booths within the exhibit hall of HIMSS was incredibly empowering. I was filled with joy and inspiration with every step. The colorful signage and well-appointed booths were on abundant display as Colin helped me wield the magnificent madness and lead the way to the HIStalk booth to check-in with Regina and the HIStalk team.

Regina Holliday and Colin Hung show off their "The Walking Gallery" jackets in the HIStalk booth at HIMSS15.

Soon I was on my own and wandered through the exhibition hall, meeting executives and representatives for the largest health IT companies as well as the next big thing and meeting the teams behind the start-ups who strive to create the next big paradigm shift in information technology. After a fabulous first day of HIMSS adventures, it was time to celebrate at the HIStalkapalooza party held at Chicago’s famous House of Blues, where I was proud to participate in judging the HIStalk "Best Dressed" and "Best Shoes" contests. In case you don’t know this about me, let me share that I love it when my passions collide, and being a patient advocate with a new Karen Kane dress on at the HIStalk HIMSS party was a real collision of my passions for health activism, fun, and fashion.

The reason attending HIMSS was such a pleasure for me is that HIMSS is a "global, cause-based, not-for-profit organization focused on better health through information technology." As a healthcare activist, I was happy to be healthy enough to attend the conference and absolutely thrilled to be able to engage and connect with the stakeholders involved with developing the next generation of healthcare devices and apps. More importantly, I was able to be seen and heard as a patient advocate.

Patient advocate "engaged" with Jan and Jack at HIMSS.

On Tuesday morning, Jan Oldenburg of the HIMSS Connected Patient Initiative shared the value and impact of engaging with patients at the Digital Health Meetup. This meetup was one of the most empowering sessions of HIMSS15. I was already teary from Jan’s passion for the community and retelling of Regina Holliday’s story "73 cents" when she asked if anyone was a member of "The Walking Gallery" and wearing their jacket.  Of course, I was. I stood up and "modeled’ my jacket. Soon after, Jan mentioned that WEGO Health CEO Jack (@healthyjack) Barrette was in the crowd. I was overwhelmed by inspiration and had to talk with Jan about how I could continue my passion for the Connected Patient Initiative and community after the conference was over.

"Connected Patient" Learning Gallery exhibit at HIMSS.

Imagine the future of healthcare where patients and doctors are able to share EMRs/EHRs with immediate access and are able to create a system of Meaningful Use. (No Meaningful Use "MU" without me.) At the HIMSS conference, the future is not some far off and distant place but "the future is now."

In addition, to attending HIMSS as a patient advocate, I was interviewed for #TalkHITwithCTG. Thank you to CTG Health Solutions for being a sponsor of the HIStalking patient advocates HIMSS registration passes. CTG Health Solutions was generous and extended their extra passes to HIMSS to HIStalk and that is how the HIStalk patient advocates were able to gain admission to HIMSS. (Thank You!)  

Headlining the HIMSS conference was former POTUS George W. Bush. He was surprisingly jovial and recalled his memories of days during his Presidential administration. I enjoyed his family stories of how his parents and family have taught him the value of family, trust, and love. Though attendees were told not to take pictures during his keynote presentation, as a patient advocate I was also told to be gently and openly "disruptive," so I enjoyed the challenge of sneaking pictures of 43 during the Q&A.

Former President George W. Bush giving the keynote at HIMSS15! Wowing the crowd.

Immediately after the Presidential keynote, it was time for the HIMSS Block Party, a celebration of the community and regional HIMSS chapters representatives were there to encourage a real sense of community.  It was at the HIMSS Block Party where Regina and the HIMSS attendees who are members of The Walking Gallery gathered for a photo op and hugs. On my way out of the party, I luckily met the California HIMSS chapter representatives, and as luck would have it, I won the Block Party prize of California wine and treats. The HIMSS community made me smile even more (on the last day after the conference) than I thought possible.

The next day, I spent more than a few hours napping and recouping from the conference, but I forced myself to get out and explore the city. In addition, to visiting the famous Bean sculpture, I went to Tribune Plaza for a special "photo op" with my favorite football team’s helmet. Despite being in Chicago, I had to pose with the New York Jets helmet, a part of the city’s preparation for the NFL draft. 

Passions collide in Chicago… #LHandSign in the New York Jets helmet in front of the Chicago Tribune. Raising Lupus Awareness in the city after HIMSS15 wrapped.

It was an honor and pleasure to join the HIMSS community. I feel so lucky to have had the opportunity to participate as a HIStalk patient advocate. I will never be able to show my deep gratitude and appreciation to everyone who made my journey to Chicago such a wonderful adventure.  Lorre, Jennifer, and of course the entire HIStalk team, I am so grateful. How can I begin to thank Regina Holliday for creating the environment where patients are included?  

I am proud to share my adventures in Chicago and hope that this post was able to give you a glimpse into my HIMSS journey. Patient advocacy is my path and I feel that my trip to Chicago was a delightful turning point in empowering me to "level up” my activism and share my enthusiasm for advocacy. In case you are wondering, yes, I am still smiling.

News 4/29/15

Top News

Vanderbilt University Medical Center (TN) will replace its McKesson Horizon system — the CPOE portion of which it developed in-house as WizOrder starting in 1995 — with either Cerner or Epic. That’s one of the last homegrown systems to bite the dust, both at Vanderbilt and everywhere else as McKesson puts its commercialized version out to pasture after a 12-year run. It’s also interesting that Vanderbilt is echoing the general market trend of considering only Cerner and Epic to be viable choices, showing no interest in looking at Allscripts, Meditech, or McKesson Paragon.

Reader Comments

From Willow: “Re: Xerox Midas+ layoffs. Four laid off so far, apparently prompted by the first poor quarterly earnings report in the company’s history, which appear to have been caused by the high consulting and infrastructure costs spent on its Juvo product.” Unverified.

From Concerned CC Client: “Re: new CEO at CareCloud. Positioned as great new, but in reality not. Since they were founded in 2009, under Santalo’s direction, they have gone through $80.5 million, are not making money, and now need $15 million to stay afloat.” EHR/PM vendor CareCloud announces Ken Comee as CEO, replacing Albert Santalo, who will remain as chairman and chief strategy officer. The company also announced $15 million in additional funding from existing investors. Technology executive Comee has been on CareCloud’s board since 2012, and according to his LinkedIn profile (which features the overly arty “more chest, less head” look above), he has no other healthcare-related experience.

HIStalk Announcements and Requests

We’ll have HIStalk Practice posts Monday through Thursday going forward (instead of just twice weekly) and Jenn will also write a Friday summary of population health management news. Sign up for short, fun, and informative updates and see what’s new in ambulatory, practice, and PHM.

Webinars

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

Acquisitions, Funding, Business, and Stock

Private equity firm Francisco Partners will acquire healthcare talent management solutions vendor HealthcareSource from majority owner Insight Venture Partners.

Merge Healthcare announces Q1 results: revenue up 6.9 percent, adjusted EPS $0.05 vs. $0.04, beating earnings estimates but falling short on revenue.

Validic raises $12.5 million in Series B funding from investors that include the venture arm of Validic customer Kaiser Permanente.

The Raleigh, NC business paper says Allscripts will build a new 18-story building for its 1,260 local employees, although the company hasn’t confirmed. The article mentions that Allscripts recently “rebalanced” 3 percent of its workforce.

The Chicago business paper profiles referral management software vendor Fibroblast.

Scanadu raises $35 million in a Series B round to further develop its Scout tricorder-like body scanner.

CTG announces Q1 results: revenue flat, EPS $0.08 vs. $0.19. The company blames soft healthcare IT services demand as providers delay projects or staff them internally.

Aetna announces Q1 results: revenue up 8 percent, EPS $2.20 vs. $1.82. Chairman and CEO Mark Bertolini said in the earnings call that its Medicity business is “seeing a lot of growth.”

Roper Industries, which owns many companies that in healthcare IT include Sunquest and Strata Decision Technologies, reports Q1 results: revenue up 4 percent, adjusted EPS $1.55 vs. $1.46, falling short on analysts’ revenue expectations but beating on earnings. The company announced in the earnings call that it has changed its name to Roper Technologies to emphasize that it isn’t just an industrial company but rather a collection of businesses that deliver 60 percent gross margins. Above is the one-year share price chart of ROP (blue, up 24 percent) vs. the Dow (red, up 9 percent).

Sales

Consolidated Laboratory Services chooses McKesson Business Performance Services for billing.

Star Medical Center (TX) contracts with Anthelio Healthcare Solutions for revenue cycle optimization.

People

  

Medical kiosk vendor HealthSpot hires Gail Croall, MD (Anthem) as chief medical officer; Eric Eichensehr (Levitate Technologies) as CTO; and Bruce Roberts (RxEngage Partners) as COO.

Announcements and Implementations

In Qatar, Al Khor Hospital goes live on Cerner Clairvia for nursing staff management.

The CEO of Henry Ford Health System (MI) says that while the system took an initial financial hit in 2013 after its $353 million Epic implementation, using Epic helped it save $65 million in 2014 and HFHS will cut $300 million in cost by 2016 as its financial turnaround continues. Meanwhile, UNC Health Care (NC) also credits Epic with its stronger-than-expected operating income.

Wellcentive, SpectraMedix, and eClinicalWorks are pilot testing NCQA’s eMeasure electronic clinical quality measure program for Meaningful Use and HEDIS reporting.

T-System announces its tablet-based T Sheets Digital for Urgent care that includes 45 chief complaint-based templates.

MedAptus releases Premium Analytics for its charge capture suite.  

QPID Health is named a Gartner “Cool Vendor.”

Government and Politics

The Institute of Medicine will rename itself to National Academy of Medicine effective July 1, 2015.

National Coordinator Karen DeSalvo, MD says in a Health Affairs blog post (which appears to have been taken verbatim from her HIMSS conference presentation) that ONC will use Medicare payments and the DoD’s EHR contract bid to push interoperability.

Privacy and Security

A security researcher finds data from Hilton Head Hospital (SC) for sale on a hacker marketplace, apparently exposed during a 2014 breach caused by PST Services, a McKesson subsidiary that provided billing services to Tenet’s hospitalist contractor and inadvertently opened up its billing records to Internet searches.

Seton Family of Hospitals becomes the latest organization to expose patient information via employee-targeted email phishing attacks. Hackers accessed the information of 39,000 Seton patients in the December 4 breach.

Other

Pella Regional Health Center (IA) opens a 24×7 nurse hotline as part of its patient-centered medical home efforts. Anyone can call the hotline to discuss concerns or make appointments with nurses who have access to the EHR.

Partners HealthCare expects to double the $80 million in annual revenue it receives from licensing and spinoffs.

Former National Coordinator David Blumenthal, MD says in a Wall Street Journal editorial that healthcare IT will fall short of its potential unless security and interoperability are improved.

A Brookings article highlights the maximum “reasonable cost” providers can charge patients for providing 75 copied pages of their records, which ranges from $19 in California to $101 in Georgia. It mentions that providers in many states can charge patients the same per-page amount for copies of their digital records even though the provider cost is essentially zero.

Sponsor Updates

• Amerinet extends through 2018 its member discounts to revenue integrity products from Craneware, also adding the company’s InSight Medical Necessity tool.
• Zynx Health and Meritage ACO will present “Using a Mobile Tool to Create a Virtual Caregiver Huddle” at the NPSF Congress April 29 – May 1 in Austin, TX.
• Cueatr posts a photo slideshow of its experience at the HIMSS conference.
• ADP AdvancedMD announces the launch of its SmartPractice e-letter for independent practices.
• AtHoc details its integration with Apple Watch.
• Besler Consulting outlines how “CMS-1498-R2 gives hospitals option to have their SSI Factor recalculated.”
• CareSync offers “Here’s How CareSync Changes Lives for the Better.”
• CareTech Solutions takes a look at how The Metro HealthSystem used the company’s solutions to realize SEO advantages and budget benefits.
• The local paper looks at how several HIStalk sponsors — CenterX, Forward Health Group, Healthfinch, and Nordic Consulting – are making an impact in their native Madison, WI.
• Team CoverMyMeds shares personal highlights of HIMSS15 in its latest blog.
• MedCPU looks back on its HIMSS15 experience.
• Health Care Improvements Institute announces its partnership with xG Health and interviews xG Health CEO Earl Steinberg, MD and President/COO Ray Herschman.

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 4/28/15

Health Information Technology: Where We Stand And Where We Need To Go

National Coordinator for Health IT Karen DeSalvo, MD publishes an article in Health Affairs on the early successes, current state, and future roles that health IT will take on in care delivery, specifically addressing interoperability, and IT goals that go beyond EHRs and Meaningful Use.

Advancing Breakthrough Devices for Patients Act

Senators Richard Burr, Michael Bennet and Orrin Hatch introduce a new bill that creates an expedited path to FDA pre-market approval for new breakthrough healthcare technologies. The bill is modeled after the 2012 Breakthrough Therapies for Patients Act which created the same expedited pathway for new breakthrough drugs.

DoD To Start Its Own Digital Service Team

The DoD will open new offices in Silicon Valley where it is building its own digital services team modeled after the White House tech team that was responsible for resurrecting Healthcare.gov in its early days. The new team, some of which has already been recruited, are currently working on solving data exchange problems between the DoD and VA EHRs.