News 5/20/15

Top News

Allscripts layoffs, which HIStalk readers have been reporting for the last several weeks, finally happen, with 250 indeed being the magic number. Several readers chimed in with their opinions just as the company made the cuts. Allscripts Peon pointed out that Allscripts “continues to lie to employees and cut staffing levels. Last month, 250-300 employees were cut so leadership could ‘right size’ the company. At that time, senior leaders told remaining employees that further cuts were not anticipated or being contemplated. Last Friday (5/15), another 250 or more employees got the axe as executives again said they were ‘right sizing’ the company. Apparently Paul Black and his team have no clue what the right size is for Allscripts.” Broadway Joe added that layoffs affected DBMotion, too. In terms of “right sizing,” the layoffs represent 3.5 percent of the company’s global workforce. Spokeswoman Concetta DiFranco explained that, “As a normal course of business, we are rebalancing our teams to ensure we have the right resources allocated to the right projects." I’m wondering how “right” those 250 folks feel right about now.

Webinars

Here’s the video from Tuesday’s webinar with Imprivata, which featured tips on how to prevent phishing attacks at healthcare facilities, as well as lessons learned from Yale New Have Health System.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making

May 27 (Wednesday) 1:00 ET. “Introducing Health Catalyst Academy: An Innovative Approach for Accelerating Outcomes Improvement.” Sponsored by Health Catalyst. Presenters: Tommy Prewitt, MD, director, Healthcare Delivery Institute at Horne LLP; Bryan Oshiro, MD, SVP and chief medical officer, Health Catalyst.  The presenters, who are graduates of Intermountain’s Advanced Training Program, will introduce the Health Catalyst Academy’s Accelerated Practices program, a unique learning experience that provides the tools and knowledge for participants to improve quality, lower cost, accelerate improvement, and sustain gains.

Acquisitions, Funding, Business, and Stock

Welltok acquires predictive analytics company Predilytics for an undisclosed sum. The timing is interesting, given that Predilytics secured a $10 million Series C round last December. Welltok will likely incorporate the new company’s tools into its CaféWell health optimization platform.

Announcements and Implementations

ADP AdvancedMD launches patient and administrative kiosk apps, plus corresponding electronic check-in and consent forms.

Surescripts announces the processing of 6.5 billion health data transactions last year, surpassing transaction heavyweights American Express and PayPal.

The Hilo Medical Center’s Hawaii Pacific Oncology Center implements Meditech Oncology 6.0x, making it the ninth and final clinic in the HMC network to migrate from paper to the EHR. The five-year, system-wide project also included implementation of secure patient bill pay through the East Hawaii Regional Patient Portal.

Arkansas Heart Hospital and Arkansas Urology implement Pingmd’s secure text messaging solution across 35 facilities. The app has been in use at each organization’s main facility in Little Rock for over a year.

Stoltenberg Consulting partners with Qlik to offer the visual analytics vendor’s data solutions to its clients.

HealthCare Synergy becomes the first home health EHR vendor to partner with Great Lakes Health Connect, a Michigan-based HIE that connects over 80 percent of hospital beds and 10,000 providers throughout the state.

Government and Politics

An OIG report finds the Coast Guard sorely lacking when it comes to protecting personnel medical records, citing a lack of instruction and process to periodically review health data security measures. The report also found no evidence of meetings between the Coast Guard’s privacy and HIPAA officers, and noted a lack of leadership as the main barrier to be overcome. The copious amounts of paper files pictured in the report (along with one black-and-white photo of a flooded records room) are also cause for concern.

Privacy and Security

The IEEE Cybersecurity Initiative releases “Building Code for Medical Device Software Security,” a 23-page set of guidelines that aims to help companies “establish a secure baseline for software development and production practices of medical devices.”

Innovation and Research

New York-Presbyterian Hospital launches InnovateNYP, a 10-week technology competition in which contestants will develop working prototypes that improve patient engagement or provider collaboration. Entries are due July 24, with a top prize of $15,000.

A study of over 300,000 free-text machine-readable documents in the Stanford Health Care EHR finds that text-mining tools can be used to detect unplanned care episodes documented in clinician notes or in coded encounter data. Researchers believe their methods could be used for quality improvement efforts in which “events of interest occur outside of a network that allows for patient data sharing.”

MD Anderson Cancer Center at Cooper (NJ) and behavioral health technology company Polaris Health Directions will launch a breast cancer behavioral health pilot project incorporating the Apple Watch. Wearable data on treatment side effects, sleep patterns, activity levels, and mood will be combined with patient EHR and population health data from within the Cooper health system to provide researchers with greater insight into engagement, feedback, and intervention.

Technology

Flatiron Health will incorporate National Comprehensive Cancer Network Chemotherapy Order Templates into its OncoEMR, beginning with breast, colon, and non-small cell lung cancers. The EHR will also link to NCCN’s website to provide oncologists with additional resources.

Fruit Street Health taps Validic to integrate wearable devices and applications into its telehealth software, PHR, and video-conferencing platform.

Proxsys partners with mobile technology developer Catavolt to create a bedside discharge delivery app for tablets. The new app will be deployed throughout the Proxsys Rx Integrated Outpatient Pharmacy Provider network.

People

Jonathan Scholl (Texas Health Resources) joins Leidos as health and engineering sector president.

Hai Tran (BioScrip) joins Specialists on Call as CFO.

Recondo Technology appoints Eldon Richards (PatientPoint) CTO and Perry Sweet (Allscripts) as chief client officer.

Mark Reed, MD (Seattle Children’s Hospital) joins JWA Consulting, a part of Truven Health Analytics, as medical director.

Other

This article highlights the decade-long collaboration between physicians at the Uganda Cancer Institute and Fred Hutchinson Cancer Research Center (Seattle). The two organizations are preparing to open a new research, training, and outpatient facility in Uganda. It will be the first comprehensive cancer center jointly built by U.S. and African cancer institutions in sub-Saharan Africa.

HIMSS issues a call for members of its new Health Business Solutions Technology Task Force. The group will facilitate discussion between health IT vendors and end-users, review legislative and administrative initiatives, and educate policymakers on aligning regulatory requirements with business needs.

Sponsor Updates

• ADP AdvancedMD explains “What the Meaningful Use deadline means for your practice” in a new blog.
• The San Antonio Express-News covers AirStrip’s expansion into home health.
• AirWatch recaps its first annual employee hackathon in a new blog.
• AtHoc recaps its annual user conference in its latest blog.
• Besler Consulting explains “The Role of Discharge Disposition in Preventing Hospital Readmissions” in a new blog.
• Bottomline Technologies and Cornerstone Advisors Group will exhibit at the MUSE conference May 26-29 in Nashville, TN.
• CapsuleTech offers a new blog entitled, “Are you aware that your patient’s ventilator has just disconnected?”
• Caradigm outlines “How Population Health Enriches the Patient Record” in a new blog.
• CareTech Solutions offers a new video explaining the benefits of cloud services in today’s healthcare environment.
• Clinical Architecture recaps its HIMSS15 fundraising efforts for the Music Empowers Foundation, Illinois Tornado Relief Effort, and St. Joseph the Worker School
• CommVault adds several new cloud solutions to its line of enterprise products.
• Connance’s Patient-Pay optimization solution receives HFMA Peer Review designation.
• CoverMyMeds Vice President of Customer Relations Michelle Brown discusses how to scale up a company’s culture during a Startup Week event in Columbus, OH.
• Culbert Healthcare Solutions offers a new blog on “Improving Population Health using Epic’s Healthy Planet.”
• Divurgent offers a new white paper entitled, “Population Health: Laying the Foundation of Healthcare’s Next Generation of Care.”
• Medecision offers a new blog entitled, “From Patients to People: Leveraging Analytics to Improve Population Health.”
• Burwood Group posts a new blog entitled, “ED Caregivers, Tech – Let’s Get Together.”
• Practice Unite offers a new blog entitled, “[Checklist] Evaluating Mobile Patient Engagement Apps.”
• SyTrue offers a new visual blog focusing on industry response to its Radiology NLP offering. 
• Microsoft blogs about its experience demonstrating nVoq’s SayIt speech-recognition solution on Surface Pro 3 tablets at HIMSS.

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 5/19/15

Interoperability Roadmap Public Comments

ONC publishes all of the public comments it received on its interoperability roadmap (PDF).

ICD-10 Transition Testing Proposed

Rep. Diane Black (R-TN) introduces the ICD-TEN Act, a bill that would introduce an 18-month period during which providers could submit claims in either ICD-9 or ICD-10 format, and during which CMS would be barred from denying claims due to inaccurate ICD-10 sub-coding.

Interstate telehealth licensing compact set to become reality

A compact drafted by the Federation of State Medical Boards that would allow providers to practice medicine across state lines looks likely to be enacted. The compact was written in an effort to ease regulatory barriers to broader telemedicine adoption. The compact required that seven states formally adopt it before it would become active.  Alabama has just passed legislation adopting the compact and as soon as the Alabama governor signs the bill into law, the compact will have met its seven-state requirement and will be enacted nationally.

Curbside Consult with Dr. Jayne 5/18/15

Dr. Jayne Adapts to New IT (and Lives to Tell the Tale)

Sometimes it’s important for those of us in healthcare IT to eat our own proverbial dog food. This week was one of those times, when I decided to buy a new laptop before heading out on a locum tenens gig. Although I did plenty of research and thought about it for several months before I took the plunge, I had some unexpected surprises. Much like EHRs, it had plenty of “undocumented functionality” to keep me guessing.

At my previous employer, we had three choices for end-user devices: standardized desktop PC, standardized laptop, or standardized convertible tablet PC. Regardless of which you selected, the desktop images were pretty much the same. I’ve always opted for the latter because it worked well for me in clinical settings. I liked to use it basically as a touch-screen laptop, so I could free text easily while navigating through EHR screens. Our hardware refresh cycle was typically 4+ years, so it had been a while since I had anything new. Additionally, we were still using Windows 7 and I had not yet had the adventure that is Windows 8.

While shopping for my new hardware, I worried that I had become out of touch with consumer electronics because I had been insulated in the IT silo of Big Health System. That became a reality when it finally arrived on Friday afternoon. I have to say, Dell does a snazzy job with their packaging. The new laptop came in a glossy box with full-color photographic images on it. I was worried that my new device was heavier than anticipated, but discovered that a good chunk of the weight was the decorator-quality box. The real shock, though, came when I tried to start setting it up.

First, I guess you can’t do anything anymore without being online. Despite having purchased full versions of several applications along with the PC, it wanted me to go online to download updates before I could do anything. I had heard a lot about the Windows 8 interface so I was prepared to not have my familiar landmarks. I was not prepared, though for how clicky it is just to navigate to items that previously lived in the start menu. Rumor has it that Microsoft is bringing back the start menu with Windows 10, and I daresay I’ll probably be looking forward to it.

I spent a good hour downloading non-Internet Explorer browsers and configuring links and bookmarks just the way I like them, not to mention the general appearance and settings items. The new keyboard has a totally different feel than what I am used to and I knew there would be a learning curve, so I decided to start slowly with some online shopping. Running skirts on sale, y’all. Get ‘em while they’re hot! I placed my order and felt I was doing well getting used to the new touchpad when I had a big surprise – apparently this model is now touch screen! When I originally researched it a few months ago, they offered it in two versions – with and without. Now, apparently, they only offer it with the touch screen and I didn’t notice when I bought it since it was the same price as what I had researched before.

Although cool, it made me wonder whether the privacy filter I purchased would work with it. Especially now that I travel a fair amount, I don’t need people reading my work on the plane. I wanted to get things organized before I had to leave town, so I left that as a project for another day. I started moving files over from my old machine. I was feeling pretty good on the new keyboard and only typing gibberish now and then, so decided to do some real work. I’ve been working on a textbook chapter for a couple of months and emailing back and forth with a collaborator. We’ve had some bad experiences with Google Docs (which everyone and their cousin seems to use for collaboration), so we do our revisions old-school, emailing them back and forth after each update. I couldn’t open the most recent document from my partner and the laptop threw some ridiculous out of memory error at me despite the fact that Chrome was the only thing running.

I ended up having to download the document on another laptop and move it via USB, so I was already aggravated and distracted. Then, while I was trying to write, I kept getting emails from Gmail alerting me that my various accounts had been signed into from new IP addresses and new browsers. I plowed through some edits then got ready to save. Unfortunately, it stuck my draft not in the good old Documents folder as I had specified, but in some AppData/Roaming folder, which apparently is a hidden folder in file explorer. Not cool.

The last straw was when I got the email from Dropbox announcing that it had somehow (and seemingly without my permission) mated with Microsoft Office Online. Seriously? By this point I was ready to go online to my local school district and start looking for community education courses to help me navigate this mess. I’m really a pretty basic user at home – word processing, email, Internet, accounting software, spreadsheets, Twitter, and the occasional Facebook. I don’t do any multimedia or gaming and don’t like storing data in the cloud unless I really have to, hence the Dropbox account. (Yes, I’m a bit of a curmudgeon that way.)

But here I was with my applications melding in a way I didn’t understand or know how to control without doing a bunch of research or calling the teenager across the street. I decided to give up on the textbook and start writing Curbside Consult. Mind you, I’ve had this computer less than 72 hours and have barely used it. I was looking forward to some straightforward word processing and what happens next? The “I” key decides to stick. The screen instantly fills with the letter I and I’m prying it up with my fingernails to get it to stop. I tried for a good 15 minutes to get it to work right and no luck. Apparently the key has three modes: stick and type a thousand letters, stick and type nothing, or depress and type nothing.

By this point I was ready to throw in the towel and returned to my lowly HP with 2 GB of RAM that I bought in 2009. It’s slow and cantankerous, but has all its vowels and consonants in fine order. As for the new one, it’ll have to wait until I get back in town and am ready to deal with it. If nothing else though, I have a new appreciation for what physicians feel like when we throw new hardware or a new operating system at them without adequate orientation and training.

What’s your take on Windows 8? Email me.

Email Dr. Jayne

Morning Headlines 5/18/15

AMA Letter To Representative Ted Poe

The AMA sends a letter to Representative Ted Poe (R-TX) supporting his bill, Cutting Costly Codes Act of 2015, which would cancel the migration to ICD-10 completely, and instead instruct CMS to wait for the international adoption of ICD-11 in a few years. 

HealthCare.gov Contractor Optum Declares Its Job Done

Optum, the contractor tapped to rescue the failing Healthcare.gov site just after its troubled launch, announces that it will not bid to continue on in its role as senior administrator once its current contract expires. 

Can the state build a better system to get your medical records to your doctors?

Connecticut will reportedly scrap its state health information exchange after spending $4 million but failing to achieve its interoperability goals.

Population Health Management Weekly Wrap Up 5/15/15

Jenn publishes the third installment in her comprehensive weekly recap of the emerging population health management market.

Monday Morning Update 5/18/15

Top News

The AMA writes a letter to Rep. Ted Poe to support his bill that would delay ICD-10. The AMA says ICD-10 should be skipped in favor of ICD-11, the first draft of which isn’t due until 2017, explaining that EHR implementation work and introduction of new payment models make 2015 a bad time (hint: it’s never a good time). Failing getting ICD-10 overturned, incoming President Steven Stack says providers should be “held harmless,” presumably meaning getting paid by Medicare no matter what they’ve done in failing to prepare themselves despite years of advance notice. Doctors are vendors and I can’t imagine any other vendor angrily telling its customer how it demands to be paid. That’s like telling your employer it’s their problem to pay you correctly even if you refuse to turn in your timesheet or fill it out incorrectly. Or, me calling up the IRS and making snooty demands about my refund check. On the other hand, CMS and both state and federal governments have proven themselves to be predictably inept at health IT and claims payment rollouts, so I’d be worried too. I’m surprised an insurance company hasn’t offered ICD-10 interruption insurance to practices, although that might indicate that the risk is too high for underwriting.

Reader Comments

From Faraway: “Re: Allscripts layoffs. Two since the first of the year. On May 15, they started tapping people on the shoulder, with 40 well-seasoned support analysts terminated from the US help desk. The heck with quality service to the thousands of customers who pay software maintenance every month – they will have to fend for themselves and deal with the language barriers that come with offshore support. Many employees feel other departments will be hit Monday morning.” Several folks have emailed about Allscripts layoffs last week, with the number most often mentioned being 250 people. Regular Reader says it was mostly Touchworks people but also some working on Sunrise. The writing was on the wall given last week’s executive comments during the quarterly earnings call, in which professional services revenue was announced as down and not expected to fully recover anytime soon, the company sold only two new Sunrise accounts and those were 50-bed hospitals, and stock analysts were told that the $6 million in Q1 severance payments won’t end there. You made a big mistake if you bought MDRX shares five years ago – they’ve dropped 27 percent while the Nasdaq was jumping 127 percent. A $10,000 investment in MDRX shares in May 2010 would be worth $7,342 today while the same money spent on Cerner shares would have yielded $32,173.

From Make: “Re: Weird News Andy’s snippets. Am I the only one who wonders whether Andy has a real job or how he finds time to track down these crazy nuggets? Keep ‘em coming, Andy — the news links and your color commentary always make my day!!” WNA’s stories and pithy commentary are a highlight for me, too. He’s been sending them in for years without recognition or reward of any kind. Every year I suggest that he take a bow at HIStalkapalooza and he always declines.

HIStalk Announcements and Requests

 

Quite a few provider readers work for employers who don’t impress them too much with their service delivery, with half of poll respondents giving them an A or B and the rest going with lower grades. At least there weren’t too many F scores given. New poll to your right or here: which company’s shares would you buy?

We had all better be interested in population health management, so that being the case, check out Jenn’s weekly wrap-up that runs every Friday. You’ll be up to speed in just a handful of minutes each week.

April 2015 appears to have been the busiest HIStalk month ever because of the HIMSS conference, with 220,000 page views from around 30,000 unique readers in 42,000 unique visits. I don’t check numbers often, but I’m always happy to see that I’m not just talking to myself like I was in those first HIStalk days of June 2003.

Here’s DrFirst’s video of HIStalkapalooza. They got a lot of good crowd shots, so you might see yourself if you were there.

Our DonorsChoose project bought a Surface Pro for math practice by deaf middle schoolers in Washington. Mrs. Burns sent over a photo, adding that our contribution as an “anonymous donor” gave the students new vocabulary words to review as they  “get to imagine our mysterious benefactor.” Every time I get photos like these I remember my early education in a very poor school and wonder which of these kids will, 30 years from now, still remember the excitement of opening that box or using a new tool that got them engaged in a subject that lit the path to their adult lives. I guarantee it will happen.

Last Week’s Most Interesting News

• Publicly traded medical group Mednax acquires radiology services vendor Virtual Radiologic for $500 million.
• McKesson’s Technology Services business reports lower hospital sales, declining revenue, and the upcoming divestiture of an unspecified product line.
• Cerner says in its earnings call that its acquired Siemens Health Services business had minimal sales and lower revenue than expected for the quarter, adding that Cerner has set aside $35 million for Q2 voluntary separations that involve 2 percent of its workforce.
• Allscripts attributed its lackluster quarterly performance to lower professional services revenue, a trend it expects to continue, and says it expects to make additional severance payments in Q2.

Webinars

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making

May 27 (Wednesday) 1:00 ET. “Introducing Health Catalyst Academy: An Innovative Approach for Accelerating Outcomes Improvement.” Sponsored by Health Catalyst. Presenters: Tommy Prewitt, MD, director, Healthcare Delivery Institute at Horne LLP; Bryan Oshiro, MD, SVP and chief medical officer, Health Catalyst.  The presenters, who are graduates of Intermountain’s Advanced Training Program, will introduce the Health Catalyst Academy’s Accelerated Practices program, a unique learning experience that provides the tools and knowledge for participants to improve quality, lower cost, accelerate improvement, and sustain gains.

Acquisitions, Funding, Business, and Stock

Paragon Development Systems (PDS) will consolidate two offices into a newly named headquarters location in Brookfield, WI. Its offices in Madison, WI; Minneapolis, MN; and Wichita, KS won’t be affected.

Optum, which in 2013 rescued Healthcare.gov from the mess CMS created with the help of contractor CGI, won’t bid to continue the $40 million per year contract. The company says its job is done and that the experience it gained will “leverage our ability to develop and operate large transactional systems that advance healthcare.”

Shareable Ink raises $3 million and plans to bring in another $1 million in funding.

Private equity investor Thoma Bravo will sell Mediware Information Systems, according to a financial report that says the company has engaged William Blair to seek a buyer. The author tossed out a rough price of $400 million. Thoma Bravo’s other healthcare IT-related holdings are Hyland Software and SRSsoft.

Government and Politics

Hillary Clinton’s financial disclosure forms filed Friday show that she was paid $225,500 to deliver her HIMSS14 speech. Quite a few healthcare and drug companies retained her pricey oratorical services as well, with the Clintons banking $30 million in just over a year in total income from speeches and books.

Connecticut legislators express interest in developing a state HIE that would replace the work of HITE-CT, which burned through $4.3 million in federal money before it was put out of its misery in 2014 having accomplished basically nothing.

Hawaii state officials say speculation that its  $205 million health insurance exchange will shut down in the next few months is premature, although they admit having to make “hard choices” since the site is losing money, CMS audit problems the found IT and sustainability problems have restricted its federal grant money and state lawmakers gave it only $2 million of the $10 million it requested. Like other states that stubbornly built their own insurance exchanges that have since failed, Hawaii is considering shutting down Hawaii Health Connector and instead piggybacking on Healthcare.gov.

Technology

It’s a shameless marketing gimmick that is delivering the obligatory YouTube viral response in pitching a questionably cost-effective healthcare product, but this video of a da Vinci surgical robot suturing the skin back onto a grape while chipper music plays in the background is pretty cute.

Other

Doctors in India question why medical school education doesn’t cover telemedicine even as the country sets up telemedicine centers for rural medicine. A medical school physician says it’s tough to remove the inertia and create telemedicine champions when students haven’t been exposed to it, while a private physician says, “We have an ethnographer who observes doctors and the way they deal with patients in terms of technologies and otherwise. Sometimes, even after training for two weeks, it is so hard to sensitize doctors and make them get used to technologies.”

Newly released tax documents reveal that UPMC paid CEO Jeffrey Romoff $6.4 million in 2013, one of 31 UPMC executives who made more than $1 million. CIO Dan Drawnbaugh, who left in September 2014, made $1.6 million.

I bet Weird News Andy would make a pun about “piece of mind.” A patient sues Norton Cancer Institute (KY), claiming that a surgeon extracted tissue from his brain for an experimental cancer treatment but then lost it.

Sponsor Updates

• Verisk Health takes a cue from HIStalkapalooza and holds a pie-in-the-face event, giving employees the chance to throw pies at their managers.
• Huron Consulting partners with 60 charitable and nonprofit organizations during its fourth Annual Day of Service.
• Patientco offers “Thoughts on PwC’s Patient Payments Report.”
• TeleTracking client Royal Wolverhampton Hospitals NHS Trust reports that monitoring of hand hygiene increased by 1,000 percent in a single month.
• Qpid Health offers “Clinical Registries Still the ‘Wild West.’”
• Oneview Healthcare outlines the “Eight Principles of Patient-Centered Care.”
• The SSI Group will exhibit at the HFMA Region 1 Annual Conference May 20-21 in Uncasville, CT.
• NVoq offers a new blog focusing on industry response to its new SayIt Code Fast service.
• MedData offers “Our People Make the Difference.”
• ZeOmega posts the final installment of “The Five Pillars of Population Health Management.”
• Imprivata wins a strategy and delivery award for its customer experience accomplishments.
• Netsmart will exhibit at the Ohio Public Health Combined Conference May 19 in Columbus.
• Nordic offers a new edition of its HIT Breakdown podcast, focusing on new revenue opportunities via the CCM CPT code.
• Orion Health explains why nurses are a healthy population’s biggest ally.
• PatientSafe Solutions offers insight into “Easing Cognitive Workload for Clinicians.”
• PMD outlines “The Cloud Confusion.”
• Sandlot Solutions outlines its support for the Institute of Medicine’s proposed streamlined set of standardized measures and recommendations for their application.
• Clinical support expert Deon Melton, RN shares how he got into healthcare in the latest T-System blog.
• Valence Health introduces the results of its pediatric care reimbursement model survey.
• Voalte offers “Nurses Taking Care of Nurses.”
• ZirMed offers “Patient Portal A/B Testing.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

HIStalk Interviews Beau Raymond, MD, CMIO, East Jefferson General Hospital

Sidney “Beau” Raymond, MD is VP/CMIO at East Jefferson General Hospital of Metairie, LA.

Tell me about yourself and your job.

I’m internal medicine trained. I did LSU for my medical residency. I initially went to a multi-specialty clinic that went bankrupt because they didn’t know how to transition from capitated payments to fee-for-service. I went out on my own, was independent for a while, another physician joined me, and then I was recruited by the hospital here to become employed and become medical director for the employed positions. With that role, I became more involved with the IT aspect of things as well as other tasks and items and got more and more involved in the administration side, became CMIO, and now I am almost fully administration, but still doing some clinic work.

What are the major systems used at East Jefferson?

We use Cerner for inpatient. We were using the same platform in the ambulatory setting as well. Due to some difficulties in getting some information out of the system for quality reporting to outside payers, we felt the need to change to a different system in the ambulatory setting, so we just recently switched to GE Centricity. We’re in our second week of go-live. Being on the same platform had benefits as well as some problems, and some of our problems were getting really good information out of the system.

I haven’t heard of many health systems that had the same systems for both inpatient and outpatient and then replaced the ambulatory one. What was it about Centricity that was appealing?

One of the problems that we had with Cerner is when we initially had it – which we’ve had it for a while — is that you had the customization. You were given lots of choices as to where you wanted to go and how you wanted to do things. Because of that, some choices were made at that time which then affected things later on because it wasn’t standardized back then. They now have become more standardized with fewer options. We were part of that learning process.

Flaws that were made way back when – that’s why we had to make some adjustments. That was the drive. GE has a very standardized database, which allows us to get information out of it to outside payers and outside resources that we need to get that information to in an easily standardized fashion.

You mentioned that your previous practice had challenges trying to survive in a value-based payment model. Will having two systems present a challenge in that kind of world?

Let me clarify. The group that I was with before was in a highly capitated system. When I joined them, which was 15 years ago, it switched from that capitated system of the HMO world to fee-for-service. They were so entrenched on how to manage capitated care, which they were doing well with, they couldn’t make the switch to fee-for-service. That was a little bit different than what we’re doing.

It’s interesting that they failed in trying to move from value-based care to fee-for-service. 

Yes, that was 15 years ago, but now the pendulum has swung back around and we’re back into value-based care. Our thing is that we want to be sure that we get the information out there as to what we’re doing and make sure that that information gets there. Because some of the problems we’re having when we deal with the Humanas and Blue Crosses out there, they look at our information, they’re not able to get all the data that’s really there. For us to be scored properly and reimbursed properly, we need to make sure they’re getting the information correctly.

You probably answered my question by saying you just went live on ambulatory with Centricity, but what projects are taking up most of your time?

That’s in the past two weeks. Actually more recently than that, inside the hospital, we went live on Dynamic Documentation from Cerner. We switched from paper progress notes to electronic progress notes. A lot of the other stuff was already being done via dictation anyway. People could still write a consult if they wanted to, but most people were dictating them. We made that switch to Dynamic Doc, which went extremely well. We had postponed it for nearly a year because of some issues that we were finding regarding how Nuance interacted with the system and with Citrix and all sorts of other interactions that were going on.

Once we got all those things to the level that they needed to be, it was working very smoothly. The first weekend of go-live, I was here walking around campus over and over and over again and was very pleasantly surprised as how well it went. Did the same thing for the two weeks, just constantly walking around talking to physicians, and they were very happy with the system. It was a very smooth transition to a fully electronic documentation.

What are you doing with population health management, patient portals, and patient-facing technologies?

We are engaged with a company that was Medseek that is now Influence Health. We’re going to have a portal that has information from both the Centricity side and from the Cerner side, all in one area. The patient can access all that information at one spot. That hasn’t actually gone completely live yet. It’s finishing up development right now because they needed Centricity to be up and running more. That should be going live soon as a single portal for both sides, ambulatory and inpatient.

On that note, that is going to be a way for us to do outreach regarding patient engagement as well as scheduling that they’ll be able to do directly inside the portal. Also possibly doing population management using that tool as well – possibly. We’re evaluating that now. We also have a clinical integration network called Gulf South Quality Network, which also is engaged in population management, especially with Blue Cross at this time. We have a new tool we’re implementing with them as well regarding trying to get that information. But linking to numerous EMRs is difficult, so it’s taking a little bit longer than we’d like it to.

The direction is value-based care, yet most organizations still get most of their revenue from traditional fee-for-service. Are you finding it difficult to try to straddle those two worlds with your technology?

Yes, well, I will tell you that we have a significant amount of fee-for-service. Actually here at East Jefferson, we have a significant Medicare population around here, but we have a Blue Cross contract which has a shared savings component to it. We think we’re doing well according to the reports that we have. That final analysis, I believe, is in August, so we’ll see where those numbers are. But what we’ve found so far is that we’re doing pretty well with that. We’re heading in the right direction.

It is very difficult because of the fact that it is only one real contract that is value based. We have some others regarding Humana and some others that have some aspect to it, but not nearly to the extent as the Blue Cross one. Technology-wise, as well as contracting-wise with physicians and compensation for physicians for those that are employed, it’s just a difficult transition because you can’t go too far too fast. When you’re stuck in the middle, it tends to be problematic, which is where I feel like we’re a little bit there now. I would love for the rest of the payers to switch to value-based all at once. It would make my life a whole lot easier.

What are you doing with MedCPU?

MedCPU is a rather neat program as to how it works. It looks at all the data within Cerner historically on a patient, has all that information, gets it processed on the back end. It takes that information, sends it over to their processors, and depending on what it finds, it sends us information back if it falls within a certain algorithm. We’ve already gone live with them on VTE as well as stroke.

Our VTE numbers, when we looked at them, were not nearly where we wanted them to be. That’s why we got engaged with MedCPU. We thought it would be an innovative way to deal with that. It has helped us tremendously. We went from some of the measures being in the 60 percent, 70 percent, up into the upper 90s now.  We’re not quite to 100 percent, but that is our goal. We’re heading in the right direction regarding that. It has been rather dramatic as to how well it’s worked for us.

For stroke, our numbers have been very good. We’re stroke certified, so that’s been working well for us. We are piloting with them a product that Merck developed with MedCPU which looks at sepsis, UTI, and pneumonia. Basically it gives you an alert when somebody hits SIRS criteria – systemic inflammatory response syndrome — and lets you know that there are certain tests you may want to order. So far in this first few weeks, it’s averaging about six alerts a day. Most of them are pretty valid and are acted upon appropriately. Some have had to be tweaked a little bit.

It’s going to be interesting to see what tweaks need to be done going forward, because if you think about it, SIRS criteria was probably created with someone looking back at a chart over a time frame rather than having real-time information, which is what we have now. We may be acting a little bit earlier than we really need to sometimes.

There have been episodes where it’s a post-surgical patient and they had a mild fever, which triggered them to get into the right criteria. They had all their factors, of course, to actually hit SIRS criteria, but with that, the physician said, let’s give it a moment and see what the next temperature is. The next temperature came back fine, so the patient was no longer SIRS criteria. It’s one of the things where I think we may have to tweak it somewhat. Right now we’re following SIRS criteria pretty strictly, but we may have to tweak it somewhat and say that they have to have it for maybe four hours or something along those lines, but we’ll see where that goes. It’s a pretty effective tool so far as what we’ve seen, but it’s in the beginning stages.

Is MedCPU’s technology good enough to trust to accurately create discrete data from free text using your rules?

Yes. It’s looking at numbers that are discrete data from lab results, from vitals that are entered, as well as from looking at information that is entered by the physicians and nursing regarding the documentation. For pneumonia, for example, if the radiology reports mentions consolidation, it’s going to trigger and say, "Does this patient have pneumonia?" It’s going to ask you. It’s pretty active and pretty accurate. For VTE, for example, it knows whether you documented that the patient is ambulating and therefore doesn’t meet criteria for VTE. You say that in your note and it doesn’t fire. It’s pretty remarkable as to how it works now.

Will you use it more broadly going forward?

We’re piloting the ones involving SIRS, bacteremia, UTI, and sepsis. We’re piloting that now and that seems to be going well. We’ve had conversations with them about some other products that they already have. One is regarding radiology — appropriateness of ordering the right test. We’re looking at that as a possibility. They’ve already done that elsewhere, so that would be implementing something that they already have. There’s also a pretty good OB product that they have, so we may take components of that and implement it over time as well.

The beauty of it — and to be honest, the thing that’s been most beneficial to us — is that the tweaks that they’re making to the program are happening on the back end. It’s not happening on our servers. It’s not interacting with what we do. It doesn’t affect speed or anything else regarding how you document or view your information. It’s just pulling that information and sending it back to their processor and sending information back across. It’s not running on your own servers, slowing their progress as well. It’s nice because you just add something and it really is kind of seamless. They monitor to make sure it’s not affecting the Citrix servers, and if there’s an issue, then they stop it and re-calibrate whatever they need to do and turn it back on and go from there.

What will the most important IT-related priorities be at the hospital?

It’s going to be population health. That’s everybody’s answer, I’m sure. It’s just trying to get that information, trying to figure out a way to manage it to continue to do value-based care, and do so with getting compensated for keeping people out of the hospital, which is the trick that we have now.

Morning Headlines 5/15/15

vRad to be acquired by MEDNAX

vRad, an outsourced radiology and telemedicine services company, will be acquired by MEDNAX, Inc for $500 million. MEDNAX is a national medical group specializing in anesthesia, maternal, neonatal and pediatric specialties.

McKesson (MCK) John H. Hammergren on Q4 2015 Results – Earnings Call Transcript

In its 2015 year end earnings call, McKesson CEO John Hammergren reports that the company’s Technology Solutions business revenue was down eight percent, to $3.8 billion, driven by anticipated declines in hospital software sales.

Here’s A Radical Approach To Big Hospital Bills: Set Your Own Price

NPR Shots covers ELAP Services, a benefits consulting firm that helps employers negotiate lower hospital bills by calculating the actual cost of services provided and then adding a reasonable profit margin.

New Company Announces Revolutionary Approach to Scribe Services in Healthcare, Finalist Spot on TiE50 Top Start-Up List

Skywriter MD launches to provide physician practices with remote scribes that listen in on exams through a microphone and navigate the physicians EHR through a remote connection. The scribes also document the encounter and enter any orders or prescriptions referenced during the visit. At the end of the session, the physician reviews the work and signs off on the chart.

EPtalk by Dr. Jayne 5/14/15

First of all, I want to say thank you to all the readers who sent warm wishes after Monday’s Curbside Consult. Quite a few people shared their own stories of leaving positions they had been in for a long time. It’s encouraging to hear from people who have been there. Right now it’s nice to not be in overdrive for a change.

I also had questions from readers about my new perspective having used multiple different systems and having worked in some different provider environments. Here’s a bit of Q&A for those readers:

Are most EHRs universally disliked? Yes, but to different degrees. I don’t think the users dislike the EHR so much as they dislike the changes to their workflow. Although it’s popular to call for more disruption in the industry, physicians don’t like that their way of life has been disrupted. When you actually ask about the EHR system itself, some of the complaints are pretty small in the grand scheme of things. As a seasoned observer, I’d say 80 percent of the time there are unresolved operational issues rather than software issues. I see a lot of physicians blaming EHR for increased work when it’s really that the implementation didn’t redistribute work to the right people at the right point in the care cycle. I also see a lot of poorly configured systems and lack of knowledge on how to improve them. Most providers have only used one EHR (or maybe one in the office and one in the hospital) so they don’t have much of a frame of reference.

Are most EPs grumbling about all the CQM, PQRS, and MU hurdles? Yes, yes, a thousand times yes. Previously with PQRS, many providers had staff that did that behind the scenes with claims submission and now they’ve got it in their faces at the point of care. Some systems have CQM alerts that actively fire in the provider’s way and the measures don’t always match with their clinical priorities, so it causes frustration. Some systems handle alerts more gracefully than others. I was in a pediatric practice recently that was so tired of answering “the Ebola questions” that I thought they were going to go mad. The data-driven reason to ask about Ebola in a US-based suburban private practice is miniscule, but they’re on a subsidized software platform from their local mega-hospital, so they are stuck with the workflow. Providers are tired of MU and the attestation numbers reflect that. Specialty providers are significantly more exhausted by the MU CQMs because they don’t match practice priorities.

What about ICD-10? Lots of fatigue here and the delays didn’t help. Although large organizations seem to be doing a good job of being prepared, I’m not seeing enough grassroots training for end users. I’m also seeing some systems that have limitations regarding dual coding. Although having a seamless switch from one ICD to another on October 1 sounds slick, providers want to ramp up slowly and feel that working in a test environment is a waste of time or double work. Systems also vary on how well they will prompt users to enter all the information required for the more granular codes. Some are adding required fields and others are adding optional fields. My gut feeling is that it’s going to be messier than it needs to be, especially since we’ve had so long to plan.

Have EPs just given up on all these programs? The bloom is definitely off the rose. At the beginning of MU, it was clear that $44K was only a down payment on what it really costs to transform a practice, but a lot of people were seduced by the money or frightened by the future penalties. Some non-participants figured out along the way that they could see one or two more patients a day and more than make up for any penalties and they seem fairly happy with their decision. Others are just figuring that out now and feel pretty bitter.

I also received many recommendations for National Parks, including a plea not to overlook the state parks. I totally agree after visiting an obscure-sounding state park in Florida last year that was absolutely lovely and completely off the beaten path. Most of my previous National Park experience was on a Griswold-style family pilgrimage. There’s nothing like hitting the Grand Canyon, Sequoia, Yosemite, the Black Canyon, Mesa Verde, Bryce Canyon, and a host of other notable places in about a month’s time span. I didn’t fully appreciate it at the time, but do remember my mother being ready to throttle my adolescent self at the Glen Canyon National Recreation Area. Although no one was harmed during the trip, there were a lot of crazy stories.

For those interested in reader recommendations, here’s the score card. Bryce Canyon is leading Arches three to two with strong recommendations on Volcanoes, Grand Canyon, and Zion. Special mention goes to Yellowstone (which Weird News Andy calls “the king, queen, and court jester of National Parks”) and to Mammoth Cave, which I hear is breathtaking but also has almost 80 miles of trails that never get any use because everyone is underground. I also hear Glacier National Park is getting ready to emerge from winter and I haven’t yet packed away my fleece jackets. Plus I could hit the Black Hills on the way.

Do you prefer “Find a Car Bingo” or “The Alphabet Game” for your in-car entertainment? Email me.

Email Dr. Jayne.

News 5/15/15

Top News

Mednax, a publicly traded provider of specialty physician services including maternal and anesthesia, will acquire outsourced radiology service vendor Virtual Radiologic (vRad) for $500 million. Mednax CEO Roger Medel, MD says teleradiology is “an economic and clinical necessity for customers” and that it can cross-sell to its customers and improve care using vRad’s IT and analytics technology. Mednax shares, which have increased in price by around 20 percent in the past year, value the company at $6.7 billion, with the aforementioned CEO holding $82 million worth.  

HIStalk Announcements and Requests

 

Ms. Mundy sent over photos of her South Carolina K-5 class of profoundly mentally disabled students, for which our DonorsChoose project bought hand sanitizer and tissues that they use throughout the day. Also, Ms. Ensor reports that her Maryland third graders were so excited to hear that they would be receiving math manipulatives that they wanted to write thank you cards right away, and three days later when the box arrived, she immediately used the fraction pieces with students who needed some extra help with equivalent fractions.

Listening: new from Melanie Fiona, smooth and sultry rhythm and blues from the Canada-born 31-year-old Grammy nominee who somehow still flies a bit under the radar.

I had my annual physical yesterday and noticed that in the year since my last visit, the glassed-in check-in area at the family practice office now has a huge, echoey expanse of rust-squared carpet and nothing else. I asked the rep why she was sitting in what looked like an empty hotel ballroom and she said implementing Epic had allowed them to remove the sea of file cabinets that formerly took up most of the space. I commented that it sounded like a good thing, which earned me an eye-roll and laughing comment something to the effect of, “Well, I guess if you look at it that way.” My PCP used Epic brilliantly – he walked me through what’s on the as we sat side by side, Epic recommended a couple of new items to discuss, and it caught a near-miss in suggesting he reconsider giving me a vaccine he was touting because of a conflict with another med. It also allowed him to look at trends in my vitals and labs in assuring me that I’m just fine, which is comforting knowing he had the full, historical picture in front of him and not just the one-visit snapshot. My blood pressure prescription refill was shot off electronically, he handed over a printed visit summary, and I was set. He’s a very good doctor, and using the EHR optimally left me with the feeling that I actively participated in my care and that we jointly validated the electronic information used to do it. The thing is, he did pretty much the same thing when the practice was using an undeniably crappy EHR, leading me to repeat my mantra that an EHR amplifies a provider’s skill and empathy regardless of whether it’s good or bad. It’s like giving a singer a robust PA system – it’s easier to tell whether they’re good or not.

I keep getting a Twitter ad from some hipster company that refers to social media (which in itself is a pretty annoying term) as “sosh.” That’s as gratingly obnoxious as people who try to make up cool SoHo type names for every wannabe part of their fly-over burg hoping for trendy restaurants and bars to open in abandoned storefronts, like strenuously coining NoSewPla for “north of the sewage plant.”

This week on HIStalk Practice: CareWell Urgent Care CEO Shaun Ginter discusses EHR transitions. Grove Medical Associates wins HIMSS award. Physician preparedness for ICD-10 leaves one guest author uneasy. MinuteClinic passes the 25 million patient mark. Delaware Health Net signs on for new technology to help its FQHCs with MU. Physicians show Twitter savvy when it comes to cancer. California’s Open Data Portal preps for a hack with the best of intentions.

This week on HIStalk Connect: Fitbit files for a $100 million IPO and in doing so discloses its impressive financial history. IBM signs 14 new customers for its Watson-based cancer treatment analytics platform. Healthbox unveils its next class, which will occupy its new Miami campus. 

Webinars

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making

May 27 (Wednesday) 1:00 ET. “Introducing Health Catalyst Academy: An Innovative Approach for Accelerating Outcomes Improvement.” Sponsored by Health Catalyst. Presenters: Tommy Prewitt, MD, director, Healthcare Delivery Institute at Horne LLP; Bryan Oshiro, MD, SVP and chief medical officer, Health Catalyst.  The presenters, who are graduates of Intermountain’s Advanced Training Program, will introduce the Health Catalyst Academy’s Accelerated Practices program, a unique learning experience that provides the tools and knowledge for participants to improve quality, lower cost, accelerate improvement, and sustain gains.

Acquisitions, Funding, Business, and Stock

Fuji Medical Systems USA acquires Milwaukee-based vendor neutral archive vendor TeraMedica. I interviewed TeraMedica CEO Jim Prekop a year ago.

Cave Consulting Group, which recently won a patent infringement lawsuit against OptumInsight, requests a permanent federal injunction to prevent OptumInsight from continuing to sell its Impact Intelligence physician efficiency scoring product.

Mediware acquires behaviorial and mental health software vendor AlphaCM. The announcement didn’t mention whether the website’s stock photo model will continue in her role.

McKesson Chairman and CEO John Hammergren said in the earnings call that Technology Solutions revenue and profit dropped 8 percent for the year on lower hospital software sales, a trend he expects to continue but that will be partially offset by contributions from RelayHealth and Payer Solutions. He also mentioned “pending sale of another business line.” He amplified on that by saying that MCK is constantly tweaking its Technology Solutions portfolio as “an aggregation of many companies” and that’s why revenue dropped. Hammergren said McKesson’s only opportunity with CommonWell is that it uses services from RelayHealth as one of an eventual many service providers, adding that, “I’m more excited about what it’s going to do for healthcare in this country than I am necessarily for the revenues of Relay, which will follow over the years.” It seemed that the only positive talking point about Technology Solutions is always RelayHealth, which is obviously a business Hammergren likes a lot, so that seems to send a signal that the rarely mentioned rest of the lineup is less strategic.

Informatics Corporation of America reduces headcount, with reports stating that 20 employees (20 percent of its workforce) have been let go.

Sales

Catholic Medical Center (NH) chooses Voalte for caregiver communication, including Voalte Me for personal smartphones.

Announcements and Implementations

Skywriter MD launches an on-demand virtual scribe service in which doctors wear a microphone and share their EHR screen with a remotely located scribe who navigates the EHR and enters information into it. Founder/CEO Tracy Rue previously worked for Sandlot Solutions and CORHIO.

Scripps Health and Sharp HealthCare will join the San Diego Health Connect HIE, which must be a relief given that their absence made its premise otherwise questionable.

Government and Politics

A old but unsettled Vermont lawsuit questions whether states can require self-insured companies to send them their claims data. Vermont wants Liberty Mutual and its third-party administrator to submit its claims data for its all-payer claims database, but federal law gives states no authority over employer-sponsored plans. The national implication is that employer-sponsored plans are growing, especially among young and healthy people,  and restricting states from overseeing them limits their ability to monitor healthcare costs for payment reform.

A North Carolina auditor’s report finds that the state’s Medicaid IT group, which oversees the troubled NCTracks claim processing system, “wasted” $1.7 million in payroll costs when the former director hired 11 family members and six members of her church, of which at least six were deemed unqualified for their jobs and seven were overpaid based on their credentials. The director also received thousands of hours of unauthorized comp time.

Rep. Diane Black (R-TN) introduces HR2247, which would require HHS to test the ICD-10 transition and to support a phase-in period.

Privacy and Security

In Ghana, a journalist, two musicians, and a hospital’s records officer are charged with trying to blackmail the CEO of the fantastically named Peace and Love Hospital (I’m picturing tie-dyed doctors flashing each other peace signs and holding love-ins in the chapel), having stolen patient records to bolster their claim that the hospital is operating fraudulently.

IBM’s X-Force Exchange allows companies to anonymously share cyberthreat information and to research IBM’s hacking attempt database.

Innovation and Research

An non-governmental organization run by two doctors from South Africa develops Mobile Triage, an ED app that replaces the paper version of the South Africa Triage Scale. The group also offers apps for Doctors Without Borders Guidance, HIV management, and TB diagnosis and management.

Technology

A Fast Company article describes a Louisville, KY air quality monitoring program that combines data generated by Propeller Health’s smart asthma inhalers with EPA’s air sensors to determine the impact of pollution and other environmental factors on asthmatics.

Other

A New Jersey couple pleads guilty for paying doctors up to $2,000 per month — several million dollars in total — to refer patients to their 10 imaging centers for tests that weren’t always medically necessary. Rehan Zuberi had already settled a 1998 Medicaid fraud charge in which he allegedly paid $300,000 in kickbacks to generate $8 million worth of business.

UK’s NHS will implement the US-Canada program Choosing Wisely that tries to get doctors to stop performing unnecessary and unproven interventions, including those involving duplicate tests and procedures. It cites statistics suggesting that physicians have “health illiteracy” in misapplying statistics to practice, such as the one-third of gynecologists who thought a 25 percent risk reduction in mammography means that 25 percent fewer screened women will die of breast cancer when the real number is less than one in 2,000, which also doesn’t take into account risks of the mammography itself. Despite the potential benefits of the program, surveys indicate that few US doctors are aware of it.

NPR Shots profiles benefits consulting firm ELAP Services, which tells its employer clients to refuse to pay ridiculous employee hospital bills and instead offer to pay what’s reasonable based on an analysis of the specific hospital’s in-depth financials. A car dealership CFO customer says, “This is the best form of true healthcare reform that I’ve come across.” A hospital billed the dealership $600,000 for a three-day back surgery stay, ELAP calculated the hospital’s actual cost plus a small profit and told the company to pay only $28,900, and the hospital took the money without complaint.

Strange: a new website offers fake, customizable doctor notes for taking unwarranted sick days, including a phony phone number with a doctor-sounding voicemail. You get a refund if someone pegs them as fake, although that probably won’t offset the sting of getting fired for lying to your employer. The site features testimonials if you’re gullible enough to believe kudos from a site whose mission is abetting liars and whose disclaimer says its products are “meant to be used as novelty items and not for any illegal purpose.” Among the notes offered: a hospital release form that includes barcodes, an oncology note that suggests something serious, an English-Spanish pregnancy note that the company helpfully suggests is “usable by most women between the ages of 18 and 50,” and a urology excuse with a target audience of “if you take frequent bathroom breaks, this note will work fantastic for you.” I haven’t worked for an employer who provided a fixed number of sick days each year for a long time since most have moved to the PTO system, but I remember one who changed to PTO after reviewing the significant number of employees who took the maximum number of sick days and not one day more unpaid, making their lack of well-being questionable.

A patient who was surprised to find that her hospital’s outpatient surgery center billed her insurance company $39,000 for a one-hour eyelift surgery that had been estimated at $3,500 is even more surprised when Blue Cross Blue Shield of Minnesota pays the entire allowable amount of $29,000. She complained to both the hospital and the insurance company that the charges were absurd, but neither seemed too interested.

Weird News Andy says he couldn’t find an ICD-10 code for this story, in which an Oklahoma man kills his stepfather with an “atomic wedgie” during a drinking binge, suffocating him by pulling the elastic band of his underwear over his head. That sounds like the kind of unfortunate demise that is, like being crushed under a truckload of ice cream bars or trampled to death by a bestialic partner, best tersely glossed over in the obituary as “a brief illness.”

Sponsor Updates

• Logicworks offers “5 Ways to Monitor and Control AWS Cloud Costs.”
• Visage Imaging will exhibit its Visage 7 Enterprise Imaging Platform at the upcoming ACR and SIIM conferences in the Washington, DC area.
• Galen Healthcare Solutions offers “10 Tips and Tricks to Make Mirth Connect Work for You.”
• Ingenious Med reports that 93 percent of clinicians submitting registry-based data through its One by Ingenious Med patient encounter platform reached the PQRS reporting threshold.
• HDS will exhibit at the Amerinet Member Conference May 17-20 in Orlando.
• Healthwise will exhibit at the TriZetto Annual Healthcare Conference May 17-20 in Orlando.
• Iatric Solutions will exhibit at the iHT2 Health IT Summit May 19-20 in Boston.
• InterSystems offers the second part of its series on “The Patient Education Chasm.”
• Impact Advisors COO Todd Hollowell is named one of “Top 25 Consultants” in the “Excellence in Healthcare” category of Consulting Magazine.
• Liaison Technologies offers “How to Enable Shadow IT Through a Data-Centric Approach to Integration.”
• LifeImage posts “Fast, Efficient Medical Image Exchange Within ‘The Golden Hour.’”
• Healthfinch offers “Back to the Future: A 2008 Presentation is Still Super Relevant.”

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 5/14/15

Stiff Interoperability penalties in new 21st Century Cures Act

The revised 21st Century Cures Act was introduced in Congress today, and the new changes included funding to develop metrics to quantify and report on the exact state of interoperability available between EHR systems today, and then report on whether each EHR vendor was in compliance with new interoperability certification criteria that would go into effect in 2018.

Meaningful Use Stage 3 NPRM Comments

At Tuesday’s Health IT Policy Committee meeting, four workgroups shared comments on the Stage 3 MU proposed rule, with three of the four expressing some form of concern over the increases to the view, download, or transmit requirement.

Patients six to ten times more likely to get HPV vaccine after electronic health record prompts

Researchers with the University of Michigan find that pediatric patients are three times more likely to start the three-dose series of HPV vaccinations, and are 10 times more likely to complete them, if their pediatrician receives EHR alerts reminding them to start or continue the regimen.

Readers Write: Demystifying Population Health

Demystifying Population Health
By Jeff Wu

Population health was once again a major topic of this year’s HIMSS conference. We saw even more vendors offering products, services, and solutions aimed at helping organizations deal with the challenges population health management presents.

Unfortunately, population health is such a broad domain that no singular solution really encompasses all of it. As a result, vendor offerings tend to only address a specific challenge. The wide and varying offerings across vendors adds confusion to the topic.

Population health shouldn’t be an industry buzzword that’s approached with trepidation. Instead, we need to understand the categories of challenges we are trying to address and the process for developing interventions to solve them. Let’s start by taking a look at the three categories that population health management interventions fall into.

• Government or mandated interventions. For many organizations, this is the primary (and perhaps only) component of their population health strategy. Some initiatives, like becoming an accountable care organization, encompass requirements that address items that will be discussed below. For many organizations, this may be enough.
• Enterprise population health interventions. These encompass interventions that are applied to the full population of an organization’s patients. Immunization and vaccination interventions or physical activity interventions are broadly applied to an organization’s full patient population. As organizations begin to try to standardize care, interventions aimed at variation reduction are also encompassed here.
• Cohort, group, or sub-population health interventions. This class of interventions is the most varied and covers any intervention that addresses a sub-population of patients. Some examples of interventions in this category include health maintenance for diabetes patients, preventative care efforts like breast cancer screening in women over 50, and depression/PTSD screening for military veterans.

Population health management evolves linearly in three stages that borrow some classical tools from epidemiological tracking.

1. Passive surveillance. Passive surveillance involves the retrospective analysis of a specific issue. This is the evaluation of data that already exists. Passive surveillance addresses questions like, "How many of our diabetic patients got a glucose test in the last six months?" or, "How many of our patients got flu vaccines last month?" Most analysis starts from this level of surveillance. It’s important to note that the majority of organizations are just getting to this point in their analytical journey. Implementation of the EHR tools necessary to do this level of surveillance are finally settling and getting to a state that allows for this to happen. To date many ‘organized’ population health based initiatives focus only on this type of surveillance. CMS’s MSSP ACO initiative is a classic example of this, where an organization participating in the MSSP ACO need only report their measures for the first year to receive their financial incentive.
2. Active surveillance. The next evolution is active surveillance. If passive surveillance identified how many patients got flu vaccines last month, active surveillance would try and answer the question how many of our patients got a flu vaccine last week or yesterday. If passive surveillance told us which of our diabetes patients got a glucose test in the last six months, active surveillance would try to address which ones are being well controlled. In the epidemiological world, passive surveillance relies on existing data, while active surveillance implies a program that generates more recent and/or new data. This could be as simple as querying the medical record or running a report more frequently for simple cases or designing a whole new workflow and data elements to monitor for more complex cases.
3. Prescriptive intervention. Once a population or initiative is identified, prescriptive intervention is what an organization uses to address the problem. This is where the art of evidence-based medicine comes in. We now have a lot more data to develop more fine tuned and effective interventions. Things like smoking cessation no longer have to be just a pamphlet, a discussion with a provider, and then a check box in the medical record. Full care teams can be coordinated and then patients can be monitored to help them with compliance.

As the industry and technology continues to advance, so do the tools at our disposal. Sentinel surveillance and predictive analytics offer some exciting opportunities to do more earlier. Additionally, the increased volume of data allows us to start taking a more in-depth look at cost-effectiveness and variation reduction between treatments for diseases.

It’s imperative to remember that every organization’s population health strategy will necessarily be different. This is because each organization’s population of patients is different. The vendor perspective often approaches organizations with packaged solutions, when in reality, it’s almost impossible for these solutions to be “one size fits all.” Even a product geared to a specific population health goal will require nuanced configuration to be effective for an individual organization.

Here in Madison, Wisconsin, population health interventions for UW Health are drastically different than Dean St. Mary’s or Group Health Co-op. UW is an academic medical center that draws high-acuity patients from across Wisconsin, while Dean has the region’s only obstetrics practice and GHC handles only primary care needs. While these organizations may benefit from adopting collaborative population health initiatives like the MSSP ACO (which both Dean and UW are a part of), their intervention focuses differ significantly based on their unique patient populations. Seldom can a product or solution apply to both, and even more rarely will it work for both.

As the industry continues to shift care delivery to encompass a population-based perspective, we are constantly introducing changes to our workflows, our assumptions, and most importantly, our expectations. These changes introduce uncertainty and apprehension, but they are also our greatest opportunity. It’s important to realize that population health management isn’t actually anything new. We’ve been here before—we’re just upping the scale.

Jeff Wu is a population health researcher at the University of Wisconsin-Madison.

Readers Write: New Discoveries in Health IT Diagnoses

New Discoveries in Health IT Diagnoses
By Niko Skievaski

Over the past decade, we’ve spent billions to digitize healthcare. Health IT was to bring us the same exponential efficiency gains that computers and the Internet brought nearly every other industry. But now that rooms of paper have transitioned into rooms of servers and swarms of software vendors attempt to surf the wakes of legacy EHRs, the acute impact of this stoic transition begin to appear. Some of these newly diagnosed alignments are approaching risk of epidemic.

I am writing this to discuss our findings from a 300-vendor study attempting to understand the root causes, and most importantly, the prevention measures individuals can take when confronted with known early symptoms.

Type 1 and 2 MU (further mutations into Type 3)

An early stage MU diagnosis was a catalyst to much of the following conditions. In 2009, it first appeared in populations incentivized to spread it via certified EHR technology. If caught early, although not curable, it could have been contained and controlled. However, it soon became chronic and subsequently categorized as type 2. And it looks now as though a more progressive mutation is afoot, growing beyond incentivized  to penalized attestation.

Hyperactive Click Finger

Most commonly affecting the right index finger, hyperactive click finger (HCF) resulted from premature adoption of EHRs as spurred by type 1 MU. Market driven adoption would have controlled click counts to safe levels as sovereign end users would have chosen vendors based on efficiency gains,rather than subsidy. A regimen of optimization efforts led by EHR therapists is a potential solution that some patients have found effective. However, these therapies are usually administered at extremely high hourly costs and repeated consults are inevitable.

Acute Alert Fatigue

As MU progressed to type 2, clinical decision support combined with CPOE brought on acute alert fatigue in provider populations. This is commonly misdiagnosed as Bipolar Disorder or mild Tourette’s. Comorbidities frequently include HCF. EHR vendors have backed off heavy alerts and periphery vendors are beginning to set precedence with FDA clearance for forceful support. Additionally, alerts are normally hard-coded based on known errors and omissions, thus avoiding opportunity for proactive machine learning.

I14Y Virus

An infectious disease has been uncovered: I14Y Virus (interoperability influenza). Red blood cells clump together and bind the virus to infected cells, making it extremely difficult to share data between inhabitants. Additionally, the inconsistencies in data models create often insurmountable barriers for new software entrants that could otherwise bring increased efficiency and quality. New therapies, including acronyms like FHIR and SMART, are beginning to change public perception of the disease, yet it is still unclear to most of us what the heck they actually mean. Private middle layers are starting up to tackle known I14Y opportunities and a race to the cure is among us. The cure standard will be defined by what is adopted, not what is agreed upon in committees.

Hyperportalitis

Patients and providers are affected by hyperportalitis similarly. Yet it affects each population quite differently. Upon surfacing symptoms, patients simply disengage, causing aggregated MU. Affected providers, under mandate to comply, simply write usernames and passwords on sticky notes under keyboards, or in severe cases, on the frames of their computer screens. This exacerbates conditions leading to potential risk of HIPAAppendicitis.

HIPAAppendicitis

Despite repeat training videos depicting hospital elevators polluted with oral PHI leaks, we still run a high population risk of HIPAAppendicitis. This creates risk-averse symptoms of committee meeting purgatory and sluggish adoption of innovative cloud-based software therapies.

This is by no means a comprehensive study. I welcome review from my distinguished peers who subscribe to this journal, as well as subsequent research and inquiry. There will be an open comment period prior to the amendment of ICD-10.

Niko Skievaski is  co-founder of Redox.

Morning Headlines 5/13/15

Health Information Companies HealthPort and IOD Incorporated to Merge

HealthPort and IOD, both health information management vendors, will merge, creating a single company with a combined revenue of $450 million and a customer base of 18,000 health care facilities in the US.

McKesson Reports Fiscal 2015 Fourth-Quarter and Full-Year Results

McKesson reports Q4 and FY2015 year end results: full-year revenue up 30 percent  to $179 billion. Q4 revenue up 19 percent to $4 billion, adjusted Q4EPS $2.94 vs. $2.71, beating expectation on both.

New machine could one day replace anesthesiologists

The Washington Post reports on an FDA-approved anesthesia machine that can automate sedation and could one day replace the need for an anesthesiologist when performing routine procedures.  An Anesthesiologists’ fee for sedation during a colonoscopy averages $2,000, but the machine can perform the same task for just $200.

An end-to-end hybrid algorithm for automated medication discrepancy detection

A study evaluating the use of natural language processing and machine learning algorithms to support medication reconciliation processes found that by analyzing notes and prior prescription lists within the patient chart, the algorithms were able to increase accuracy and reduce manual labor.

News 5/13/15

Top News

Health information management vendors HealthPort and IOD will merge, creating a company with $450 million in annual revenue that offers release-of-information services, audit management, coding and abstracting, and document conversion.

Reader Comments

From Robert Lafsky, MD: “Re: typo. You could use this. I’ll take plaque instead of plague, I think.” You would need to choose dental, dermal, or arterial, of which Door #1 is the obvious preference.

From Spaulding Smails: “Re: news items back story. Newsletters sometimes include a ‘why this is interesting’ explanation that your readers might find useful.” I did that in the snarky, weekly HIStalk Brev+IT email newsletter that I wrote 100 or so years ago. Above is a sample from those innocent, pre-HITECH days of early 2008 just in case you weren’t one of the eight people reading it back then. I added some history, perspective, and smart-alecky editorial comments to each news item. I don’t think I’d want to do that for every item I include in HIStalk (which is far more than the three items I ran in each Brev+IT), but I’m open to suggestions if anyone wants to see that commentary added. Some headlines I noticed as I reviewed them for the first time in seven years: “Is That Your iPhone In Your Pocket Or Are You Just Glad To See Me, Doctor?,” “Looking Up Britney’s Dress Was Free, But 13 Pay Dearly For Ogling Her EMR,” “Allscripts and Misys Consummate Desperate Lust: Shareholders Hose Them Down,” and “Survey: Old People Don’t Want to Pay for Health IT or Any Damned Thing Else.” Those newsletters were a lot of fun to write even though I had the equivalent of about three full-time jobs at the time.

HIStalk Announcements and Requests

Elsevier put together this video of their sponsorship of HIStalkapalooza.

It’s the annual post-HIMSS lull where I can finally catch my breath. I’m always on the lookout for brilliant guest writers and interview subjects who work for providers rather than vendors and who want to share their expertise and opinions with the industry. Let me know if that describes you.

Webinars

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making

Here’s the video from Tuesday’s interview with Regina Holliday, which is really mostly just audio but still a good introduction to what she does and is doing.

Acquisitions, Funding, Business, and Stock

Practo, which offers a doctor-finding website for Asia, will double its India-based headcount to 2,000 in 2015 following a $30 million investment earlier this year. The gray-on-white website theme made me think I was losing my eyesight.

Premier announces Q3 results: revenue up 16 percent, adjusted EPS $0.38 vs. $0.34, beating expectations for both and raising guidance for the year. The company announced in the earnings call that Catholic Health Initiatives has purchased PremierConnect Enterprise. President and CEO Susan DeVore says “acquisitions play an important role in our future” and adds that IBM’s acquisition of Premier population health management partner Phytel won’t change the existing relationship with either company. The CFO says the recent TheraDoc and Aperek acquisitions are on track to meet the $20 million in annual revenue contribution that was expected. PINC shares are up 35 percent on the year and are 24 percent higher than at the September 2013 IPO. The company’s market capitalization is $1.4 billion, with Susan DeVore holding shares worth $8 million.

PerfectServe opens an office in Knoxville, TN to handle the 50 percent headcount growth the company has experienced in the past 10 months. The new space adheres to the open floor concept and provides sit/stand desks, collaboration rooms, and a health food micro-market. The hospital I worked for had a temporary open office concept when they were ripping up carpet and had to take down the IT area’s cube walls, which I initially hated but liked at least a little bit as I got used to having everybody inadvertently making eye contact and quickly looking away from the shame of sitting in what looked like a 1950s secretarial pool. The entertainment factor was reduced as employees had to leave the area to make personal phone calls instead of being comforted by the illusion of privacy from the thin cube walls, through which everybody could clearly overhear symptomatic details of their need to schedule a doctor’s appointment and the sometimes shocking manner in which they spoke to their family members.

McKesson announces Q4 results: revenue up 19 percent, adjusted EPS $2.94 vs. $2.71, beating expectations for both.

Sales

UC Irvine Health (CA) chooses Strata Decision’s StrataJazz for decision support, cost accounting, contract analytics, budgeting, and management reporting.

National Institutes of Health selects Connexient’s MediNav smartphone wayfinding product for its Bethesda, MD campus.

People

The Hospital for Sick Children (Toronto, CA) names Sarah Muttitt, MD, MBA (Alberta Health Services) as VP/CIO.

CTG announces the resignation of SVP Ted Reynolds, who took over the company’s healthcare business and earned the SVP title six months ago.  

TriHealth (OH) promotes John Ward to CIO. He had held the job as interim.

Announcements and Implementations

NVoq announces GA of its Code Fast service that offers real-time conversion of spoken narratives to standards such as ICD-9, ICD-10, SNOMED, and LOINC in a partnership with SyTrue.

Lexmark launches Perceptive Checklist Capture, which automates the gathering of data and documents from PCs, mobile devices, and multi-function devices into a project or case folder.

Greencastle Associates Consulting receives its fourth Pro Patria Award from the Pennsylvania Employer Support of the Guard and Reserve for supporting reservists and National Guardsmen who are called to service. Veteran-owned Greencastle, which has veterans as 96 percent of its employees, has also earned Patriotic Employer, Above and Beyond, and Seven Seals awards. The company’s management team is Senior Partner Celwyn Evans (retired US Army Ranger), Director Joe Crandall (US Naval Academy graduate and former naval special warfare officer), and Director Will Woldenberg (former Army communications officer deployed to Iraq).

Privacy and Security

A California woman claims she was fired for uninstalling an employer-required iPhone app that tracked her location 24 hours a day. Her lawsuit claims her boss bragged to co-workers that he was monitoring her GPS location, driving speed, and time spent everywhere she went.

Innovation and Research

A Washington Post report reviews FDA-approved, software-powered, personalized anesthesia machines that may at some point replace anesthesiologists, who lobbied hard to prevent their introduction. Anesthesiologist fees for a colonoscopy sedation run up to $2,000 while the machine costs less than $200, while faster sedation and recovery allow more procedures to be performed in the same suite.

A small Cincinnati Children’s Hospital Medical Center (OH) study finds that analyzing free-text clinical notes and discharge medication lists using machine language and natural language processing can increase accuracy with less work than manual medication reconciliation.

ONC names six winners of its HHS Competes challenge that will receive $50,000 each to fund pilot projects that begin in August:

• ClinicalBox (Lowell General Hospital), care coordination critical task visualization.
• CreateIT Healthcare Solutions (MHP Salud), patient engagement and messaging by SMS, email, and voice.
• Gecko Health Innovations (Boston Children’s Hospital), respiratory disease management with medication sensors, reminders, and symptom tracking.
• Optima Integrated Health (UCSF), real-time blood pressure monitoring.
• PhysIQ (Henry Ford Health System), biosensors and analytical tools to monitor CHF and COPD patients.
• Vital Care Telehealth Services (Dominican Sisters Family Health Service), telehealth care coordination.

Technology

A clinical review of 46 insulin dosage calculators finds that only one was free of problems such as lack of edits for missing or clearly incorrect information. Two-thirds of the apps were poorly designed to the point that they gave recommendations that violated clinical assumptions, did not use their stated formulas correctly, or didn’t update properly when users changed information. I can say from experience that hospitals know you can’t let programmers develop stuff like this without a lot of oversight, including design and testing, because they just don’t see the big picture and fail to appreciate the risk of missing a corner case. App developers don’t have that level of oversight and attempt to reduce complex medical rules into a simple algorithm just because they can.

I went to a restaurant this week that uses the NoWait iPad-powered wait list and seating tool for restaurants that don’t want to go the OpenTable route since they don’t take reservations. The hostess took my name and phone number and said I’d get a text message when the table was ready. The message also included a link to download the app, which when connected via just my phone number, showed me my place on the wait list, and gave me the option to cancel or change the size of my party. It seems something like this could be used for healthcare purposes since the patient wouldn’t have to do anything in advance. The worst waiting rooms I’ve been in were LabCorp or Quest (even worse than EDs) and most folks there are cranky walk-ins who have fasted for hours, so I’d definitely sign up to avoid being overdosed on unemployment TV while waiting for an hour to get my 60-second blood draw.

Other

The local paper highlights the use of Nuance’s Dragon Medical speech recognition by St. Joseph Warren Hospital (OH) in a pilot project of 70 users. Doctors say Dragon is easy to use, saves them a lot of time, and “is a great way to get our true voice heard and down on paper, so to speak” (I assume the pun was unintentional).

The HIEs of Dallas and San Antonio, TX will merge.

A KQED Science article covers patients accessing their own data, the MUS3 dial-back of view / download / transmit requirements, the cost of obtaining copies of medical information, and the lack of provider incentive to provide it. Patient advocate Regina Holliday is featured prominently.

A survey of clinicians who participate in the Meaningful Use program and who work for practices that have earned patient-centered medical home status finds that only half of them receive timely notification of hospital discharges, a capability they believe is “very important.” One-fourth of the respondents actually worked for hospital-owned practices, so the percentage of independent practices that receive hospital discharge alerts for their patients is pretty abysmal.

The New York Post features Brooklyn’s Brookdale Hospital as one of the worst in the country, one of only 20 US hospitals to fail Leapfrog Group’s hospital safety analysis. It recently received $68 million in taxpayer money to allow it to remain open as a safety net hospital despite the fact that locals would be better off hopping into a taxi to ambulate the few blocks to a safer hospital. The paper says that an “unholy alliance of unions, trade associations, and government officials” make excuses for dangerous hospitals like Brookdale in claiming that care is too complex to measure (note that it’s never the good hospitals that say that). We might create a better healthcare system by focusing on inter-facility transportation (instead of turfing that function off to ridiculously overpriced taxis posing as ambulance services) and moving patients to the facility best equipped to give them a good outcome rather than sticking them with whatever hospital they were closest to at their initial time of need.

I’m wary of polls that ask people what they “would” do instead of what they “actually” do or have done recently. A HIMSS Analytics nurse survey finds that 71 percent say they wouldn’t go back to paper-based medical records. My question would have been: if your employer decided to go back to paper, what hourly salary increase would keep you from leaving your job? (with “$0” being a poll choice that would have been chosen often, no doubt). The question as submitted reflects the poll sponsor’s bias, which respondents are quick to pick up on in choosing the most virtuous-sounding answer. Consumer polls always find that Americans want digital health records, smartphone access, and all kinds of nifty-sounding features they don’t really understand, but when asked if they would change doctors or pay extra to get them, they almost always say “no,” meaning their original answer was a shallow attempt to sound nobler. It’s nearly always a mistake to judge people by what they say they’ll do instead of what they’ve actually done.

Apparently salaries are discussed more openly in India than here. An “elated official” of a state-owned technical school proudly announces that two of the college’s seniors have received “plum job offers” that are the highest-paying placement packages in the school’s history, $105K annually from Epic.

Weird News Andy calls this “#2 with a Bullet.” A New Jersey criminal frequent flyer whose bathroom urges raised the suspicion of arresting officers pulls a stolen, loaded .25 caliber pistol from “between his butt cheeks” during the resulting strip search, which WNA says “is a pretty crappy holster if you ask me.”

Sponsor Updates

• The HCI Group is named a finalist in the Entrepreneur of the Year award in the healthcare category.
• CareSync posts a new blog about its preparations for AARP’s Life@50+ event May 14-16 in Miami.
• ADP AdvancedMD offers a sneak peek of its solution for any browser.
• AirWatch will exhibit at the Gartner Digital Workplace Summit May 18-19 in Orlando.
• Impact Advisors VP Lydon Neumann will serve on the panel of “Evidence-Based Approaches and Practical Tools for the Never Ending Implementation Journey”at the AHIMA iHealth Conference May 28-29 in Boston.
• Cumberland Consulting Group recaps its HIMSS15 experience in an interview excerpt.
• XG Health Solutions features an interview with Janet Tomcavage, RN, SVP of Geisinger Health Plan.
• Aventura will exhibit at the iHT2 Health IT Summit May 19-20 in Boston.
• Besler Consulting asks, “Is it too early to prepare for Modifier -59 Billing Changes?”
• Capsule Tech offers “Not All Superheroes Wear Capes.”
• Medecision offers “For Population Health Tech to Work, You Need Data.”
• CoverMyMeds offers “Electronic Prior Authorization: Sustainable Solutions and the Road Ahead.”

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 5/12/15

Core Functionality in Pediatric Electronic Health Records

AHRQ publishes a report calling for pediatric-specific functionality to be included in EHRs, including more advanced medication ordering tools, immunization tracking systems, and data sharing between family member records.

IBM’s Watson to guide cancer therapies at 14 centers

14 cancer institutes across the US and Canada will use IBM’s Watson computer to help oncologists create cancer treatment plans based on a  tumors genetic.

US attorney subpoenas records related to Health Connector

The federal government has subpoenaed records related to the Massachusetts health insurance exchange following a failed go-live that resulted in the site being scrapped and a new site being built. Federal investigators have not yet disclosed why the records were requested or whether an investigation is underway.

Experts Criticize World Health Organization’s ‘Slow’ Ebola Outbreak Response

An independent report criticizes the WHOs response to the Ebola outbreak, saying the organization failed to seek outside support in a timely manner and claiming that there is “strong, if not complete, consensus that WHO does not have a robust emergency operations capacity or culture.”

Curbside Consult with Dr. Jayne 5/11/15

Jayne Becomes “Available to the Workforce”

Unfortunately, George Clooney didn’t arrive on my doorstep to give me a pink slip as his character did so many times in “Up in the Air.” Instead, resigning from my hospital position was fairly anticlimactic.

If you missed my previous post, here’s the short version. My hospital is migrating to a single platform EHR and I’ve been on the fence about taking a role on the new project vs. doing something else. I made my decision quite some time ago, but have been procrastinating actually writing about it. Readers have been asking whether I am opting for “fight or flight,” so I’m finally ready to let the cat out of the bag.

I ultimately decided not to apply for a position in the new organization, primarily because of the way the transition was being handled. Not only for leadership, but for my staff. There were so many consultants in the mix that it wasn’t clear who was making the decisions or what the eventual structure would be. I couldn’t even tell who I might report to or who my boss would be in six months.

Although it would have been tempting to jump into the fray and find something to make my own, I didn’t feel it was tenable. Apparently I wasn’t the only one thinking the same way – several of our best managers opted not to make the jump either.

I could have stayed in my old role and helped turn the lights off on the old systems. I realized quickly, though, that my team was being gutted, not only by movement of key resources to the new project, but also by the departures of those who felt sticking around would be risky. There were no guarantees of employment in 18 months after the legacy systems shut down, so people grabbed opportunities as they came by. The prospect of trying to continue to roll out new physicians and support our existing users with an inexperienced staff didn’t excite me.

Although I’ve resigned from jobs before, this was my first time resigning from one at this level. Once my decision was made, the next concern was what would happen once I handed over my letter. Would they walk me out or would I work out my notice period? I really wasn’t sure which way they would go and I wasn’t about to poll my colleagues. I’ve seen it happen both ways. On one hand, I didn’t see them with a reason to walk me out – I’ve been a loyal employee and a highly visible leader. On the other hand, I had access to all kinds of sensitive information, including upcoming physician acquisitions, strategic planning, and financial data.

I couldn’t imagine having someone else pack up my things if they did show me the door. Even in our increasingly digital world, there’s a certain amount of “stuff” that accumulates over 10 years. While I was debating my decision, I did a fair amount of multitasking as I sorted files during conference calls and took home a laptop bag full of personal belongings here and there. I couldn’t take much off the shelves, though, since I didn’t want it to be obvious what might be going on.

The weekend before I was ready to hand over the letter, I came in on Saturday and took all my personal belongings except the medical textbooks and the diplomas hanging on the wall. I figured HR could box those up and ship them, or if I had the dubious honor of doing the “pack your things while we watch” routine, there would be no question of what was mine vs. company property. It was probably an overkill approach, but you never know how it’s going to turn out when you’re dealing with a corporation.

It’s not like I was leaving to go work for a competitor. I may have been the first executive who actually resigned to “pursue other opportunities” for real rather than as a euphemism for being terminated. Still, I was pretty nervous when I headed to meet my boss for our weekly one-on-one meeting with my letter tucked in a manila envelope.

I knew he wouldn’t be surprised, but actually delivering it was another thing. He opened our meeting with his usual, “What’s on your list for today?” as expected, so I prepared to hand it over. Unfortunately, I was more nervous than I thought and my attempt to gracefully slide the letter across the table ended up being more flippant than intended. An image of an air hockey game popped into my head and I have no idea what my facial expression was, so he may have thought I’d finally gone off the deep end.

He was actually pretty cool about the whole thing since we had been talking about my need to make a decision for some time and he was aware I had decided not to move to the new system team. I sensed a little disappointment as he said he hoped I’d stay to “hold things together” but understood the decision.

The only real suspense was waiting for the answer after asking him what happens next. Apparently the topic of executive departures had been covered as part of project planning for the new system and I was on the “OK to stay” list. I have to say I was a little disappointed on some level at not being shown the door since having an extra month of paid vacation would have been nice.

I had timed my notice so that I would depart with the other team members, thinking that would minimize the disruption since there would already be activities in place to reassign work, reorganize teams, and create new reporting structures. It turned out to be a good decision since I had a natural support structure of people to talk to as we went through the process. Even when leaving is voluntary, it’s still difficult, and even more so when you don’t necessarily have something you’re headed to.

While they would be flying off to training after their last week on the team, I was headed towards a bit of a sabbatical while I burned through a decade of accumulated vacation and comp time. The last day was a bit teary all around, but overall the final month went better than expected.

I’m not going to say how long I’ve been away from the hospital – Dr. Jayne’s timeline is fairly fluid and sometimes I don’t publish what I write until weeks or months after it happens to preserve anonymity and make sure it doesn’t come back at me. I know readers will ask what I’ve been up to. I didn’t want to relocate for another CMIO position, so it’s been an interesting combination of clinical work (both local and locum tenens) with a sprinkling of healthcare consulting. I’ve worked with nearly a dozen different EHRs, which gives me a perspective that I didn’t have before. I’ve been able to travel to cities I’d not normally visit and have had access to a stunning variety of office and health system dysfunction. Locum tenens work is not for the faint of heart – often the positions are opened to locums because they’re virtually non-fillable by traditional candidates.

My plan was to lay low for at least six months while I figured out what to do with the rest of my life, but already some opportunities are on the horizon. One came knocking after I updated my LinkedIn profile – from an organization that had been interested in me for some time but thought I would never leave Big Health System. Another is an organization that is looking to hire their first physician IT expert.

I’m not going to jump into anything just yet, but it’s nice to feel wanted. In the mean time, I’ll be adding stamps to my National Park Passport, collecting multiple state medical licenses, and seeing whether the grass is any greener on the EHRs used by other Eligible Providers. Please remember to be kind to drivers with out-of-state plates because one of them just might be me.

Have a National Park recommendation? Email me.

Email Dr. Jayne.

HIStalk Interviews Jordan Kalal, Software Engineer, Cerner

Jordan Kalal is a software engineer with Cerner and volunteer mentor with Tech sHeroes, a program of the Kansas City Women in Technology that encourages middle school girls to explore careers in technology.

Tell me about yourself and your job.

I came to Cerner two years ago after studying computer engineering. I work as a software engineer on a research and development team. I joined up with Tech sHeroes about a year ago and have been working with them ever since to develop a curriculum for their middle school program.

Why are women underrepresented in technical fields?

That’s a question that has a lot of answers. It is in part because of impostor syndrome, which is not a self-fulfilling prophecy, but it’s the condition of being underrepresented. That keeps people out. You become the representation for your gender. That’s a big role to take on and people don’t want to do it. 

A lot of it is social conditioning, which we were overcoming up until the 1980s. That’s why every other STEM field has fared a lot better than us in the technical field. As toys and movies started getting into tech and computers more, they were geared towards boys and they were geared towards a bad image. You have two factors working against you. Your male peers have been exposed more to it all throughout childhood and adolescence. Then the way it’s represented in movies and comic books and all of that — very nerdy, very loser-ish. 

It’s a lot to overcome to go into a field that you may have never been exposed to. It’s not like it’s represented in schools really at all. You know what it is to be a physics major or a math major or go into art because you’ve done all those things. Sometimes you haven’t ever written a line of code by the time you get to college, and then they say, what do you want to be?

Is that changing?

We are starting to see the very first bits of change, but it is highly, highly ingrained. I like to pick “Big Bang Theory” as an example because everybody knows that one. Nerd culture and computers are getting bigger exposure, but it’s still very bad. “Big Bang Theory” is just an excuse to be able to laugh at that nerd-dom and the loser vibe and all the stuff they’re interested in. It’s good that at least it’s becoming mainstream, but it’s bad that it’s still in such a negative light. 

Again, women aren’t represented there. It’s a pattern that goes across all media, whether it’s movies or shows or books like that. It’s pretty prevalent, at least in the US.

In the 1960s, not many women worked outside the home, but the economy’s lack of personal income growth made two-earner households common and gave women new opportunities. Looking back on that longer perspective, how do you see the trajectory in the big picture going from there to now?

That’s actually a very interesting trend to look up. There’s a wonderful graph that marks four STEM careers — I believe physics, chemistry, IT, and maybe mathematics. It shows, starting in the 1960s, the percentage of women in those fields. It starts out really low — you know, down to zero. It shows them trending up, trending up, trending up. Then while the other three careers continue trending up to the point we’re at now — we’re right about 40 to 50 percent for most of those STEM careers – computer science actually dips right at 1987, I believe, when personal computers were introduced. They were marketed and put in little boys’ rooms. It was the first time you have that disparity in exposure. 

These boys were then choosing that field, knowing something about computers. It deterred their female counterparts because they just looked at it like they were already a step behind. "I’ve never used this, I’ve never programmed before, and oh, my gosh, look at them, they have. I’m always going to be behind and I’m not ever going to be able to catch up with them."

That’s why we trended down to the point we’re at now, where from 1991 we were at 37 percent of women in computer-related fields and now we’re down to, I believe, 26 percent. If you go even farther, it’s only 12 percent of women in software engineering kind of roles. On the trend down, that’s a nine percent drop just in my lifetime. That’s a massive drop that really can’t be ignored.

Do you see that same gender disparity in countries like India, which was well positioned educationally and vocationally to embrace work in new technologies as an economic imperative?

I don’t have the stats outside of the US. It’s on my to-do list to investigate all those. I imagine the numbers are different just because of our cultural ecosystems that we grew up in, whether it’s how hard we push good-paying jobs and how hard we push going into a high intellectual field. Of course, our exposure to all our social media and stuff like that. I’m sure the numbers are definite and quite fascinating. I just haven’t looked into them yet.

What response do you get from mentoring and what results have you seen?

The response has been overwhelmingly positive and our support has just been off the charts. Schools are happy to take us in and give us the time to do this. A lot of them are backing us with their teachers, rolling it into their extracurriculars, categorizing it in the same way as like football or basketball so that teachers can come sponsor us. Even within Cerner, when I put out the call on our internal boards for mentors, it was 20 people emailing me all within 24 hours. “I want to help any way I can. If I can’t mentor, I’ll help you write the code" and stuff like that.

It’s been positive because everyone can see the inevitable fallout of not only a lack of women in engineering, but just a lack of engineers in general. I like to say I focus on a really bad problem, but there’s a bad problem looming for all of us. There’s not going to be enough engineers to even maintain the code that we have written today. It’s sad to think that we’re going to come to this weird standstill as there’s no further development because we used all of the developers to maintain.

What level of diversity are you seeing among your colleagues?

I don’t have the numbers on that. We obviously have quite a diverse campus here. Just because we have a fabulous reputation in the engineering world, a massive portion of our engineers are self-referrals. Someone’s here and they say, “You know, this is a great company. You should come work for Cerner.”

Specifically, getting back to women engineering, around this controversy, a lot of people are starting to look at recruiting women in the US who have dropped out of the market. I’m not sure if you’re aware of this stat, but 45 percent of women in tech fall off of the tech wagon, essentially by the age of 35. You’re talking about half your female workforce in this industry leaving for another job in a different career path. A lot of people, when they talk about the reason for the shortage or trying to vie for that, they say, why don’t we start hitting that demographic? And saying, these women aren’t staying home to become mothers — they’re leaving for a different career because they’ve been pushed out by the culture or stuff like that. We say, if we can just get them back, then it would be a massive boost in numbers without all that trouble.

Is there the equivalent of refresher training to re-integrate women back into the technical workforce whose experience is a few years old?

We like to say in the programming world that it doesn’t matter which language you know. As long as you know how to code, you can code forever. Anything like that would almost be standard training, getting you up to date on which languages the company uses and what tools they use. That’s different for every company. If you were trying to re-integrate someone who has been in a different field for a while, it would just be as easy as putting them through their normal training. You’re just telling them, here are the languages, here are some online courses if you aren’t familiar with it, and here are the tools we use. That’s all standard.

Cerner gets a lot of press for supporting diversity and is admirably active in social causes, yet when I look at its corporate leadership team, it’s almost all white men. There are three women and no minorities out of 15 on the corporate leadership team and four women out of 16 in the executive leadership group. Do women face business barriers as well as technical barriers?

The lack of women in leadership is, of course, something that’s highly studied. Yes, it’s there across all industries. Healthcare is actually the number one industry to go upwards and try to achieve those goals, so I’m in the right place if I want to go up.

But yes, that’s a whole other set of interesting statistics and reasoning. It’s almost two different barriers — the barrier to technology and the barrier going up. It is prevalent across all industries. That’s another one where it is changing, and that one is changing rapidly due to women’s success in startups. They actually have much better statistics than men, and certain investors are starting to key into that. As the startups become not startups, it will shift. As we get this next generation of empowered women coming in, I think we’ll see a shift very rapidly in the upper ranks.

Companies like IBM always promoted engineers, while others rewarded experience in sales or management. That may be a barrier that isn’t gender-based, but rather that technologists might not have taken the right roles to lead a particular company. How do you see that unfolding in healthcare?

I think it’s becoming more and more appreciated to have a technical background. It’s hard to find that mesh of a people person and engineer. But more and more companies are starting to see that it’s easier to teach an engineer how to do business and be business savvy and interact with other people than it is to take a business person and try to teach them how to write code and how to make those decisions. You need someone with that technical background to make those instant choices and to make those strategic choices. You have to have someone who understands all facets of it.

That’s not to say that the business people don’t have a whole new skill set that I don’t. But it’s easier to teach them the business savvy than to teach the tech to someone else. Again, it’s a shift in the way companies are thinking and the paradigm they’re following to try to get the most. You have to be a little more agile now than you’ve ever had to have been to be on the path to be competitive.

What actions would you recommend for someone who is interested in getting more females and minorities into healthcare IT?

If you have a passion, it is not difficult to find others who have that same passion. My only recommendation is to choose one point and try to fix it. We talk about the pipeline of engineers – I’ll  use that as my example since I’m familiar with it. We talk about the fallout very young with gender stereotypes and then with toys. By fourth grade, half of females aren’t interested in STEM any more. Then you talk about the high schoolers trying to choose a career and they don’t go into this. Then of course, even past that, going into career, you have the fallout of women engineers from tech.

My suggestion is to try to just fix one piece. Choose one thing and do it very well. Focus on an age group and try to key into them and provide a quality experience that’s fun and that keeps them engaged. I always say that by the time people get out of Tech sHeroes, I’d love it if they can write a website and write their own code, but more importantly, I want them excited about tech. I have taken that one group and I’ve got them excited about tech. They totally know what engineering is. They totally know what computer science is. They know what code can do now. 

I’ve impacted that one group instead of trying to run five after-school programs at a bunch of different levels and having them be watered down. Choose something, be passionate about it, and greatly impact a certain group.