Five Republican senators co-author a Health Affairs piece questioning what value EHRs and the governments $35 billion HITECH investment have returned to taxpayers.
Anthem has been refusing to let the Office of Personnel Management’s inspector general perform "standard vulnerability scans and configuration compliance tests" since 2013, before the recent cyber attack on its network that compromised 80 million medical records. The insurer still won’t allow the IG’s office to conduct its tests, citing a corporate policy that bars outside agencies from accessing its network.
The FDA has launched a mobile app, its first, that identifies current drug shortages, resolved shortages, and recent discontinuations. It is available for both iOS and Android devices.
As a CMIO, I’ve spent most of my time working for hospitals and health systems. The bulk of my experience has been in with face-to-face using a “train the trainer” model. Our in-house trainers learned from the vendor’s trainers; our trainers in turn deliver the training curriculum to end users.
As healthcare has evolved, many organizations have wanted to get away from traditional classroom training, whether due to facility, logistic, or cost issues. Having users participate in at least some kind of online or self-directed learning prior to in-person training is highly desirable.
We created this kind of training at my organization last year and it’s been fairly successful. I haven’t really been able to judge it as objectively as I’d like, however, because I already have a deep knowledge of our system and had been previously trained in the old methodology. I’m glad that my employer allows me to moonlight at other facilities.
I mentioned last month that I was going to start at a new site. Since I’m clearly a health IT geek at heart, I was actually excited to receive the email today with my password to their learning management system.
It’s clearly a vendor-driven system – my new employer didn’t go out and code this on its own. It’s branded with the vendor name and the graphics are fresh and inviting. Maybe I was looking for a reason to procrastinate, but it made me want to put aside the HL-7 specs I was reading and dive right into training. I think I was most excited about experiencing what online training might be like in a situation where I wasn’t involved with designing or maintaining it.
The system was ridiculously easy to navigate, with both a traditional navigation bar and a more graphical representation. That made me smile since I spent a lot of time arguing with some of our developers about the need for “old school” navigation when we configured our system. People have different learning styles – some are abstract thinkers and others concrete – and often seem to do better with one approach over the other. I’m more of a traditional girl, so I dove right in with the top-down navigation.
The introduction was handled with a video presentation. What struck me first was that it had background music. I haven’t seen that much in the training content I’ve used previously, but it was somewhat spa-like and unobtrusive, so I decided I liked it, although it kind of made me want to get up and light some scented candles to match the mood. Once I completed the introduction, it released me to view the courses in which I had been enrolled.
Many organizations assume providers don’t care about the practice management aspects of the system, so I was excited to see that I had been enrolled for training on the billing system as well as the clinical system. Knowing my background, they may want to revoke my enrollment in the EHR Configuration section but I am looking forward to seeing how things work with a new and different vendor.
Once I moved into the provider training, I was glad to see that it had option for both video/spoken content as well as turning off the audio and just reading. Putting myself in a typical physician’s shoes, I found it to be a little heavy on the technical jargon as it discussed virtualization and thin-client delivery. I don’t know that I need to be told that 100 million users have experienced “the promise of proven application compatibility” that is Citrix XenApp, but you can bet I’m going to use that factoid in our next office trivia contest.
I’ve spent most of my career using enterprise-class EHRs that attempt to support every specialty under the sun. This is the first time I’ve used a specialty-specific EHR. I have to admit it’s significantly different than my past experiences.
There were other exciting non-specialty features as well. In contrast to the system in place at our hospital, patients can pre-register and check in online. Instead of jumping right to the physician part, the module then walked me through the basics flow of a visit, including what the front desk staff would see and do. Not at the level where I could perform the tasks, but just to give me an idea of the features. I often think that physicians would be more forgiving of a lengthy check-in process if they understood what really went on in the front office.
This will also be the first time I’ve used an EHR that is optimized to run on an iPad. Although it looks cool, it was kind of jarring to keep looking at a screen in portrait layout rather than the landscape layout we’re all so used to. As I went through the initial training session, I saw a couple of things that raised my EHR developer hackles: inconsistent use of color and blood pressure fields where systolic and diastolic were combined are examples I noted. I know I’m more discerning than the average user, but I had thought vendors were well past those entry-level design flaws.
I have to admit, though, I drooled a bit when I saw how the system handles approximate dates. My primary vendor has struggled with this for quite some time. Maybe the way my new EHR is handling it isn’t glamorous, but it gets the job done much better than I’ve seen other vendors do it. Unfortunately, that was just a teaser during the EHR overview, and I’m going to have to wait to dig into it a little more. Each module shows the length of time allotted and most look like they’re 20-25 minutes. Since my eyelids were already drooping from a long day at the office followed by yet more snow shoveling, I decided to call it a night.
Do you have a passion for online training? When is the last time your CMIO learned a new EHR? Email me.
A Health Affairs article written by five Republican senators says their 2013 question of what value Americans have received in return for their $35 billion HITECH investment hasn’t been answered. They say EHRs “are not meaningful for physicians,” interoperability remains elusive, the $12.5 billion CBO-predicted EHR savings haven’t been realized, and ONC’s interoperability roadmap doesn’t provide enough specific details for vendors to work from. It criticizes ONC for releasing its interoperability roadmap well after Stage 2, which “was promised to be the stage when health providers were interoperable.” The article finishes on a slightly positive note in complimenting Karen DeSalvo:
In listening to the concerns from EHR vendors and EHR users from across the care continuum, ONC has taken an important turn under the leadership of Dr. Karen DeSalvo. The previous ONC leadership did not understand the difficulty and enormity of creating government-approved products in a market that struggled to exist before government incentives arrived. As a result, our nation’s health care providers are stuck with the huge cost of unwieldy systems trying to conform to government mandates. They are stuck adopting EHR systems which don’t fit into their established workflows. And if they actually want to share their patients’ data, they are stuck with even more costs imposed by vendors. At the center of all this is the patient who must sit quietly in the exam room looking at her physician use a computer instead of directly talking with her, who likely has seen no better access to her own data, and who is struggling to understand why her doctor has such a difficult time getting her lab results.
HIStalk Announcements and Requests
I was thinking today about the kind of reader who probably shouldn’t be reading HIStalk because I won’t be able to meet their expectations. I’m not offended by losing readers who:
Assume there’s a direct relationship with how important a story is and how much space is used to describe it.
Need repeated mentions of the same story over several days, with no new information, to make sure they understand they should pay attention to it.
Enjoy catchy headlines (especially those click-desperate, frothy ones that include a number as in a “listicle”) with cartoonish action verbs that sit atop stories that fail to deliver anything insightful.
Don’t mind stories that fail to link to the source document with the hopes you’ll mistake the story as containing original reporting.
Require pictures even if they have nothing to do with the story, like generic shots of stethoscopes or smart phones, or who value slick design over substance.
Are convinced that keeping up with the industry requires spending a lot of time each day reading several sites.
Enjoy reading opinion pieces written by people who have never worked in either health IT or healthcare.
Quite a few people are writing about the study that found little overlap in the “best hospitals” lists of four organizations that create them. It’s a lost cause in my opinion – any “best” list, whether it be restaurants or plumbers, is situationally subjective and even medical experts can’t provide a definitive answer. Go to an academic medical center when you have a tricky diagnosis or need a rare surgery performed by someone who does a lot of them, but expect to have privacy and restfulness compromised by rounding teams made up of everybody and his brother popping in at all hours, expect more mistakes to be made (especially in July, on holidays, on weekends, and at night), don’t mind the happy indifference of employees who aren’t afraid of being fired, and expect to have a lot more tests done because that’s the research culture (no pun intended). Community hospitals are fine for most medical situations, but they don’t always have high volumes in what you need done, the employees they attract are probably friendlier but maybe less accomplished, and if you crash you might be a long way from somewhere better equipped to save you. I would rather see a list of the worst 30 percent of hospitals (as measured by mistakes, poor outcomes, low-quality medical staff) and then feel safe in choosing any of the others as long as you bring someone to watch everything done to you like a hawk. It also won’t matter which hospitals are “best” if you aren’t willing or able to travel halfway across the country and possibly go out of network, and for many mid-sized cities, consolidation has left only one or two choices anyway. I think for most people, long-term health is driven more by the choice of PCP and specialists rather than the big, bureaucratic building with the lights on all night that often makes things worse instead of better. The “best” hospital is the one you stay out of.
Welcome to new HIStalk Platinum Sponsor HCTec Partners. The Nashville-based HIT/HIM solutions and staffing provider offers services related to EHRs (build, implementation, training, optimization, go-live support), clinical transformation, revenue cycle and ICD-10, data migration, data warehouse, and HIM and coding. I was happy to see prominent mention on their site of the extensive benefits they offer consultants as well as the company’s “giving back” activities, such as working with Habitat for Humanity. Testimonials from clients and consultants are here. Thanks to HCTec Partners for supporting HIStalk.
I had a sign made to commemorate Atlanta’s convincing HIStalk reader poll win as healthcare IT capital of America that Jenn presented it to the folks at Metro Atlanta’s Bioscience-Health IT Leadership Council on Thursday. Receiving the award from Jenn were Council Chair Robert Hendricks of McKesson and Pat Williams, chair of the Institute of Health Information Technology and TAG Health.
This week on HIStalk Practice: Palm Medical Group picks HealthFusion as its VoC. KVC Nebraska turns to telemedicine for behavioral health services. Hospital employment loses luster with Ohio physicians. CHESS and Chase Brexton Health Care implement new pop health management tools. ClickAClinic CEO discusses telemedicine business model outlook. The Consultant’s Corner takes a look at primary care networks.
This week on HIStalk Connect: Google and Stanford University publish a paper on the use of deep learning neural networks to expedite drug discovery research. During the Mobile World Congress conference in Barcelona, Jawbone announces that it will partner with Huawei to provide access to Jawbone’s UP fitness ecosystem for the company’s growing portfolio of smartphones and wearables. Rock Health invests $100,000 in Chrono Therapeutics, a startup building a wearable device that supports smoking cessation programs by administering nicotine at strategic intervals based on the time and intensity of each user’s actual cravings.
Webinars
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Here’s the recording of the “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care ” webinar.
Acquisitions, Funding, Business, and Stock
I mentioned that the Forbes list of 2015 billionaires omitted Terry Ragon of InterSystems, with my speculation that his net worth should be in the same $1.5 billion neighborhood as Cerner founders Cliff Illig and Neal Patterson. Turns out he’s actually on the list at #1190 at $1.6 billion, but categorized under “technology” rather than “healthcare,” which is technically correct (no pun intended) since the company’s Cache’ database has at least some use outside of healthcare.
Stanford Health Care and GE Ventures launch Evidation Health, which will pair digital health companies with possible provider customers to define product value.
Sales
Greenville Health System (SC) chooses Caradigm’s population health management products.
People
CareCloud clarified a reader’s rumor report that CEO Albert Santalo was asked to step down. Per the company, he’ll be “focusing his time almost entirely on advancing our products for the next several months,” with an emphasis on meeting the needs of large-practice customers, but will remain chairman and CEO.
Announcements and Implementations
First Databank will distribute Polyglot’s Meducation simplified medication patient instructions.
Physicians at Community Memorial Health System (CA) are entering 98 percent of their orders and notes electronically into Meditech after implementing PatientKeeper’s CPOE and NoteWriter systems.
Agastha and Axon HCS add the CompletEPA electronic prior authorization solution from Surescripts to their systems.
Government and Politics
FDA releases its first mobile app, which identifies drug shortages.
HHS Secretary Sylvia Burwell publishes an article on HHS’s move to value-based payments, but reading it involves another type of payment – sending $20 to the New England Journal of Medicine for the privilege of seeing the comments of the government official whose salary is paid by your taxes. It should be law that elected officials should not publish paywall-protected articles or appear at conference sessions that require a fee or that are invitation-only. They represent all of us, so they should speak to all of us.
Here’s Karen DeSalvo’s keynote and comments from a Wednesday session on health IT at Brookings Institution.
Privacy and Security
The Australian radio station whose “morning zoo” hosts called a London hospital in 2012 claiming to be the Queen and Prince Charles and were given information on the condition of the Duchess of Cambridge may lose its license for airing the call without consent. The India-born nurse who didn’t recognize the “ridiculous comedy accents” transferred the call to the floor. The nurse committed suicide three days later, leaving a note blaming the shame of the call for her death. British prosecutors declined to press charges against the two DJs even though they probably broke Britain’s privacy and malicious communications laws, explaining that they weren’t likely to be extradited from Australia and their action was intended to be a harmless prank.
Texas Health Resources, responding to a negligence lawsuit brought by its nurse Nina Pham over her exposure to Ebola, says in an email to employees that despite her claims, it had her permission to release information about her and that it followed HIPAA rules.
The federal government’s Office of Personnel Management OIG says Anthem twice refused to allow it to perform security testing of Anthem’s systems as part of a routine OIG security audit. Anthem told the OIG that its policies don’t allow external entities to connect to its networks (Chinese hackers excluded).
An Oregon TV station uncovers an interesting privacy law: universities are allowed to dig into the health records of any student who sues them without running afoul of HIPAA. They’re covered under a separate law called FERPA.
Technology
A JAMA Internal Medicine case study profiles the case of an occasionally symptomatic patient whose tachycardia was diagnosed only after his PCP suggested he buy an AliveCor smartphone-based cardiac monitor.
RxRobots delivers four of its pain management robots to the Alberta, Canada hospital where they were developed. The robot distracts children who are undergoing painful procedures.
Other
Garen Sarafian from Citigroup sent over the company’s analysis of the most recent Meaningful Use data titled “Stage 2 Clingers: Weak Vendors Try Holding On.” While I would be cautious about reading too much into the skimpy number of EP Stage 2 attestations, the report’s conclusions feel about right:
Cerner and Epic are increasing their Stage 2 market share (somewhat at the expense of Meditech, which is sliding a bit) and Athenahealth is succeeding on the EP side.
Provider EHR difficulties should drive a robust replacement market that will benefit those same three companies.
Low EP attestation rates should benefit quickly implementable products from Athenahealth and Practice Fusion.
A dropoff on Stage 2 attestations by users of Allscripts and NextGen could indicate declining market position, especially given their acknowledged problems with reduced client spending and satisfaction problems, respectively.
The BBC finds that the US is the most expensive place in the world to give birth, drily adding that, “there is no publicly financed health services as in most developed countries.” A Johns Hopkins professor summarizes our healthcare mess succinctly: “If you can make more money as a doctor by ordering more tests, you are going to order them and therefore patients end up getting more tests … If you don’t have health insurance in the US, hospitals and doctors will ask you to pay three to four times what someone with insurance will pay for the same service because no one is negotiating rates on their behalf.”
The AMA, seemingly unable to find anything to whine about these days other than technology and the EHRs its members bought of their own free will, twists CMS’s latest ICD-10 testing results to suggest that “the claims acceptance rate would fall from 97 percent to 81 percent if ICD-10 was implemented today.” AMA and other physician groups want CMS to develop contingency plans “to save precious heath care dollars” (the Medicare ones that arrive in the pockets of doctors) and to describe how PQRS and Meaningful Use reporting will work given that the calendar year will straddle ICD-9 and ICD-10 (that part is valid). Meanwhile, AMA’s online newsletter wraps up a supportive article with a link to its online store, where those cash-strapped doctors are invited to buy AMA’s ICD-10 data file. AMA makes a good point: CMS should release more specific testing details. It also makes a bad one: CMS should pay doctors in advance in case they have billing problems.
Weird News Andy notes what he calls a “kidney kidney kidney kidney kidney kidney” transplant. A San Francisco hospital performs six paired donation kidney transplants, using software developed by a technology executive (who underwent a kidney transplant himself years ago) that performs the number-crunching that matches unrelated donors and recipients using their medical characteristics.
Sponsor Updates
VisionWare CEO Paul Roscoe provides thoughts as part of Health Data Management’s “Visionaries for 2015” special edition.
Bill Kinsley, enterprise architect for NextGen, will chair the HIMSS EHR Association’s privacy and security workgroup.
Galen Healthcare Solutions posts “Health Management Plans: A Better Way to Care for Patients.”
Extension Healthcare creates a new infographic on the “Evolution of Clinical Alarms and Text Messaging in Healthcare Communications.”
Etransmedia Technology Chairman Vikash Agrawal summarizes his experience at the Pacific Crest 10th Annual Emerging Technology Summit.
LifeImage posts “Medical Image Sharing for Neurological Care & Research.”
Holon Solutions CEO Mike McGuire explains the company’s rebranding strategy.
Healthwise offers a blog on how it helps its customers get the information they need.
HealthMEDX will exhibit at LeadingAge Oklahoma March 10-11 in Midwest City.
Iatric Systems exhibits at the Privacy & Security Forum through March 6 in San Francisco.
Logicworks posts a new blog on the Internet of Things security.
The Wall Street Journal covers freeware-EHR vendor Practice Fusion and its decision to embed big pharma-funded vaccine reminders into its EHR. Practice Fusion CEO Ryan Howard explains “For every project we do that drives forth public health or gives data away, we need to make sure it’s balanced out by a monetizable exercise.”
The American Medical Association and 99 other professional associations are calling on CMS to improve its ICD-10 transition plan following recent end-to-end tests that resulted in 19 percent of submitted claims being kicked back, almost all due to errors made by the submitting organization.
The Supreme Court hears arguments on King v Burwell, a case that could undermine the Affordable Care Act by stripping subsidies from any consumer that purchased health insurance through Healthcare.gov. Defendants of the ACA argue that withholding subsidies from states that did not launch an insurance exchange would be tantamount to the federal government applying illegal ”coercive pressure” on states.
Understanding the Importance of Prioritizing e-Prescribing By Louis Hyman
As the industry awaits confirmation of a compliance deadline delay for the New York State e-prescribing mandate—which will require electronic prescribing of controlled and non-controlled substances—it’s important that providers don’t delay their preparation efforts, as this process can be time- and resource-consuming.
Under provisions of the New York State e-prescribing mandate and subsequent regulations (such as amendments to Title 10 NYCRR Part 80 Rules and Regulations), all prescriptions in the state must be transmitted electronically by authorized prescribers unless an exception exists. However, as many providers are struggling to meet compliance by the original March 27, 2015 deadline due to a myriad of challenges beyond their control, the New York legislature is working to pass a law to delay implementation of the mandate to March 27, 2016.
No matter the timing of the deadline, this mandate serves to be a game-changer for how providers share prescription information, and they should be aware that other states are closely watching New York’s rollout, with several already considering following suit.
The scope is intensified because the law covers both controlled and non-controlled medications and applies to all providers in New York State, including long-term and post-acute care organizations (LTPACs) and senior living facilities. Providers must start transitioning to the new requirement now to avoid significant penalties including fines, imprisonment, and/or professional license suspension or revocation.
As such, providers must make e-prescribing a priority in the midst of other major industry initiatives such as ICD-10 and Meaningful Use. However, e-prescribing easily can be incorporated into these efforts if organizations are already leveraging technology and staff training in their preparation.
To comply with the new mandate, healthcare organizations first must fully comprehend its scope. They need to look at its impact on provider, practice, and facility workflows, as well as how it ultimately affects patient or resident care. The following four best practices can help healthcare organizations engage providers and create a smoother transition:
Generate physician awareness of the implications. Regardless of the care venue, it’s important to meet with physicians to raise their level of awareness and engage them in understanding the law’s full scope. Providers need to be clear on what is expected from them within the new e-prescribing workflows, just as they adapted workflows for EHR implementations to meet Meaningful Use requirements. Building physician awareness is even more critical among those organizations that have not yet implemented an EHR and may therefore require standalone computerized order entry or electronic prescribing technology. These providers may not be accustomed to any form of e-prescribing.
Evaluate the workflows of all clinicians involved in the traditional prescribing process. This step is especially important in regard to the complex workflows in hospitals, skilled nursing facilities, and other senior living care settings. Because the law applies to both controlled and non-controlled medications and does not allow physicians to delegate the final steps within the prescribing process, four basic workflows need to be reviewed to understand how they will be impacted by e-prescribing. These workflows include: orders generated in-house for controlled medications, orders generated in-house for non-controlled medications, orders generated upon discharge for controlled medications, and orders generated upon discharge for non-controlled medications. Additionally, providers should examine specific workflows for nurses, physicians, and other clinicians. For instance, because telephone orders will no longer be accepted, healthcare organizations need to plan for physician availability during off hours and periods of high admission and discharge volumes.
Engage caregivers in decisions. Because caregivers are key stakeholders, they should be included in the workflow evaluation to gain accurate insight into the overall impact of e-prescribing. It’s important for organizations to involve these individuals in any technology selection as well to ensure the appropriate tools are in place to support necessary workflows. As part of the selection process, engage caregivers in active testing of how their workflows are accommodated on a day-to-day basis. Beyond supporting workflows, healthcare organizations also should confirm the selected technology performs on a variety of platforms used by caregivers – such as tablets, smartphones, laptops, and PCs, as the physician may not always be on site.
Train and practice e-prescribing. With workflows and technology in place, it’s now time to employ a robust training program to support efficiency and compliance by all caregivers. Providers should begin actively practicing e-prescribing as soon as possible to identify and resolve any issues prior to the compliance date.
Even with the possible New York State e-prescribing mandate deadline delay to March 27, 2016, New York providers need to make e-prescribing a priority. By focusing now on an e-prescribing strategy, healthcare organizations and providers across all care settings – including LTPACs and senior living providers – can realize the benefits to medication management and patient/resident safety while also maintaining compliance.
Louis Hyman is chief technology officer for SigmaCare.
HIStalk is funding five, $1,000 scholarships for patient advocates to attend the HIMSS conference, with conference registration credentials provided by CTG Healthcare. Applicants provided their biographies and a statement of what they hope to achieve by attending, with the winners chosen by Lorre and Regina Holliday.
I have another motive. I’ve often pondered what our patients would think of the over-the-top excesses and unchallenged claims of both providers and vendors at the HIMSS conference. I hope these attendees, clearly identified by tee shirts bearing Regina’s artwork above, will serve as neutral observers keep us all focused on the people who we say we work for, but who we may rarely see face to face.
Each attendee will attend whatever educational sessions they choose along with having access to the exhibit hall in representing the patient’s point of view. Each will provide ongoing social media commentary during the conference as well writing a summary HIStalk article afterward. We’ll announce a time where the attendees, along with other members of The Walking Gallery, will be available to meet people in the HIStalk booth.
I created a contact form for each attendee to avoid publishing their personal email addresses. Please don’t spam them, but you can get in touch about anything related to their conference goals. It’s up to each person to respond if they so choose.
Kim Witczak
I became involved in pharmaceutical drug safety issues after the death of my husband, Tim “Woody” Witczak in 2003 as a result of an undisclosed drug side effect. I have taken my personal experience and launched a national drug safety campaign through www.woodymatters.com. My work has been featured in major news media such as Fortune, Readers Digest, Consumer Reports, Wall Street Journal, New York Times, and Star Tribune. I have testified before US Senate on PDUFA/FDA reform issues as well as numerous FDA Advisory Committees. In 2008, I was appointed to the FDA’s Psychopharmalocgic Drug Advisory Committee as a Patient Representative. In 2013, I co-organized the Selling Sickness: People Before Profits international conference held in Washington, DC bringing academic scholars, healthcare reformers, consumer organizations and advocates, and progressive health journalists to develop strategies and solutions challenging the “selling of sickness.” I am an active member of the Consumer Union Safe Patient Project as well as a part of the DC-based Patient, Consumer, and Public Health coalition making sure the voice of patients and consumers is represented in healthcare/FDA related legislative issues. In addition, I was just appointed to the National Physicians Alliance Board of Directors.
Professionally, I am an advertising and marketing professional with 25 years of experience in a variety of industries (e.g. airlines, automotive, fashion, and retail). I am one of the founders of Free Arts Minnesota in 1996, a non-profit dedicated to bringing the healing powers of the arts to over 4,000 abused and neglected children in Minnesota. I earned a BA in Business and Economics at Lake Forest College in Lake Forest, Illinois.
I am excited to be granted the scholarship to attend HIMSS in Chicago. It’s a great opportunity to network with leading healthcare providers and learn about the new healthcare solutions on the horizon. I also hope to be able to infuse the patient perspective with those I meet. Oftentimes others are speaking for what “patients" want and it’s not always in alignment with the real world patient / public voice.
As someone who has spent my entire career in advertising and marketing, technology is at the core of communicating with the public. Communication is also at the center of healthcare, not only between companies, staff, hospitals, but also between provider and patients and their families. I truly believe the only way we will advance healthcare is by working together, collectively.
Since I have a unique perspective of having foot in both advertising and communications AND patient safety worlds, it will be interesting to see HIMSS through this lens.
I am looking forward to attending HIMSS in Chicago this April. As one of the lucky HIS-talking Gallery Patient Scholarship recipients, as well as a woman who lives with Lupus, I am excited about the opportunity to meet and connect with stakeholders and businesses that believe including patients in the process is vital to the creation of successful partnerships within the healthcare and wellness industries.
Currently, I co-host and moderate @LupusChat, which leads a bi-monthly Twitter Chat (#LupusChat). I am a healthcare activist and recently was the host of WEGO Health’s #HAChat on the importance of Self-Care for Healthcare Activists. I am also a Creator of POPULOVE.net, which “redefines what fans can accomplish through music,” where I write and curate some of the content for the Pop Ed. and Causes sections of the community.
Being a part of the HIS-talking Gallery Patient team at HIMSS will be an informative adventure. My enthusiasm as a passionate healthcare activist and patient voice is loud and clear. If there is a chance to meet and engage with HIMSS attendees so that together we can gain insight to how the patient experience can be incorporated into their practice and businesses I am happy to share. I hope to connect and create an open dialogue with today’s change-makers.
Why do I want to attend HIMSS? It’s the biggest event of its kind — so big that most convention halls cannot contain it. My involvement in health IT has expanded in recent years, as this is the field most likely to include patients and one of the more innovative spaces in healthcare today. HIMSS is the preeminent health IT event — it’s the place to be! So it’s critical that patients are there, too.
It is crucial that patients attend healthcare events. We are in a transitional time where patients are recognized as more important than ever, but the reality is that there may not be a single patient on stage in the course of a multi-day event.
Who am I, as I patient? I have been living with chronic illness for 21 years, since I was diagnosed with Crohn’s disease at age 13. I’ve never been able to experience life as a healthy adult, but have enough medical education to warrant an honorary doctorate. More recently I’ve developed some secondary complications from the Crohn’s disease, and also Fibromyalgia. Because of this grab bag of conditions, I am in pain and discomfort (physical or emotional) at all times, but the levels vary.
My illness is not a blessing, but I do consider it a credential, along the same lines as my MBA or project management certification. I don’t primarily identify as a person with Crohn’s disease. Rather, I identify as a patient, in general, and if pressed, as a chronic illness or invisible illness patient. For a long time I did not know about many opportunities for patients, except for volunteering with my disease-specific non-profit, or fundraising for research.
My early experiences with disclosing my illness were so traumatic and dangerous that I was in the closet for most of my life. It was not until I started using social media to find and connect with other patients that I began to learn of ways to be involved on a different scale. In my professional life, I went from a graphic designer, to an MBA student, to a project manager, to a program analyst. I started off as a small cog in a large system, but slowly began to understand, and be excited by, working as a larger system. Recently, I realized that my advocacy evolved in a similar way.
I am excited about all the awesome people I will meet at HIMSS. To improve the health care system, we must understand the challenges and motivations of all the stakeholders. I need to understand why the doctor only has eight minutes to talk to me during my appointment. I need to understand why my pharmacy can’t accept refills on certain types of medicines. I need to understand how reimbursement works, and the regulations that hospital face. I need to understand why the timelines for improvements are so far out. I need to meet pharma employees and insurance CEOs and understand that they are not the enemy. I need to tell my story to all of these people, and yes, I need to listen to theirs.
We cannot solve problems by considering a single cog, we must see the whole machine and we must understand that it’s made of human beings, all with hopes, dreams, frustrations, and solutions.
My name is Melanie Peron of Paris, France. I am the founder of the Butterfly Effect. In September 2011, I decided to make a career transition and create the Butterfly Effect after my personal experience as a patient supporter for my companion. During this time I discovered the social exclusion and all the difficulties of families and patients have to face up.
I deeply believe that little actions can bring great consequences and that is why I chosen this name. The idea was to bring sweet moments for patients and families and allow people to live normal moments in difficult times.The Butterfly Effect has several missions : providing supportive care (art therapy, aesthetics, relaxation therapy, writing workshop), a 3D social network application (Bliss), cultural action (shows in patients’ bedrooms) and research (evaluation of the supportive care and the quality of patients lives).
Some numbers: more than 1,000 patients and families received 20 shows of music and storytelling in their rooms, over 200 people received collective and individual sessions (aesthetic, relaxation therapy, art therapy, writing workshop) and a pilot study evaluating of the well-being of patients treated with chemotherapy was conducted with a team of oncologists in Victor Hugo Le Mans [April 2014-January 2015].
I’m delighted to participate to HIMSS because it will allow me to connect with people who share the same dream as me: make health policy move forward for the benefit of patients and citizens. It will also be the opportunity to meet other walkers of the Walking Gallery and that is something very meaningful for me.
Whether we live in France or in the United States, thanks to our experiences as patients, supporters, and careers, we can improve our health and I deeply believe that it is by being together we can make a real and concrete impact ! I also will be happy to show Bliss, our 3D social network, to professionals. Maybe one day Bliss will be available in the US?
Finally, six years after the first idea of The Butterfly Effect, I’m very happy and honoured to come to Chicago to live this experience and to share it all over the world.
Thank you for the generous scholarship to attend HIMSS as a patient and family advocate. My overall goal for attendance is to deepen my knowledge about HIM and current trends. It is also most important for me to understand the gap between what hospitals and healthcare companies provide for EHR / EMR and HIT support to patients, such as what patients receive via patient portals vs. what we need, which is fuller access to our chart’s medical history, test results, and even the chance to review notes and visit summaries about us. Why is it so hard for us to get our own data? And why is our data not fully portable?
As the mom case manager to Jameson, a young adult with complex congenital heart disease, we need all of his data, both to make informed decisions and also to help him become knowledgeable about his medical situation. Along with most parents of children with special healthcare needs, we share the larger mission to raise young adults who are as health confident and as medically independent as possible. For most of my son’s life I’ve had no other choice but to collect and track his data on my own. I’d like to know how to help hospitals to better engage with us, to serve us and to meet our needs as key customers, by fully understanding our experience and the role we play in managing our own and our family’s healthcare.
Another problem I’ve experienced is that HIPAA rules are often applied unevenly, leading to yet another barrier that inhibits my ability to partner with and teach my son. These challenges only strength my resolve to find new and innovative ways to break down the silos between us and open the path to access our health information.
I’m very much looking forward to attending and absorbing all I can at HIMSS, not only to further my own learning but to inform my advocacy work. I’m happy to share my perspective on HIMSS15 by blogging or writing about the event; I also hope to present to other parents in my advocacy networks back at home. Perhaps most importantly, as a HIMSS first-timer who has been repeatedly warned by seasoned past attendees, I already have my comfortable shoes at the ready!
March 4, 2015InterviewsComments Off on HIStalk Interviews Frank Nydam, Senior Director of Healthcare Solutions, VMware
Frank Nydam is senior director of healthcare solutions in the office of the CTO of VMware.
Tell me about yourself and the company.
I’ve been with the company for just over 12 years. The last seven have been dedicated to our healthcare provider market. My team and I develop solutions along with our customers and ISV clinical application partners to help healthcare make that jump from yesteryear to tomorrow.
CIOs have to deal with infrastructure issues such as security, mobility, and cloud computing. What worries CIOs the most?
Top of mind in the last couple weeks has been security. I’d like to touch on that, but prior to that, it’s the overwhelming complexity that healthcare CIOs are dealing with.
If you think about the last 20 years of the applications and the infrastructure they needed to build to support the hospital, they still need to support that infrastructure and application set today, yet some of those technologies are pretty old and brittle. If you look at some of the new services, EMRs, and new mobile services, it’s almost a collision between the old world and the new world. That’s on top of their mind. That’s a lot of complexity to try to fit those two worlds together.
Number two is definitely security. With the recent breaches out there, I’ve had several CIOs say to me that the only thing the board would like to talk to them about is keeping their names out of the paper. That is definitely a big issue now. Obviously with so much complexity, it’s very hard to secure assets like that. That’s been our main talking point when I’ve been on the road meeting with our customers.
Everybody was worried about external hacking against their domains, but the big problem seems to be phishing attacks used to steal administrator credentials. Do any solutions look promising for that problem?
A good analogy would be that if you look at a hard-boiled egg, it’s very secure on the perimeter. It’s got a hard shell. If you look at healthcare security, we do a good job of securing the perimeter of the hospital from intrusions. But once somebody gets in and breaks through that proverbial egg, they have the full run of the infrastructure. Once they’re in, they can start snooping around, picking up passwords, data, what have you.
We have been focused on what happens once you get through that perimeter security. We purchased a company just about two years ago called Nicira. It was a startup out of Stanford. Our goal here is to do for networking what VMware has done to the compute side, to provide policy-based network services. Not at just at the perimeter, but for every workload, and make it really intelligent that regardless of the location of that virtual machine, it’s always protected by that security policy. It can only ever talk to its web server or its client.
We feel that’s going to help what we call the east-west communications. Going back to the egg analogy, if somebody does get through the perimeter, how are we going to protect the inside of that? We’re bullish on that. It’s a solution we have been working with in our enterprise customers. We’re trying to bring that into the healthcare industry right now.
Maybe hackers are using phishing attacks because perimeter security is working and they had to look for other weaknesses. Could there be a virtual firewall for the desktop since you have control of each VMware session and also AirWatch for mobile sessions? Can you protect users similarly to the way firewalls and antivirus software work?
Absolutely. If you walk through that from a virtual desktop perspective, we created a solution called AlwaysOn Point of Care. Right off the bat, the patient records never leave the data center. We present that desktop out to the clinician, whether it’s on a mobile device, on a desktop, what have you. That first step of security is not even having the patient records outside the perimeter.
You hit it on the head. Our product called NSX provides a distributed firewall in every single ESX server that’s out there. Whether it’s a VDI desktop, a server application, what have you, we put a virtual firewall around that device, around that application. If you think about trying to do that in the physical world, it would be nearly impossible to put a physical firewall in front of every single desktop device and application out there. It’s physically impossible as well as financially impossible. That’s one of the benefits and disruptions of our technology, that ability to have a firewall in front of everything and protect it. A term out there that’s emerging for that would be called micro-segmentation.
It’s been just over a year since VMware acquired AirWatch. What are hospitals doing with it?
If you look at healthcare, there’s not only an external generational issue with patient population, but it’s internal as well. The younger physicians want that same experience that they have outside the hospital inside the hospital. Call it BOD, call it what you wish. AirWatch allows us to provide that consumer-like experience to that physician so they can take their patient records home with them and work from home. We often get, “It’s really changed my family life because I can start doing charting from home rather than being inside the hospital. It has really been a revolution for us.”
But we’re just scratching what we’re going to be able to do with the AirWatch product. If you think about higher-level features, imagine geo-fencing to be able to contextually say, the doctor is outside of the hospital, they’re at home, they want to do e-prescribing. Let’s enforce two-factor authentication so they can do e-prescribing. But if they’re inside the hospital on that specific network on that specific device, let’s make it easier for the physician to do their job and take some clicks out of that workflow.
We feel that’s that next stage. We’re calling it the next-generation clinical workspace. How do we move from the technology of 20 years ago and give that physician that workspace, that device, regardless of their location application, to get their job done?
Is a point coming where hospitals can get away from running physical data centers and managing servers and infrastructure and get back to their core mission of using rather than maintaining technology?
Absolutely. We believe it’s going to be a hybrid world, meaning that we’re going to see hospitals continue to hold on to some of their infrastructure and applications where they feel its core value to the hospital. They’ll run that on-premise in a private cloud.
But for applications that no longer fit the mission but are required for the hospital to run, we’re starting to see those applications move out to a hybrid cloud. In our world, we want that private cloud and public cloud to be connected, and that’s what we call hybrid.
Probably the biggest use case we see for hospitals right now is something we’re calling legacy decommissioning. If you think about all the mergers and acquisitions that are going on in healthcare today, hospitals are saddled with a lot of old data and old applications that may not be core to their mission any longer, but they need to take it forward for merger acquisition or for read-only. We’re allowing our customers to decommission that legacy data and those applications to a cloud that looks, feels, smells, has all the security of their private cloud, yet it sits in a VMware vCloud — what we call VMware vCloud Air. We believe that’s a great first step for a lot of these hospitals who may be wary of putting PHI in the cloud or older applications or even newer applications. That has been a big hit for us.
In medicine it’s not that we don’t have enough medical experts, they’re just not spread out equally, so Boston has a lot and North Dakota doesn’t. The same is true with technology support talent, where small, rural hospitals don’t have the same technical resources. Will a move to cloud access better distribute the technical expertise needed to keep applications running?
That’s absolutely correct. I’m personally passionate about rural healthcare. I think it’s something we as an industry need to keep an eye on, making sure that these rural community hospitals, physicians, and caregivers are getting access to the right data, new applications, what have you. The ability to run some of this in the cloud and let a developer that’s really good at MUMPS in Boston support a physician or a small community practice of North Dakota — that’s a perfect use case for helping retain our rural community healthcare centers.
It’s almost like a democratization of healthcare IT talent in the same way that you can be a C++ developer sitting in Germany working for an American company. We need to bring the same type of democratization of skill sets into healthcare.
What are small and medium community health systems doing with the cloud?
It’s funny — there’s been so much “cloud washing” over the last five or 10 years that we had found ourselves stopping using the word “cloud.” I’ve seen some CIOs actually putting in a spam filter that says any email with the word "cloud," send it to the junk bin.
We took a different approach. We sat back with our customers and focus groups and said, at the end of the day, what are you trying to get out of that? What’s the outcome you’re trying to get from going to a cloud? They came back to us with about eight outcomes that any cloud should provide. That allowed us and our customers to focus on the outcome they’re trying to get rather than this fluffy computing term called cloud.
We built a framework called vCloud for Healthcare that defines the outcomes that a hospital can consume, whether they be application delivery services like virtual desktop or AirWatch to analytical, financial, and continuity services. That has allowed the smaller hospitals to consume and find value out of it quicker. Because again, there has been so much cloud washing that some vendors were walking and saying, “We can do anything with the cloud.” It was slowing down progress and innovation. Defining the outcomes and not being too concerned about the big fluffy name has helped us move along.
I’ll give you a great example. I had mentioned earlier legacy decommissioning. It’s a great opportunity for a small community hospital to see and feel what it looks like to use the same tools that they use internally and externally and relieve some pressure — regulatory pressure, data center pressure, and financial pressure. You hit it on the head — there is a big disparity between larger IDNs and academic research centers versus the community hospitals. This has really helped them.
Do you have any final thoughts?
When I started here, we were about a 300-person company. We’re about a 17,000-person company now. It has been quite a journey over the last seven years focusing on a specific customer set. I have been able to attract some of the most passionate and talented healthcare IT professionals. I have former CIOs, CEOs across the country, and heck, some folks even have patents out there in smart room technology.
This has been not only rewarding personally and professionally, but I’d like to look back on my career to be able to say we’ve left healthcare with something positive. Not from a sales perspective or a revenue perspective, but that we can look back five or 10 years from now and say we made healthcare a little bit better for you, my family, what have you. Some would say that’s a pretty idealistic view of the world, but it’s a great way to get up every day and help our customers. I just am so jazzed about the future of what we’re going to be able to do.
We need to help healthcare IT industrialize itself. For too long it’s been a piecemeal of this part and that part. I’m excited about how we can help healthcare industrialize, to make them look, feel, and act a little bit more like financial services so they can go innovate.
I do a lot of traveling and I see a lot of frustration out there among customers just trying to keep the lights on all day. We’ve got to get you guys away from just keeping the lights on and get back to your day job so you can innovate. That’s what gets me going in the morning.
Comments Off on HIStalk Interviews Frank Nydam, Senior Director of Healthcare Solutions, VMware
Reuters reports that Truven Health Analytics is preparing for an IPO that will value the company at $3 billion. Truven was acquired by Veritas Capital Fund Management in 2012 for $1.25 billion.
The OIG investigates the VA Chief Business Office, concluding that it violated appropriations laws when it spent $92 million on a new IT system from a fund that was only authorized to cover medical, construction, supply, and research costs.
Nina Pham, the Texas Health Resources nurse that contracted Ebola while treating a patient last fall, is suing her former employer, claiming that a lack of training, established policies, and proper equipment led to her exposure.
The Wall Street Journal compares four hospital ranking sites (US News & World Report, Consumer Reports, Leapfrog Group, and Healthgrades) and finds that there is virtually no consensus among the lists. 27 percent of the hospitals listed among the nation’s best were rated among the nation’s worst on one of the other lists.
Reuters reports that Truven Health Analytics is planning an IPO that will value the company at $3 billion. Veritas Capital Fund Management LLC bought the company from Thomson Reuters in 2012 for $1.25 billion.
Reader Comments
From DejaVuAllOverAgain: “Re: Leidos Health. Laid off over 50 people last Friday, the third round of layoffs since Q3 2014. SAIC bought two $400M consulting companies (Vitalize Consulting and maxIT Healthcare) thinking they’d get $800M annually. Revenues now less than $300M. The typical acquisition story.” Unverified.
From LL Cool J: “Re: Allscripts and NantHealth partnership = desperate.” The wordy announcement wasn’t very clear on who’s doing what, but NantHealth seems to be signing up a bunch of partners and Patrick Soon-Shiong is drawn to TV cameras like a mosquito to a bug zapper.
From RutRoh: “Re: CareCloud. It was announced at the CloudUp corporate meeting that CEO Albert Santalo has been asked to step down.” Unverified. He’s still listed on the executive page and I assume that even if the rumor is true that he’ll remain as board chair. Update: CareCloud says Santalo will remain chairman and CEO but will be focusing his time over the next several months on advancing products, with emphasis on optimizing operations for larger practices.
From Dysf(n): “Re: microbiology interfaces. CAP Today puts out an annual review of laboratory middleware. New version is due in June 2015, I think. Here’s last year’s in PDF format. Data Innovations is in there, along with another six or seven. If that doesn’t cover the specific instruments / systems you’re looking to integrate, it may be a good start — search elsewhere through CAP Today online.”
HIStalk Announcements and Requests
Here’s a fun fact that everybody who orders HIMSS-related giveaways already knows: China-based manufacturing shuts down for two weeks each February for Chinese New Year. Last year we had to settle for inferior quality lapel pins because the factories where the good ones are made were closed.
Divurgent is offering all HIStalk readers the chance to attend summitHIT15 in Chicago’s best rooftop lounge on the 27th floor of theWit hotel on Sunday, April 12. RSVP here.
Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.
Webinars
March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.
March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Acquisitions, Funding, Business, and Stock
Becton Dickinson acquires CRISI Medical Systems, with which it co-developed a wireless, EHR-integrated electronic checking system for drug identification, dose, and allergies for drugs given by IV push.
Sales
Memorial Sloan Kettering Cancer Center will use PeraHealth’s Rothman Index health scoring system throughout its system to provide an early warning for patients whose conditions are deteriorating.
Cornerstone Health Enablement Strategic Solutions (NC) chooses Lightbeam Health Solutions for population health management.
People
T-System names Janie Schumaker, RN, MBA (Heartland Regional Medical Center) as chief nursing officer.
Rick Toren (Qpid) joins healthcare analytics vendor Atigeo as president of its healthcare division.
Announcements and Implementations
ScImage updates its PICOM365 systems to support the new ASA 2015 echocardiography cardiac chamber standards that were released in January.
NantHealth and Allscripts announce their collaboration on development of precision medicine solutions for cancer patients.
Spectrum Equity makes an unspecified investment in healthcare database vendor Definitive Healthcare.
Government and Politics
A Connecticut bill would require insurance-related companies to encrypt consumer information, introduced in response to the Anthem breach by politicians who clearly don’t understand that encryption is rendered instantly worthless once hackers obtain administrator account information by phishing (as they did in Anthem’s case).
The VA’s Office of Inspector General finds that the VA’s chief business office knowingly violated appropriations law by using $93 million in medical support and compliance money to help pay for development of a claims processing system to avoid going through the VA’s IT process.
Privacy and Security
ProPublica plans another article in its series about medical privacy and invites readers to contribute stories about problems they’ve had.
The New York Times runs pro-con arguments about genetic testing data. Negative arguments: drug companies are paying 23andMe big money to get their hands on test results, genetic testing is a minor disease predictor compared to lifestyle choices, DNA information could be hacked for manipulating crime scenes or medical records, and laws against genetic discrimination need to be strengthened. Positive arguments: shared data speeds up healthcare research, technology can protect the data, companies making millions from selling data should buy insurance of $500,000 per user since they claim the breach likelihood is low and if that’s true the insurance should be inexpensive.
Patient information in Minnesota’s doctor shopper prescription database was accessed hundreds of times by a former insurance company nurse after the state forgot to revoke his credentials when he was reassigned. The nurse was previously disciplined by the state nursing board after admitting to stealing narcotics from two hospitals, a fact the state says they were unaware of even though his record is in a public database. He still works for Blue Cross Blue Shield.
Technology
Antivirus maker AVG debuts prototype infrared LED privacy-protecting glasses that prevent facial recognition systems from identifying their wearer. The company says “invisibility glasses” are a valuable privacy tool because candid smartphone photos are often posted to Facebook, Google’s StreetView puts identities in the public domain, and Facebook’s DeepFace can match up different photos of the same person with human-like accuracy of greater than 97 percent.
Other
Texas Health Resources nurse Nina Pham, who contracted Ebola in the Thomas Duncan case, sues her employer for negligence, claiming lack of training and violations of her privacy that made her “a symbol of corporate neglect – a casualty of a hospital system’s failure to prepare for a known and impending medical crisis.” She says she told THR not to release information about her when she was hospitalized, but a doctor recorded her on video using a GoPro body-worn camera and released it publicly, with her attorney claiming THR “used Nina as a PR pawn.” She also claims THR announced her condition as “good” while simultaneously counseling her on end-of-life decisions as documented in the EHR. Her attorney has a history of successfully suing THR and other hospitals for her $750 per hour fee and has hit defendants with $675 million worth of settlements and verdicts in the past five years.
Named to the Forbes list of 2015 billionaires from healthcare IT are Patrick Soon-Shiong of NantHealth (#96, $12.2 billion, although he made his money from pharma), Judy Faulkner of Epic (#663, $2.8 billion), Neal Patterson of Cerner (#1006, $1.9 billion), and Cliff Illig of Cerner (#1605, $1.2 billion). The list omitted Terry Ragon of InterSystems, who should be worth about the same as Patterson and Illig based on previous reports. Elizabeth Holmes, founder of lab provider Theranos. is the youngest self-made woman at 31 years old (#360, $4.5 billion). Your best chance by far of being one of the world’s richest people is inheriting $40 billion each in Walmart money as did the four Waltons who hold spots in the top 12.
A note to PR people: they say there’s no such thing as bad publicity, but that might not hold true when a press release misspells the company’s name.
Chuck Denham, MD, the former co-chair of a National Quality Forum patient safety panel charged with taking $11 million in CareFusion bribes to have its product added to national standards, settles with the Department of Justice for $1 million. At least he sold his integrity for a great price, netting $10 million after expenses. Meanwhile, briber CareFusion settled last year for $40 million and it’s still a $12 billion market cap company whose shares have risen 50 percent in the past year. Anyone who says crime doesn’t pay needs to get into healthcare.
A Wall St. Journal article titled “The Next Marketing Frontier: Your Medical Records” highlights the alerts and reminders sent to patients in Practice Fusion’s EHRs, with some of those messages paid for by drug companies. Practice Fusion’s CEO defends the practice, saying that with regard to the alerts and presumably the company’s free EHR, “someone has to pay for it” and adds that new agreements have been signed to deliver sponsored alerts from Aetna and another drug company. He also states, “For every project we do that drives forth public health or gives data away, we need to make sure it’s balanced out by a monetizable exercise.”
The Wall Street Journal highlights a Health Affairs-published study that found major inconsistencies in the “best hospitals” lists published by four sources (US News & World Report, Consumer Reports, Leapfrog Group, and Healthgrades). Only 10 percent of the hospitals that were highest rated by one service received an equally high ranking from even one of the other three, while 27 hospitals that were named among the nation’s best by one service were named as among the worst by another (UCLA’s Ronald Reagan Medical Center being an obvious example). Lead author Peter Pronovost, MD, PhD says just about every hospital tops somebody’s list and urges better methods “so it isn’t just a beauty pageant.”
Sponsor Updates
Impact Advisors publishes a white paper titled “Selecting a Population Health Management Vendor: Taming the Wave.”
PatientSafe Solutions posts “Quality care and Mobility: Case 2.”
Caradigm is participating in the iHT2 CHIME & Health IT Summit through March 4 in San Francisco.
Aventura and Bottomline Technologies are exhibiting at the Spring Hospital and HealthCare IT Conference through March 4 in Orlando.
CareTech will host the New England HIMSS & Social Networking event March 10 in Warwick, RI.
AirStrip writes about “Bringing Up Baby: the Value of Remote Monitoring for High-Risk Pregnancies.”
CMS publishes a report measuring progress made on quality measures since 2006, finding that improvements have been made in 95 percent of the 119 publicly reported performance measures reviewed.
Allscripts and NantHealth will partner to develop genome-based clinical decision support features within Allscripts’ EHR that will help oncologists create personalized cancer treatment plans.
AMA applauds CMS’s decision to extend the MU attestation deadline for eligible providers, but complains that even with the extension the program is too rigid and still needs to be overhauled.
I received an email from ONC on Thursday that they were extending the deadline for nominations to the HIMSS Interoperability Showcase, citing “feedback that organizations needed more time to submit nominations for participation.” From the time the email arrived, that’s a whopping three business days until the deadline. It made me wonder exactly why the deadline was extended and what their current applicant pool looks like. If they were delaying because they didn’t have many applicants, then they hardly gave much of a window for organizations that weren’t already prepared. Was the announcement a way to raise awareness about the Showcase rather than being designed truly to solicit participants?
Perhaps organizations didn’t apply because they didn’t want to spend $8,000 to participate. That’s just for the kiosk at the Showcase, which includes a monitor, keyboard, mouse, power, and Internet connectivity as well as two exhibitor badges. Travel, meals, and lodging will be on top of that. We’re doing some cool things with interoperability at my health system, but they’re not about to spend upwards of $12K for developers to go show it off at HIMSS.
Whatever the reason, I can’t help but think about the ongoing list of government initiatives that have to be delayed, extended, or otherwise modified because they don’t seem to be achieving the desired results. Being a process improvement person, I’m always looking for the root cause when outcomes are not achieved or when projects run off the rails. Recently, we’ve had delays in ICD-10, Meaningful Use, and Healthcare.gov. Some of us, however, remember delays in the implementation of the 5010 claim standard and those of us deep in the weeds know about dozens of lesser-known parts of HIPAA and other omnibus legislation that are virtually unimplementable.
In medicine, we have a doctrine about ordering laboratory and diagnostic tests: don’t order it if it’s not going to change your plan for the patient. I do a lot of work with reporting from our EHR data and we have a similar dictum: don’t run the report if you’re not equipped to act on it. You’d think there would be a similar mantra about not making rules that people can’t actually follow, but that doesn’t seem to be a factor for those happily engaged in rulemaking. Only in healthcare do we come up with creatures like the “Two Midnight” rule and other similar nonsense.
My extended family is always asking about some of the wacky things that go on, such as provider-based billing, which allows hospital-owned practices to charge both a professional fee and a facility fee for outpatient visits. I’ve become as expert at explaining the Medicare Part D “donut hole” as I am at teaching patients to use a home blood glucose monitor. In trying to find some method to the madness, I stumbled on an article that attempts to explain why healthcare regulation is so complex. The first paragraph opens with a perfect summary: “Health care professionals may feel that they spend more time complying with the rules that direct their work than actually doing the work itself.”
The author contends that “regulation arises largely from a set of confrontations between opposing interests that created the system.” I agree that there are clashing agendas and learned that first hand as a young physician when the hospital’s chief of staff wanted to know why he wasn’t getting my referrals. It felt more than a little like a shakedown. He wasn’t aware that I sent nearly all of my referrals in his specialty to one of his partners, so at least his practice was seeing volume if he wasn’t personally. It didn’t matter, though, since it was apparently all about his ego. These conflicting agendas are ongoing, and “Doctored: The Disillusionment of an American Physician” talks about one physician’s struggle.
Although there are certainly turf wars at play, the regulatory soup includes rulemaking at so many levels that it’s nearly impossible to keep track of what needs to be done. I have to follow the rules of multiple hospital medical staff organizations, two state licensing boards, two specialty certification boards, one professional society, dozens of payers, the city, the county, the state, and the federal government. These rules (and non-rules that often have the force of law) sometimes conflict each other and often fail to make sense.
Several times in the last few decades, studies have looked at everything a primary care physician should be doing for his or her patients and how long that would take. An article in the Washington Post summarized the most recent data from the Annals of Family Medicine, which found that for a typical panel of 2,300 patients, the physician would have to spend nearly 22 hours a day to provide all the recommended care. That’s just delivering the care itself – it doesn’t factor in the time needed to comply with everything else a physician does such as arguing with payers, managing staff, dealing with regulations, worrying about compliance with programs, and trying to stay current with medical knowledge.
That’s what we’re dealing with in the ambulatory setting. Hospitals and health systems deal with many more rules and countless regulatory bodies. Similarly their IT departments are trying to keep the systems up and running, prevent breaches, avoid breaking something that’s required for Meaningful Use, and so on. It’s no surprise that people are not coming out of the woodwork to sign up for the Interoperability Showcase.
What regulations keep you hamster wheel spinning? Email me.
We’ve been around since 1996. The vision of the company is that providers should be in charge of how healthcare is delivered, and for them to be in charge, they have to be at risk financially. Our job is to help provider organizations decide on the level of risk, help them figure out how to organize around the risk, and then manage the risk.
We have products around analytics. We operate all the way to a provider-sponsored health plan. We manage those things, so we pay claims, we do care management, customer service … all the functions you would do to run a health plan. It’s moving groups through the value-based care spectrum to any level of risk that they want to be.
How do you think HHS’s seemingly ambitious goals in moving quickly toward value-based payment will go?
I think it’s good. The general issue for us has been that their approach to doing training wheels was a problem. The old version of the shared savings models — we don’t think they were good enough or strong enough. They tried getting into risk, but what’s happened is those organizations – from funding it and actually operating — are finding they are not being successful, most of them, and they just need to assume more risk. We would like to see more risk in those rather than less risk. We think the moves that they’re making now make a lot more sense.
Insurance companies and doctors have always been blamed for healthcare costs, but people are recognizing that hospitals and their increasing clout in driving favorable contract terms are a lot of the problem. Do you see HHS or CMS addressing the cost role of hospitals?
It’s interesting because the hospitals can play a major role in this if they do it right. You’re right that if they get market share, they certainly can drive pricing from that perspective. But I think if you get into more risk, where you’re actually getting a PM/PM amount, the hospitals are a large part of the cost and they’re going to be the organizers.
Hospitals should play a major role, but it’s not on a fee-for-service basis. They’re the ones who can organize the doctors and pull together an organization that can assume the risk, so I see hospitals having a major role. The market share issue is an important one, but if you’re getting into competitive PM/PM insurance-type rates, that’s where you need to go with this.
Back in the HMO days and attempts at moving to a capitated model, assembling risk pools that made actuarial sense was also politically awkward because you had to decide who you could afford to cover. If you’re a hospital and you’re trying to figure out the steps toward accepting risk, how do you define and measure your risk for the population that you have?
We still have conversations with some insurance companies that are saying, I get a PM/PM and I want the healthy people, I don’t want the sick people. I think that’s what you’re getting at. From a risk entity perspective, as provider groups get into risk, the population that really needs to be taken care of are those more expensive people.
What we need to do is make sure that the PM/PM that we’re getting for that population is the right PM/PM. That was a problem in the old models. You had in a market where say the commercial PM/PM was $200 and you had an academic medical center taking in a population and got adverse selection, their cost might have been $300 PM/PM. We need to make sure that for the population that you’re responsible for, we’re looking at the dollars that are being spent on that population, then managing for that as compared to the old insurance model. That’s an important element of this.
Nobody wants the high-cost patients, but it’s not usually acceptable to charge those patients more. How many ways can the buck be passed?
Somebody is paying for it now, right? Those people are getting coverage, or they’re not getting coverage and they’re just using the ERs and hospitals to get their care. It’s recognition of that population and making sure that they have coverage. There’s great opportunity to manage that population better than it’s being managed now and the overall dollars will go down.
You just need to make sure you tie the actual expense for an individual, so if X-person costs $1,000 PM/PM, that should be the basis for the risk of that particular patient or that particular population. You need to tie the cost of the person to the actual risk that you take, or the cost of the population to the risk that you take, as compared to saying, “The overall population is $200 PM/PM, so let me try to get all the people that are $100 and leave the $300 people out.”
Somewhere, that $300 person is getting healthcare. We just have to do a much better job of making sure that the dollars that we’re spending per person is where you take on the risk for that population at that dollar base.
As health systems and insurance companies start looking more alike, what technologies and information do each have that the other needs?
From a health system perspective, very few have the technology and the information to actually manage the population. A hospital has its information and each individual physician may have his or her information. The hard part has been aggregating the data for a population.
If you take any given market, you probably have some physicians that are employed by a hospital, you have independent physicians … they all have different EMRs and different practice management systems. One of the keys is data aggregation. Maybe 10 years from now it will be different, but right now the key is tying all those systems together into one platform. It sounds like an HIE, but it’s the analytics behind that data that becomes important. There’s got to be ways of collecting that data from everybody and then doing the analytics around that. It’s the pharmacy data, it’s the lab data. There may be 300 different practices that may have 70 different practice management systems and EMRs.
You’ve got to be able to tie that data together to do the analytics. To me, that’s the biggest gap that exists today — pulling that data together, figuring out what it’s actually costing for that population, and managing that data to manage the care better for that population.
What health system metrics will be important to monitor for long-term success?
Today they’re focused on a patient entering their system and how they manage that patient who’s sick. They have to move to a higher level of managing the population as a whole. They’ve got to get a whole different level of data.
Once you’re within a system and you’ve determined how care should be provided for that population, you now have to determine if the services that are needed are actually getting done within that village. If you have multiple health systems in a marketplace, which is usually the case, how do you make sure that the services are all getting done, especially if people leave the system? The physicians in that particular organization have agreed on how care should be provided. You need to push those services to within that organization and make sure that you’re tracking it and making sure things are getting done.
If a diabetic is supposed to get an eye exam, we need to make sure that the eye exam is done by the ophthalmologist that’s in the network and not outside the network, because if it’s done outside the network, we probably don’t have that information. It gets back to the data aggregation piece and managing the population as a whole.
Explain what “narrow network” means.
I think of it as a village of hospitals and physicians that have come together to agree on how care should be provided and agree on the level of risk that they’re going to take. Do they become a health plan, do they just do risk contracting with health plans, do they do a combination of things? It’s that organization that’s made that decision and then it’s got it technology that it needs to manage that in its operation.
What’s really important is that you don’t separate the technology from the operations. There are a lot of smaller technology firms or single-source technology firms that are doing one piece of this thing. But there really needs to be an overarching perspective on how the technology relates to the actual performance on these risk contracts. There’s operational pieces, there’s technology pieces, and then there’s just network development pieces.
For people on the IT side, the biggest thing is around data aggregation, the management of that data overall, and how that helps the operational people succeed in making sure that you’re caring for that population as best you can so you’re managing that population and the best quality of care is given at the lowest possible cost. Getting that information that’s not just from the hospital, but from these other independent sources, and getting it on a daily basis so that you can track what’s actually going on and manage the population going forward and helping your physicians and their practices figure out what needs to happen in the next six months with a population of people.
Do you have any final thoughts?
The main thing to me, and one of the things that I hear in the marketplace, is that as a health system doing this, you have to be really big. I don’t think that’s the case at all. There is a certain life threshold that you need to manage and there’s no question about that, but that life threshold doesn’t require you to be a mammoth system at all.
Groups, provider organizations coming together to cover a state is certainly an approach to do this, but again, I don’t think you need to be a 5,000-bed system in a particular marketplace. You don’t want to be a 50-bed hospital. There’s a certain size that you need to be to do this, but it’s not huge.
The level of risk for a provider assuming risk is very different than the level of risk for an insurance company to assume risk. If you’re UnitedHealthcare and you have a patient in a hospital and that patient cost $50,000, UnitedHealthcare has a direct expense of $50,000 for that patient. Now you take a health system that has that same patient in their hospital, what does it actually cost that health system to provide care for that patient? Eighty percent of the costs in a hospital are fixed. It’s much less costly for them to assume that risk as long as the care stays within that network. If it leaves the network, they have the same situation as United has. But as long as they stay within the network, it is much less risk for a health system to assume risk.
Another way to say that would be, if you’re a billion-dollar health system and I told the CFO tomorrow they were going to get a billion dollars in revenues next year, would they assume that’s more risk or less risk? I would say that everyone would say that it’s less risk. That’s full capitation from that standpoint. The concept of risk on the provider side is much less risky.
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Oracle escalates its legal battles with Oregon over the failed insurance exchange it was hired to develop by filing personal lawsuits against five Oregon campaign advisors to the state’s former governor, saying that they worked behind the scenes to kill the site for political reasons.
Allscripts CEO Paul Black acknowledges that the company is disappointed in its year-long revenue, citing lower patient portal sales and overall client fatigue driven by MU as primary reasons for sluggish sales.
Banner and the University of Arizona Health Network complete their merger. No decision has been made over whether UA will be allowed to keep their brand new $100 million Epic system, which experienced go-live delays and cost over-runs, or if they will be migrated onto Banner’s Cerner system.
A patient’s spouse writes an open letter calling out Rideout Health (CA) CEO Robert Chason for publically claiming that a recent EHR system failure did not result in patient harm. In the letter, a spouse states that his wife was treated at Rideout during the unplanned downtime and was sent home because test results indicating that she had a minor heart attack did not make it back to her cardiologist until two weeks after she was discharged. Hospital representatives contacted her to schedule additional tests and told her that the delay was caused by the EHR system crash.
Oregon and Oracle keep suing each other over the state’s health insurance exchange and its Medicaid system, but now Oracle takes things to another legal level as it files personal lawsuits against five staff and campaign organizers of former Governor John Kitzhaber, who Oracle warns may also find himself sued shortly. Oracle says the five were politically motivated in trying to shut down Cover Oregon and then blamed Oracle as a smokescreen.
Reader Comments
From Lab Retriever: “Re: microbiology interfaces. I’m looking for something that will interface with our three blood culture instruments – Bactec, VersaTrek, and BacT/Alert – to get the data into our LIS.” My first thought was Data Innovations, just acquired by Roper Industries and paired up with Sunquest, but I’ll invite more knowledgeable readers to offer their suggestions.
From Maple HIZZ: “Re: University Health Network, Toronto. Not proceeding with their HIS replacement project in which Epic was the preferred vendor due to the $600 million cost, including interest. Annual operating expenses are projected to be an additional $50 million per year even when legacy IT systems are sunset. Glad to hear that UHN decided not to write the cheque and spend taxpayer dollars wisely.” Unverified.
From Interoperability Blues: “Re: SMART project. Every vendor talks a big game about interoperability, but the public availability of C-CDA samples for each vendor is non-existent. The SMART project gathered several, but you will notice one major vendor is missing and most vendors provided only one or two. If there were thousands of C-CDAs available, the gaps would be more clear. Heck, it would even be helpful if all vendors just posted what they used to get through certification.”
HIStalk Announcements and Requests
Two-thirds of poll respondents say Epic’s App Exchange is a PR move to support its DoD bid. New poll to your right or here: is a health system CIO’s article or presentation always more believable than that of a vendor VP? Surely your vote deserves clarifying comments (which you are welcome to add).
Attention HIStalk sponsors: we’ve made contacts about attending the sponsor networking reception event Sunday evening of HIMSS week in Chicago, but have received few RSVPs. Contact Lorre if you want to meet your industry peers and enjoy great food and drinks. Otherwise, I may just start inviting random readers since I’m stuck paying the facility’s minimum anyway.
Our five patient advocate scholarship winners (along with Regina Holliday) have run into a HIMSS snag. They had anticipated that Chicago hotels would be expensive and planned to share a room to minimize cost, but they are now finding that availability is nearly non-existent. Let me know if you have ideas of a place that would be available for at least Sunday and Monday nights – I’m thinking perhaps someone’s occasionally rented apartment. They are even exploring couch-surfing options, so they could use some help. We’re checking VRBO and Airbnb.
I swear I’m going to throw up the next time some inspiration-impaired “thought leader” tries to draw parallels between anything healthcare-related and Uber. Or for that matter, who can’t come up with anything more original than drawing strained healthcare inferences from the death of Leonard Nimoy or something else they saw on TV. As Mark Twain said, “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.”
I say a lot of good things about Walgreens, but here’s a first-person “fail” experience. I had to switch pharmacies because of an insurance change and was initially thrilled at the apparent ease of transferring prescriptions to their store using its cool-looking app. Upon my first attempt at getting the prescription filled, it wasn’t on file there when I called for some reason, so I made another request via the app – it looked successful and the app told me to pick up the prescription any time after 2:00. I showed up at around 2:45 and the pharmacist on duty got snotty, saying he had been too busy to call the other pharmacy, that “the computer doesn’t work back here” in flatly declaring that the stated 2:00 time wasn’t his problem and he’d get around to it whenever he could because he was backed up with both in-store and telephone to-do items. He then suggested going back to the competitor’s pharmacy and paying cash since it would be faster. The pharmacist promised to call me when the prescription was ready – it’s now 24 hours later and nobody has called, but I drove to the store and it was ready. Lesson one: it takes only one unpleasant personal experience to wipe out a lot of corporate-level goodwill. Lesson two: the technology isn’t impressive when the people aren’t (I bet the store cuts staffing to the bone since he seemed to alone behind the counter). Lesson three: shop around (as I did) before buying electronic items at Walgreens since the Sony earbuds I was about to pick up for $20 were only $12.99 on Amazon and even better ones were just $5.99.
Last Week’s Most Interesting News
CMS reports that it correctly processed 81 percent of ICD-10 claims in its most recent testing round and says it is ready for the switch.
Merge Healthcare acquires DR Systems.
New York’s mandatory electronic prescribing date of March 27, 2015 will likely be delayed for a year, with only the governor’s signature remaining to make it official.
The FBI says it is close to identifying those responsible for Anthem’s breach.
Cerner offers voluntary separation to its older employees.
CTG says its services business is suffering as the EMR market cools.
A study finds that Googling medical terms sends personal information to third party websites 91 percent of the time.
A delayed $670 million EHR implementation in British Columbia involving IBM, Deloitte, and Cerner is rumored to be headed toward arbitration.
Webinars
March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.
March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
CEO Paul Black says Q4 sales were down due to lower patient portal sales driven by Meaningful Use Stage 2 timing.
Black says the company is disappointed both with its year-long revenue as well as the unrealistic Wall Street expectations the company allowed to be created.
The company will collaborate with MaineHealth on population health management projects.
Allscripts says that Meaningful Use Stage 2-required upgrades have caused client fatigue, with many of those clients deferring other upgrades.
When asked about the “barbell” effect in which Allscripts ambulatory clients either love or hate their products, Black says the company is offering them everything they need to manage populations and accept risk and that attrition won’t have a huge impact.
Black says the company loses clients to acquisition-related system replacements or a missed deliverables, but the list of reasons it loses a customer is a lot shorter now than than when he was hired two years ago.
Black said of the performance of the company’s professional services work, “Nobody’s pleased with it and we do still have some work to do. We’ve changed some of the talent that’s managing that organization.”
The company quoted KLAS numbers indicating that 453 provider organizations will buy acute care systems in 2015 and that Sunrise is “overlooked” despite being more competitive than when he was hired.
CEO Justin Dearborn says the acquisition of DR Systems gives Merge the #1 KLAS-ranked solutions in cardiovascular information systems, hemodynamics monitoring, and radiology information systems and consolidating providers want to deal with fewer vendors.
The company believe that attention will swing back from Meaningful Use and ICD-10, releasing pent-up demand for other solutions.
Merge put the DR Systems deal together so quickly that its debt holder didn’t have time to perform due diligence and DR Systems was reluctant to share information with competitor Merge, so if the due diligence doesn’t pan out, the company will have to find alternative financing to close the deal, “which could be challenging.”
The company expects to see opportunities given that providers who are going at risk know that a significant portion of unnecessary and redundant healthcare spending is related to imaging.
People
Vanderbilt University Medical Center promotes Titus Daniels, MD, MPH to executive director of Vanderbilt Medical Group and COO for adult clinical operations at the hospital. His new responsibilities include clinical documentation and coding and EMR design, adoption, and support.
Rex Adams (Children’s Healthcare of Atlanta) joins PaySpan as CEO.
Leidos Health hires Douglas Herr (Logic Healthcare) as VP of its Epic practice.
Announcements and Implementations
ADP AdvancedMD offers the free “ICD-10 Toolkit” app.
American Family Children’s Hospital (WI) is piloting Epic’s MyChart Bedside. The tablet-powered app providers patient-caregiver communication, a scheduling display, and the display of EHR information.
Privacy and Security
Security experts at ThreatConnect say evidence from the Anthem breach suggests that a Chinese espionage group is responsible. “They made an effort to hide, but they messed up,” says one of the experts, who also implicated a Chinese university professor who works with a China-based government contractor.
Technology
HP is rumored to be close to acquiring Aruba Networks, with speculation of a Monday announcement.
Other
Central Peninsula Hospital (AK) will replace its “clunky” Meditech system with a new system from Meditech, Cerner, or Epic. They’re planning to spend $5 million to $15 million.
Texas-based for-profit hospital operator University General Health System files Chapter 11 bankruptcy, blaming poorly chosen acquisitions and unfavorable managed care contracts. The hospital’s website shows plush facilities and boasts that it provides “exceptional personalized care in a luxurious, five-star environment” and declaring that its sole hospital of 69 beds offers “private rooms, where meals are served on fine china, comfortable, flat screen televisions, oil paintings, wood accented and marble flooring all compliment the hospital room, while a baby grand piano and soothing waterfall with valet parking greet each patient and guest.” Shares are trading at $0.004, having dropped 76 percent after the announcement. The corporation is run by pain management anesthesiologist Hassan Chahadeh, MD.
Banner Health was set to take over Tucson’s University of Arizona Health Network this weekend, prepending “Banner” to UA’s existing hospital names and most likely thinking about replacing UA’s Epic system with Banner’s Cerner one. The money-losing UA spent $115 million on Epic through June 2014, of which $32 million was unbudgeted due to a go-live delay. At the time, UA said installing Epic was “the biggest operational change this organization has every undertaken,” possibly failing to foresee that just a few months later, UA’s red ink would force it to sell out to Phoenix-based Banner. Every hospital operator should want to buy an academic medical center – easily identified waste and bureaucratic incompetence fertilize a lot of low-hanging financial fruit.
A letter to the editor by a patient of Rideout Health (CA) accuses the hospital’s CEO of lying when he claimed that its recent computer downtime caused no patient harm. The man says his wife had a cardiac test whose results indicated a possible heart attack and the need for intervention, but she didn’t receive them until two weeks afterward because of the computer problems, the hospital person told her.
The local North Carolina TV station profiles the use by Vidant Health and ECU Physicians of Epic’s Canto and Haiku mobile apps to share information.
A Florida nephrologist is accused of inappropriately touching an elderly patient, who explained that he had no reason to touch her since all he does during her visits is to read her kidney function levels to her from his computer.
The State of Washington indefinitely suspends the medical license of an anesthesiologist who repeatedly sent sexually explicit text messages during surgeries, used medical images for sexual gratification, texted a nude selfie to a patient, and had sex on the job.
A posthumous Los Angeles Times editorial by reporter Laurie Becklund, who died last month of metastatic breast cancer, says to forget Susan G. Komen-type “cures” and expensive pink ribbon awareness campaigns and instead treat every patient as a one-person clinical trial and store their information in a cancer database to which both doctors and patients can contribute.
Surely this is either a hoax or massively wishful thinking: a surgeon in Italy says he’s just two years away from being able to plant a person’s head on a donor body. Somehow I don’t think insurance companies are going to pay for that.
Sponsor Updates
Zynx Health VP of Clinical Informatics Victor Lee, MD writes about “Medicare Reimbursements for Value.”
ZirMed will exhibit at the Pay for Performance Summit March 2-4 in San Francisco.
The Sandlot Solutions-powered MetroChicago HIE reaches 1 million patient records.
Tamara St. Claire, chief innovation officer for commercial healthcare at Xerox, offers a recap of the company’s recent presentation on patient engagement.
Frisbie Memorial Hospital Healthcare Project Director Sally Gallot-Reeves, RN writes about “Achieving an 82% ROI with smartphones” in the latest Voalte blog.
VitalWare President and CEO Kerry Martin will speak at the HCP Hospital and Healthcare IT Conference March 3 in Orlando.
Verisk Health creates the Idea Hub, a virtual library that collects the company’s research, solution information, and social buzz.
ZeOmega Chief Strategy Officer Nandini Rangaswamy defines population health management in the first of a blog series.
Merge reports Q4 earnings: revenue remained flat at $53 million, EPS $0.02 vs. $0.00, missing analyst’s expectations for both. The company also announced that it has acquired medical imaging vendor DR Systems for $70 million.
In Australia, the nation’s $800 million Personally Controlled e-Health Record project is still sitting unused three-years after its launch. Just 10 percent of the general public has a medical record on the system.
I literally had almost 100 people forward me news articles about the CMS announcement pushing the Medicare Meaningful Use attestation and PQRS reporting deadlines to March 20. Although no specific reason was announced, possibilities include winter weather emergencies, the fear (or reality) of attestation site glitches, the complexity of preparing reports and audit documentation, and lack of vendor readiness as possibilities. Buried below the fold of several articles was the fact that this does not impact the Medicaid Incentive Program, so I hope those practices realize they’re still on the hook for the original deadline.
The hideous cold and repeated snows pounding a good chunk of the country have put a cramp in the style of many fitness enthusiasts. Although I once had a serious dislike of treadmills in general, I’m glad that I finally got one at home at least to be able to get some miles in despite the cold. I might have been more fond of treadmills sooner had I known about iFit, which allows compatible fitness equipment to automatically deliver uphills and downhills to match real-world routes while showing pictures from Google street view.
I’ve now run through Ireland, Paris, Norway, and my own neighborhood and definitely like it better than the standard programs on the treadmills at the gym. Once people’s New Year’s resolutions start failing, used equipment will start popping up for sale and I’m glad I have something to talk about with patients who think walking on a treadmill is boring. I also found a National Geographic “Everest” video workout on the site and although it bested me the first time, I’ll be back for more. Having the ability to track and quantify my efforts to stay in shape has been a benefit for me, although I draw the line at sharing every workout to Facebook.
A reader who has picked up on my running habit shared these high-tech socks from Sensoria that use sensors and conductive fibers to gather information about a runner’s speed, distance, steps, and how their feet strike the ground. They debuted at the recent Consumer Electronics Show and are from the same people who brought us shirts and running bras to sync with heart rate monitors. A magnetic anklet communicates with Android and Apple devices to provide real-time feedback. I’m not sure I want my socks to coach me and they aren’t cheap, so I think I’m going to take a pass this time. I do enjoy reading about wellness-related tech, so keep sending your finds.
I do some volunteering at a local school and they asked me to speak at an upcoming career day. When I get requests like that, I always have to ask whether they want me to talk about my “doctor job” or my “computer job” or both. When I decided to become a family physician, I never imagined myself on the cutting edge so I was happy to come across this piece on physician informaticists to help explain exactly what it is that I do all day. Apparently UCLA is thinking outside the box and is making their informaticists available for consultation with other Epic customers. It looks like a win-win situation to me – in addition to assisting other organizations, their team can also bring back successful approaches from other sites.
NCQA is offering the opportunity for the public to provide feedback on proposed change to 2016 HEDIS measures. There are a handful of proposed new measures and changes to several existing ones, so plan to get your comments in before the March 18 deadline.
Speaking of deadlines, Friday is the cutoff for HIMSS hotel changes. I’m mixing it up this year and staying somewhere swanky with a couple of my gal pals since I was able to get ridiculously cheap airfare. Although registration for HIStalkapalooza is closed, I know Mr. H is poring over the guest list and I’m looking forward to seeing many of you there (anonymously, of course). The event is one of the most fun parts of being on the HIStalk team, although I am feeling the pressure when it comes to finding a pair of outstanding shoes. Maybe Sensoria should make an insert to gather data on what happens to the feet of fashionable ladies and gents out for a night on the town.
Have you put together your HIMSS wardrobe plan yet? Email me.
Merge Healthcare announces that it has acquired DR Systems for $70 million.
Reader Comments
From Weapons of Mass Distraction: “Re: DoD EHR bid. Pretty sure Epic has already won and that’s been known to insiders since back in January. Not saying that as an Epic advocate, just saying it because this process of press releases, vendor elimination, etc. reminds me of watching a movie my friend already told me the ending of.” DoD is planning to announce the winner in June, so they should be far along in the process. Maybe an anonymous expert can help us understand what should be going on behind the scenes right about now.
From Mad City: “Re: Epic’s AppExchange. It’s funny that so many respondents in your poll believe it’s related to the DoD bid when it’s been discussed in Epic user groups for years and was announced last fall at UGM.” My sources say early adopter customers have already completed the paperwork and submitted their items, with developers coming up next once Epic locks down processes to review security and handling of PHI and most likely figuring out how to support turnkey installation. They’re working with Apple to understand the best ways to run an app store. Epic didn’t announce the AppExchange – sites picked up as “news” a third party’s comment about it that was followed by Epic’s confirmation of its plans, but customers have known about AppExchange for many months.
From Clinic Director: “Re: Meaningful Use audit hell. We started receiving pre-payment audits for MU in early January, with 96 requests for 139 providers. So far we have been able to pass all of them, but the amount of work necessary to provide the requested additional data has been a huge burden. So much so that we are unable to configure our system to start seeing how we are doing in 2015. In looking at the Epic user web, there are A LOT of other organizations experiencing the same thing. It is certainly a focused effort by the government to delay the payments and look for all options to penalize 2016 reimbursements for Medicare. This is ridiculous.”
HIStalk Announcements and Requests
This week on HIStalk Practice: MGMA welcomes new CEO. Physicians balk at the not-so-hidden costs of interoperability. Rock Health breaks down telemedicine. Illinois Telehealth Initiative launches at Matter Chicago. Practices worry payers won’t be ready for ICD-10. Partisan bickering stymies healthcare cost transparency efforts in New Mexico. Horizon House and Tidewater Physicians implement new HIT. Thanks for reading.
This week on HIStalk Connect: The FDA relaxes its regulatory oversight on personal genetic tests and clears 23andMe to resume marketing some genetic screening tests. DARPA announces that it is working on an implantable computer chip that will deliver headset-free augmented reality. TraceLink raises $20 million to bring serialized tracking to the pharmaceutical supply chain.
I was thinking about how EHRs are blamed for turning previously interactive doctor-patient conversations into form-filling exercises, where not only are physicians forced to restate their complex thoughts as fill-in-the-blank items, but even patients themselves are forced into that same mode by the doctor who just wants to feed the EHR screen’s demands and steers the encounter accordingly. Studies show that doctors interrupt patients quickly and often, which I suspect is due not only to the short encounter time allotted, but also the doctor’s need to complete forms (it’s like your tax guy – he wants documents and short answers rather than a deep financial discussion because he’s sitting in front of federal tax forms, not a freeform word processor). We’ve devalued the rich, nuanced doctor-patient conversation into a mutual form-filling exercise, which probably seems ideal to everybody except doctors and patients. I like the idea of having the patient complete intelligent questionnaires before the visit starts and send that information to the EHR to reclaim some of the lost encounter time for less-discrete activities.
Webinars
March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.
March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Here’s the video of the “Cloud Security Primer” webinar that was presented by Sensato CEO John Gomez last week.
Acquisitions, Funding, Business, and Stock
Merge Healthcare announces Q4 results: revenue flat, EPS $0.02 vs. $0.00, missing expectations for both. Shares dropped 12 percent Thursday following the announcement before the market opened. Above is the one-year MRGE share price chart (blue, up 57 percent) vs. the Nasdaq (red, up 16 percent).
Allscripts announces Q4 results: revenue down 3 percent, adjusted EPS $0.09 vs. $0.08, missing revenue expectations but meeting on earnings. Above is the one-year MDRX share price chart (blue, down 31 percent) vs. the Nasdaq (red, up 16 percent).
Orion Health opens an office in Glasgow, Scotland. The company also begins hiring another 100 people for its Scottsdale, AZ office.
Sales
Tidewater Physicians Multispecialty Group (VA) chooses Lightbeam Health Solutions for population health management.
GetWellNetwork announces several sales of its recently acquired Marbella data collection product.
In Australia, Cerner wins a New South Wales tender for a medication management system for Millennium-using hospitals. Districts that don’t use Millennium, such as those that use Orion Health, will be able to choose a different system.
People
Cureatr names three vice presidents: Kent Hiller (Indiana HIE), Karl Kiss (InteHealth), and Jay Smith (Sparta Systems).
Joining PerfectServe are Terry Hayes, RN, MSN (OptumInsight, above) as VP of client experience and Michelle McCleerey, PhD, RN (TeleTracking) as VP of product marketing.
Announcements and Implementations
SRSsoft launches its Essentials EHR for specialists and new EHR users, labeling it as “an alternative, non-MU EHR” that allows users gain benefits without having to change the way they practice.
InterSystems releases Cache’ 2015, which doubles the scalability of previous releases. Epic benchmarked the new release and was quoted positively in the announcement.
Convurgent Publishing releases the third edition of “Clinical Integration: Population Health and Accountable Care.” One of its editors is Divurgent CEO Colin Konschak.
Caradigm will include Cohort Designer in implementations of its Caradigm Intelligence Platform.
Government and Politics
CMS extends the date for Medicare EPs to attest for Meaningful Use to March 20, 2015, giving providers an extra three weeks for unspecified reasons.
Netsmart executives are meeting this week with their Kansas legislators to discuss HITECH’s exclusion of behavioral health providers for Meaningful Use incentives.
It appears that New York’s mandatory e-prescribing scheduled for a March 27 live date will be pushed back a year, or at least that’s the impression from an email sent by Healthcare Association of New York State, which is pushing for the delay. The governor seems inclined to sign S.2486/A.4274 that has already passed both houses, which would reset the date to March 27, 2016.
The US Supreme Court rules that state professional licensing boards can’t use their authority to limit competition, finding that North Carolina’s dental board (made up mostly of practicing dentists) can’t prohibit non-dentists from whitening teeth since the board’s motivation was to protect the income of dentists rather than the safety of the public.
Massachusetts Governor Charlie Baker replaces the four of 11 board members of the state’s health insurance exchange that were appointed by his Republican predecessor, among them MIT economist and Affordable Care Act key player Jonathan Gruber.
CMS reports that it successfully processed 81 percent of 15,000 ICD-10 claims in a week-long test, with 6 percent rejected due to invalid ICD-9 or ICD-10 and 13 percent rejected due to non-ICD problems such as missing information or invalid service dates.
The FCC rules on an open Internet, banning providers from blocking content, throttling traffic, or prioritizing traffic to give higher-paying content sources a “fast lane.” Chairman Tom Wheeler said of the 3-2 vote, “The Internet is too important to allow broadband providers to make the rules.”
Privacy and Security
The FBI closes in on the Anthem hackers and is trying to decide how much information about them to reveal publicly. China-sponsored hackers are the likely culprit, but naming them would require technical proof that might compromise future FBI cybercrime investigations.
Innovation and Research
Facebook releases tools to support suicide intervention that will be used when a user reports seeing a troubling post.
Healthbox changes its accelerator model so that participating companies won’t have to give up equity and “studio programming” won’t require full-time participation.
Technology
LG announces a new smart watch that doesn’t require a cell phone running Android Wear – it will connect directly to an LTE network to play streamed music, make device-to-device voice calls, and make mobile payments.
Orion Health adds FHIR support to its Rhapsody Integration engine.
Other
Epic is named #7 of “The 11 Best US Companies for Students to Get Summer Internships,” although the listicle’s methodology is shaky (reading intern ratings from Glassdoor). Facebook led the list.
The Pew Charitable Trusts highlights New Mexico’s NurseAdvice telephone hotline that is free for all state residents, saying it keeps 65 percent of its 15,000 monthly callers out of the ED. The hotline also generates real-time public health data, with CDC recommending that other states adopt a similar model.
The bond rating agency of Baptist Health Care (FL) notes that the health system may borrow money to replace its McKesson Horizon system in 2016.
Sovita Chander was inspired by Ted Reynolds’ recent HIStalk article about healthcare delivery in Europe vs. the US and wrote a Canada-focused piece titled “7 Reasons Why Healthcare Companies Get Stuck at the Border.” Item #1: “Canada is 10 markets (plus three). Healthcare delivery is driven by ten different provincial governments (and three territorial governments serving a population of about 100,000), so you have 10 different sets of IT-related requirements, regulatory frameworks, and buyer landscapes to address. Sales cycles are longer in Canada than in the US. You have more hurdles, and you will go to RFP in some provinces on just a $25,000 deal.”
Aetna sues a for-profit 139-bed Texas hospital that takes in $1.5 billion annually, claiming that the physician CEO pays doctors kickbacks disguised as “ownership interest” and has overcharged Aetna $120 million in the past six years by treating patients out of its network. The hospital says a similar Aetna lawsuit against it has already been dismissed and that the company is trying to strong-arm providers into participating in its network.
In Australia, the local paper calls out the $800 million (USD) Personally Controlled e-Health Record (PCEHR) that has been live for three years with minimal use by doctors and patients. The government blames its predecessor opposition party for a rushed implementation.
Moffitt Cancer Center (FL) sues one of its surgical oncology residents over a Google Glass-powered tumor visualization tool he invented. The hospital says it made the doctor sign over his rights for anything he developed while working there, but he reneged on the deal while filing for a patent. Since then, the resident and his partner formed a company and then sued the hospital for demanding credit for an invention in which it wasn’t involved.
Google buys 70 iPads for MUSC Children’s Hospital (SC) so that hospitalized children can use Google Hangouts to video chat with friends and family.
New York City eliminates a nearly universally ignored requirement that parents sign consent forms before their newborn boys undergo “oral suction circumcision,” an Orthodox Jewish ritual in which mohels suck blood from a baby’s circumcision wounds. Mayor Bill de Blasio says the consent requirement was offensive to some community members even though 17 babies have contracted herpes from the procedure and two of them died. The agreement requires mohels suspected of infecting babies to undergo DNA testing, although in previous incidents parents refused to name the person involved and parents can’t avoid them anyway because the city refuses to name those already identified as carrying herpes.
Sponsor Updates
Capsule Tech added 190 hospital users and 35,000 beds to its SmartLinx medical device information system in 2014.
Divurgent is in the running for the US Chamber of Commerce’s Community Excellence Award (voting is here) and will make a donation to the Shriners Hospital for Children if it wins.
E-MDs posts a preview video for its users group conference June 18-20 in Austin.
Greythorn offers a sneak peek of its HIMSS15 plans (and giveaways).
Ingenious Med President and CEO Hart Williford calls for “All Hands on Deck.”
Hayes Management Consulting’s Robert Freedman offers three steps to drive a compliance checkup.
The HCI Group will sponsor the Future Stage at the HIMSS UK Annual Innovation Conference March 3-4 in London.
Steve Zeller of Logicworks writes about “The Healthcare Cloud: A Journey.”
Influence Health will exhibit at the ACO & Payer Leadership Summit Spring 2015 March 5-6 in Las Vegas.
Tracy Kimble of Galen Healthcare Solutions asks “Are You Ready for the Shift to Value-Based Payment Models?”
The latest Healthfinch blog points out the ironic twist of technology as a cure for physician burnout.
Iatric Systems will exhibit at the Hospital and Healthcare IT Reverse Expo March 2-4 in Orlando.
Extension Healthcare is nominated for the Health Tech Award and Tech Company of the Year Award.
The Shkreli Awards, celebrating excellence in quackery! Be the Best at being the Worst! Innovate your way to prison and…