The CBO estimates that the House-passed SGR repeal bill will increase the federal deficit by $141 billion over the next ten years. The bill is now with the Senate.
John Halamka, MD weighs in on the recently published MU3 rules, concluding “The sheer number of requirements may create a very high, expensive and complex set of barriers to product entry. It may stifle innovation in our country and reduce the global competitiveness for the entire US Health IT industry.”
An article in the American Journal of Roentgenology suggests that the ongoing shift to centralize IT services in hospitals has left radiology departments, which were often early health IT adopters, with fewer clinical IT experts and less control over the direction of innovation in their specialty.
Seniors Wireless launches a $30 per month telehealth service that promises unlimited 24/7 access to physicians by telephone or video for anyone over the age of 55.
The Congressional Budget Office says the Medicare doc fix bill that passed the House Thursday and moves on to the Senate will add $141 billion to the federal deficit. The cheers you may have heard came from people getting the money, not those providing it. Somehow “reform” always ends up costing taxpayers more. At least nobody has slipped in another ICD-10 Easter egg like last time, although Congressman Gary Palmer (R-AL) tried to work in another one-year ICD-10 delay Wednesday that was rejected in committee.
Reader Comments
From Lemmy: “Re: Children’s Hospital Boston. The EMR is down, clinics are cancelling appointments, and the labs are sending samples out.” I contacted CIO Dan Nigrin, MD, who explains:
“We recovered yesterday (Wednesday) from an extended, unplanned downtime caused by a failed segment of a storage array for the database underlying our EHR, and which caused significant database corruption. As you would expect, the hardware was architected to be fully fault-tolerant with complete redundancy, yet nonetheless it failed us. So we’re still figuring out root cause with the vendor. We used our disaster recovery system and paper-based processes to run the operation. To be on the safe side, we postponed a few elective admissions (for less than 48 hours), but otherwise care was delivered normally at the hospital.”
From DoDEHR: “Re: US Coast Guard. Considering scrapping their $40 million Epic rollout as the DoD selects its vendor. Funding is frozen and USCG hasn’t gone live in any of its 42 clinics after four years with no dates projected. They are in danger of reverting back to AHLTA/VistA.” Unverified.
From Booth Babe: “Re: HIMSS exhibitor tips. Can you recap those you’ve run before?” You can use the search box to find them, but here’s my #1: confiscate the cell phones of employees while they’re working the booth. They are hopelessly addicted and will start by slipping furtive glances at email, but before you know it, they will be heads-down immersed in screwing around instead of paying attention to the prospects milling around their expensive telephone booth. I’ve seen guys playing with their phones while standing at an airport restroom urinal, so I guarantee people (especially the shorter attention span younger ones) won’t make it through a multi-hour booth shift unless you remove the temptation. I also suggest making it clear that booth employees aren’t allowed to talk to each other unless they’re collaborating on an attendee question because they’ll end up socializing, with is a huge turn-off to a prospect who might want to ask a quick question or who has a reasonable expectation of being welcomed without feeling like they’re intruding. It’s depressingly easy to find expensive booths staffed by inattentive employees. If your carrot needs a stick enhancement, mention that every year I take candid photos of inattentive booth employees and it will be pretty embarrassing to be memorialized on HIStalk that way.
From Job Hunter: “Re: taking a new job. Can you give me the link to what you ran previously about company danger signs?” I don’t think I’ve ever run such a list, but I would try to steer clear of companies with these characteristics:
The CEO is a well-traveled hack who has left a trail of corporate destruction behind him or her or is a private equity hired gun whose primary job is to boost the bottom line by whatever short-term means are necessary to get the company sold before the wheels come off.
The CEO can’t be bothered to relocate to the city where most of the employees work.
The executive job you’re being offered is not housed at the home office. Out of sight means out of mind, which is great until your ambitious peers conspire to stab your absent back.
The company requires new hires to sign a restrictive non-compete agreement that will harm your ability to find their next job. My favorite strategy is from Dilbert: scan the non-compete into Acrobat, change the wording, then print it and sign it. Chances are the always-clueless HR department won’t notice that what you signed isn’t what they handed you.
Budget and travel freezes are common. That means lazy executives don’t have a clue about what is essential, so they just penalize everybody equally regardless of corporate consequences.
They’ve laid people off in the past couple of years. Layoffs are a symptom of executive failure (either in hiring choices or in strategy) and indicate that the company would rather jettison people who have been loyally working in their assigned roles instead of retraining them even though they have a lot of reusable positive attributes beyond specific product knowledge. That or they don’t have the guts to fire people for cause and instead conduct a layoff of losers.
Executives with reserved parking spots. I loathe big shots who think they’re better than everyone else.
Your interviewer is late, distracted, or someone you wouldn’t hang out with after work. They’re on their best behavior during your interview, so it can only get worse.
You get a vague answer when you ask what happened to your predecessor or the company declines to name them for fear you’ll solicit their honest opinion about why they left.
Your prospective boss talks about himself or herself instead of you.
Two people who are related serve on the executive team, especially if the position you are considering is also on the executive team. You, Sammy Hagar, serve at the pleasure of the brothers Van Halen.
HIStalk Announcements and Requests
I’m doing a video interview series at the HIMSS conference along with DrFirst and we need interviewees. We’ll probably ask simple questions, such as what interesting things you’re seeing at the conference or who has the best giveaways. Let me know if you’re willing to participate and we’ll set a time to connect in the exhibit hall.
Welcome to new HIStalk Platinum Sponsor Engage. The Spokane, WA-based company, a division of Inland Northwest Health Services, is one of the largest Meditech hosting partners in the country and offers four service lines: hardware integration, hosting services, Meaningful Use, and professional services. Its 225 application analysts provide Meditech implementation and support to 130+ customers, among them some of the first hospitals to successfully attest for MU Stage 1 and Stage 2. Its infrastructure solutions include hardware refresh, virtualization, data migration, and data center migration, working with partners such as HP, NetApp, IBM, and BridgeHead. Engage provides its customers with a 24x7x365 US-based help desk that covers both infrastructure and application support. Thanks to Engage for supporting HIStalk.
This week on HIStalk Practice: MUS3 proposed rules take the air out of one rural physician’s HIT sails. The Physicians Alliance expands its Wellcentive partnership. A new study confirms that urgent care and retail clinics are overtaking primary care practices in terms of patient preference. Aledade partners with WVMI and Qsource to establish ACOs in West Virginia and Tennessee. One MD makes the case for pulling primary care out of the insurance system. Practice Fusion integrates with Medi-Span. New study finds that the ACA did not flood physician practices with appointments. Dr. Tom offers practices tips on thinking like retailers. Dr. Gregg snapshots the technology-induced workloads of today’s busy physicians. Thanks for reading.
This week on HIStalk Connect: Meaningful Use 3 preliminary rules are published and include some aggressive patient engagement goals. Researchers from Mayo Clinic analyze potential use cases for drones in healthcare. A new Rock Health report finds that women are still sorely underrepresented in health IT leadership positions. In England, the NHS launches a mobile app library with clinically-vetted mental health apps.
Listening: the fairly new rarities boxed set from Seattle’s amazing grunge rockers Soundgarden. If you like Black Sabbath (and how could you not?) then you probably like Soundgarden. And since I’ve already mentioned Van Halen, they (including on-again, off-again singer David Lee Roth) will be touring heavily starting July 5, mostly doing the amphitheater circuit, and releasing a made-in-Japan live album from their 2013 tour. I called it nearly perfectly on that last tour when I said on February 13, 2012 that I wouldn’t buy tickets for shows after mid-March because I expected them to storm off mad and cancel the tour and sure enough they did, although not until a few weeks after I predicted. Eddie’s voice is mostly shot (just like DLR’s kicks only go about knee-high these days) but he can still shred the guitar and he looks a heck of a lot better at a slightly chunky 60 than a couple of years ago when could have passed for a homeless crackhead.
HIStalkapalooza
Thanks to the fun folks at DrFirst who have volunteered to provide a videography team to cover HIStalkapalooza. That was one of the features we were going to eliminate since we are too buried in other event details to deal with it, but DrFirst is filming (not literally, since there’s no actually film involved) and will produce a YouTube video we can all enjoy after the fact. DrFirst’s stepping up so enthusiastically restored my enthusiasm and faith in humanity since I was pretty tired and frustrated dealing with all the not-so-fun parts of putting on HIStalkapalooza. They’re a fun bunch.
The only thing we haven’t arranged is someone to shoot still photos, so we will probably ask attendees to send us those they take.
I invited each of our event sponsors (which I’ve listed in a link box to your right for ongoing reference) to provide a little background on what they do and what they’re planning for the HIMSS conference and for HIStalkapalooza, which seems fair given that they are paying for your food, drinks, and world-class band. Here’s what the folks at Falcon Consulting Group have to say.
Soaring into HIMSS15, Falcon Consulting Group looks forward to showing attendees and exhibitors alike that we are no ordinary flock of consultants. Falcon brings together specialized EHR technical and clinical talent, Big-4 operational and industry expert leadership, and avant-garde strategies and technological solutions. We are landing in a reserved meeting room inside the Lakeside Center Building (MP-7), and we would love for you to stop by and let us show you how we can help your organization fly to new heights. In the event has worn out your wings at the conference, we will also be hosting nightly events throughout Falcon’s home city of Chicago. For more information, contact Steven Stull at 312.751.8900 or by email.
Webinars
March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line.
Acquisitions, Funding, Business, and Stock
Analytics vendor Ayasdi, which offers a healthcare-specific package for identifying clinical best practices among its other non-healthcare products, raises $55 million in a round led by Kleiner Perkins, increasing its total to $100 million.
Orion Health’s US sales leader Paul Viskovich describes what it’s like being a New Zealand-based company selling predominantly to a US market and opening an office in Scottsdale, AZ: “It’s hard. You’re not from here. You talk differently. It wasn’t possible for us to go meet the CIO of UCLA — it was a good day if we talked to the security guard. Healthcare as a whole is largely not good with innovators either, and when you combine those two things, it’s very difficult … Our teams are cross functional. People in New Zealand are also working on projects at the same time as people in the United States, and if you manage that correctly, it can be a real benefit.”
Sales
Six-hospital Cone Health (NC) chooses Phynd to manage its 16,000 physicians in a single provider profile that crosses Epic and ancillary systems.
People
Jitin Asnaani (Athenahealth) is named executive director of CommonWell Health Alliance.
The Integrated Healthcare Association hires Jeff Rideout, MD (Covered California) as president and CEO.
Announcements and Implementations
Seniors Wireless announces TeleMed Assist, a $30 per month, contract-free program ($40 for couples) that offers unlimited 24×7 access to physicians by telephone or video. Being a cynic and wondering how all these virtual visit companies will find reasonably competent doctors willing to take calls in real time, I’m picturing those 1990s 976-number dial-a-porn services where the hot Brazilian dominatrix you’re talking to is actually an obese, hirsute, 60-year-old Medicaid recipient whispering sweet nothings with Cheetos breath and a genetically confused grandchild on her knee while watching the muted “Jerry Springer Show.” I would be interested to talk to a physician who provides services through companies like this since I’m curious how it works.
Practice Fusion adds the Medi-Span drug database from Wolters Kluwer Health to its free EHR.
The Florida HIE announces that 200 hospitals have signed up for its event notification service for admissions, discharges, and ED visits.
GetWellNetwork announces that it added 58 new facilities and 10,000 new beds in 2014, with a 13 percent growth in employees to 250.
Government and Politics
Even the ever-optimistic and supremely knowledgeable John Halamka and Micky Tripathi seem to be fed up with the endless Meaningful Use parade, concluding of the latest MUS3 and certification requirements:
”… each incremental proposal is tolerable, but the collective burden is making practice impossible … the sheer number of requirements may create a very high, expensive, and complex set of barriers to product entry. It may stifle innovation in our country and reduce the global competitiveness for the entire US health IT industry by over-regulating features and functions with complicated requirements that only apply to CMS and US special interests … The certification criteria are often not aligned with what EHR users ask for. In some cases, the criteria are completely designed to accrue benefits to people who aren’t feeling the opportunity cost … There needs to be a very public discussion with providers as to who should prioritize EHR development — ONC and the stakeholders they’ve included or EHR users.“
I’ll add my counterpoint, however. Providers who whine about irrelevant and burdensome MU requirements can ignore them completely, but rarely do. You sold your soul to the federal government, but you can buy it back by accepting the Medicare penalty and then start following your own agenda instead of someone else’s. MU money is either worth it or it’s not – your participation indicates that you think it is, and that acceptance drives the user-unfriendly development agenda of EHR vendors. You don’t even need to use an EHR at all if you truly (questionably) believe it has a negative impact on quality or revenue – it’s your business and your patients. I cite “Lost Boys” in reminding that a vampire can enter your home only if you invite them.
A great tweet from US Surgeon General Vivek Murthy, MD, MBA: “The levers for health aren’t in hospitals, they are in communities.” What Vivek didn’t tweet: “On the other hand, the hospital levers are raking in untaxed billions and thus they have little incentive to make communities healthier.” In the US, “public health” is export-only compassion and outreach to all who need help; domestic healthcare services delivery is a big business dominated by special interests that threatens to bankrupt the country; and never the twain shall meet.
Rep. Phil Roe, MD (R-TN) reintroduces a bill that would require the DoD and VA to develop a shared EHR using criteria established by a temporary panel that would be given 90 days to complete its work. The contract winner would get a flat $50 million upfront and then $25 million per year for five years to develop and implement the custom system, which Roe says would complement the $1 billion already spent by the DoD and VA in trying to create the integrated EHR. My opinion: the DoD-VA interoperability challenge is more about willingness and less about technology (the same as in the civilian world made up of uncooperative competitors, in other words). Those groups, despite how ridiculous it seems to taxpayers, distrust each other and refuse to stoop to each other’s level for the good of the serviceperson turned veteran. Perhaps they should be assessed a 1 percent CMS-type annual budget penalty for failing to interoperate.
Here’s an interesting quote from the head of DoD’s DHMSM project: “I’ve visited a number of facilities that have gone through this, and their message routinely is, it’s all about the change management and the training. It’s not about the tool. It’s about how you use that tool.” Maybe that’s a hint that DoD will choose whichever of the three bidding groups offers the best training, implementation, and optimization services rather than just the best EHR.
The Economist calls out inept US government financial management as chronicled by the GAO, including $125 billion in improper Medicare payments in the last fiscal year. The Brits seem to be enjoying our admittedly questionable DoD-EHR dual (or dueling) EHR projects:
”The GAO has few kind things to say about the government’s approach to information technology (IT), on which it plans to spend $79 billion in this fiscal year. Fragmented data storage and needless duplication have wasted billions of dollars. For example the Department of Defence—which accounts for around half of federal discretionary spending, and so may well not notice when billions of it vanish like loose change between sofa cushions—and the Department of Veterans Affairs are both now developing, from scratch, two separate electronic health-record systems, even though they will basically serve the same people. But the most common problem with the government’s IT ventures is a mix of grand ambitions and incompetence, as the launch of Healthcare.gov in 2013 handily showed.”
Technology
Michael Archuleta, IT director at 25-bed Critical Access Hospital Mt. San Rafael Hospital (CO), tweeted out this photo in announcing that the hospital’s server infrastructure is 99 percent virtualized. Nice.
Amazon announces unlimited consumer cloud storage for a flat fee of $60 per year with a free three-month trial.
Other
Among the reasons University of Mississippi fired its chancellor is the medical center’s signing of contracts without board approval, with an audit finding that its EHR RFP process in which Epic was chosen contained incomplete cost breakdowns.
An article by three prominent radiology informatics leaders questions whether IT centralization and standardization has caused radiologists — who were among the first hospital informatics practitioners — to lose control of the domain. It says early and profitable hospital radiology departments were able to hire clinical IT specialists that the IT department didn’t have, giving those departments the technical freedom to innovate that has since been revoked. The authors suggest that subspecialist informatics radiologists find a place at the hospital IT table despite current underrepresentation. My experience is similar – the other pioneering clinical departments (lab and pharmacy) integrated well into the IT environment because of share order entry systems that were used by a general audience, while radiology had its own pseudo-IT systems that were used by minimally visible doctors and techs working alone in dark rooms, often ignoring sound IT processes. The above graphic is correct – IT’s focus is on reduction of corporate risk exposure through standardization, centralization, and budget control, which usually extinguishes rather than encourages innovation. Whether that’s good or bad depends on whether you have a visionary CFO (is that an oxymoron?)
Reading Health System (PA) reorganizes its IT department and eliminates 33 positions after completing its $150 million Epic implementation.
Eighty percent of the 1,000 children and teens who have used Kurbo’s $25 per month weight management app and email-based coaching service have lost weight, the company says.
Group brainstorming meetings don’t work, says Harvard Business Review. Reasons: people expend less effort when working within a group, introverted and less-confident attendees participate less, stellar performers are dragged down to the level of the least-competent ones, and groups larger than 6-7 people have logistical problems getting everyone’s ideas on the table.
Sponsor Updates
A family practice improves hypertensive control rates from 78 percent to 94 percent in the year after implementing Forward Health Group’s PopulationManager.
The Health Management Academy partners with MedCPU to identify solutions to overcome point-of-care challenges.
ZeOmega Founder and CEO Sam Rangaswamy describes how ZeOmega’s acquisition of HealthUnity positions the company.
A new Healthcare Data Solutions case study confirms that pharmacies using its Prescriber Validation Subscription Service have saved millions in potential hydrocodone fines.
Ivenix produces a video that highlights how its Infusion Management System is designed to help nurses improve patient safety and workflow efficiency for infusion therapy.
Hayes Management Consulting offers “10 Tips to Create a Workflow Manual That Your Users will Love.”
Valence Health announces that its Further 2015 annual conference will be held in Chicago September 23-25.
Galen Healthcare Solutions CEO Jason Carmichael welcomes the new GHS leadership team in the latest company blog post.
Impact Advisors offers early impressions of Meaningful Use Stage 3, plus looks at data center trends.
Healthwise offers “Creating a Group Health Culture Where Shared Decision Making is the Norm.”
LifeImage posts “Medical Image Exchange for Cardiology Care.”
I read with interest Mr. H’s summary of Chicago’s April weather over the last several years. One of my friends was in Chicago this week and posted pics of snow. Right now I’m still planning a ball gown for this year’s Histalkapalooza, so I’m crossing my fingers against rain, snow, sleet, hail, and slush. I do have an opera length coat at the ready, but I am not looking forward to figuring out how to pack it all. The fact that I’m thinking about HIMSS planning right now underscores the fact that I’m procrastinating the continued reading of the Meaningful Use Stage 3 documents that were released last Friday.
I’ve only received a couple of pre-meeting mailers, but there have been a couple of ads in healthcare IT publications that caught my eye. Sponsor ChartMaxx is giving away some Chicago pizzeria gift baskets in their “Grab a Slice of the Windy City” promotion. Winners could receive a gift basket and pizzas delivered to their home – sign me up for that one. The two mailers I did receive both mentioned Apple Watches, but I’m not an iPhone girl, so they didn’t engage me. Additionally, one had my title wrong and another botched the address. It never ceases to amaze me when a mail merge goes awry or that people don’t proof things before they go out.
Speaking of proofreading, I wonder if 1-800-Contacts realizes that their most recent mailing provides a possible time-travel option for customers? Although it was mailed earlier this month, it invited me to place an order through January 2013. I guess it’s not just conference marketers who can’t get it straight, but I’m wondering if I can call and see if they’ll honor their 2013 pricing.
Procrastinating on the Meaningful Use documents also means catching up on journals this week. I’ve been doing a better job of keeping the pile on my entryway table to a minimum, but still am not current. A blurb about using Fitbit devices to predict recovery from back surgery caught my eye, however. Researchers at Northwestern University, New York University, and the University of California-San Francisco are looking at patient activity four weeks prior to a procedure and six months after. Preliminary data shows that patients not only reach their pre-procedure activity level after about a month, but continue to increase to levels that weren’t possible prior to surgery. Although they’re only looking at a subset of spine surgery procedures, I like the idea of capturing that data to model real-world results.
I’m glad I went through the journal pile because nestled in the back pages of American Family Physician was a “Patient Oriented Evidence that Matters” (POEM) segment answering the question of whether computerized decision support systems linked to EHRs improve patient outcomes. The ‘not really’ response cites a recent meta-analysis and I’m glad I read the original article. It was a little less pessimistic than the “bottom line” summary provided in the POEM. I printed a couple of copies of the actual paper to keep on my desk because I’m sure someone will bring the summary in next week as support for why we should not have an EHR. I’ll be ready when they do because at this point EHRs are not going away, but I do love a good medical literature spitting match.
Going back to January in the stack, I also found reference to an editorial in the Annals of Family Medicine that talks about allowing medical students to use EHRs so that they’ll be ready for later phases of training such as residency. Our students get a lot of experience with EHRs in our academic hospitals, but very little when they’re on their community-based rotations. The barriers cited by our sponsoring physicians include licensing issues with EHR vendors, lack of dedicated training for students, inability to separate student documentation from rendering physician documentation, and the transient nature of clinical rotations. Most of these were echoed in the editorial, which also mentions the need for students to learn how to manage populations using registries and other analytic components of EHRs.
I’ll be interested to see how the current generation of medical school and residency grads use EHRs after completing their training. In many parts of the country, we’re to the point where students may not even be exposed to paper charts. In my area, even our community free clinics are using EHRs. I’d love to do a study of new physician interactions with patients in an EHR-enabled exam room vs. physicians who transitioned from paper charts.
March 26, 2015InterviewsComments Off on HIStalk Interviews Jay Savaiano, Director, CommVault
Jay Savaiano is director of worldwide healthcare business development for CommVault.
Tell me about yourself and the company.
CommVault is a data and information management company. Not only do we move data for purposes of data management for backup recovery, archive duplication, replication, disaster recovery, and continuity planning, at the same time, we take an index of all the associated content within that data so it can be used for e-discovery, information management, legal situations, any other reason that you feel that you would want to search against all your data in your environment from an unstructured perspective.
You hear a lot about big data, but hospitals already create a lot of data they don’t use. What examples have you seen where a hospital found something useful in what they already had?
The big part of it is the unstructured data. It’s easy enough when you have a solution that has a database back end and you want to search for “Jay Savaiano.” You can search for “Jay Savaiano” and you can get all the data from that solution. What you don’t get is the unstructured data that resides in your environment — Excel spreadsheets, Word documents, PDFs, all this content that’s residing out there that you don’t have an actual database that indexes all the pieces.
That’s the challenge any time we bring up dark data to the healthcare space. We have a ton of it and we don’t know what’s in it. It’s what scares us the most.
We understand exactly what’s in the EMR. We can search that all day and get all the data points we needed. It’s all those unknowns that are the scary part, especially all the way out to the edge, all the way out onto a laptop. Not knowing what type of documents that any one particular individual has — whether it’s a doc or whether you’re in a hospice scenario — data resides on those edge devices that can be snagged.
That’s always everyone’s concern, even from a perspective of what’s in email. How many times is a doc or an individual taking something, attaching it to an email, and sending it to their Yahoo account? Those are always the concerns of not knowing if PHI is all of a sudden traversing outside of the network, going to unsecured areas that leave them open to issues.
An examples would be outright broad compliance. To tap into that unstructured content, especially even in an email scenario. A situation such as an employee who is also a patient. That individual has taken data from the organization, emailed it outside to themselves to their Gmail account, and now all of a sudden there’s an issue from an employment perspective with that individual. They’re trying to come back and say they weren’t treated fairly or anything that could have been brought up. We’ve had organizations that have gone back and done searches against all the email content as well as the unstructured content that resided on their laptop that was on the edge and be able to understand all the data points of possibly where they opened up the organization to step outside of compliance and not be properly managed across the board.
The flow of what we do is taking data and ingesting it and moving it to support the needs of data management. At the same time, fully indexing the content to be able to make sure it’s queryable and searchable is one fluid component of having a complete data and information management strategy. Not just in the data center, but all the way out to those edge devices.
The examples that you’re giving are mostly from a compliance and regulatory retrieval type aspect. Is that the focus of the product or are there other elements such as clinical data searching?
It is more of a compliance-based play. It’s backup and recovery at its core. You have a data management component, but at the same time, organizations have to buy two or three other products to do the indexing of their email so they can turn around and do e-discovery and search. Or they have to buy another product to take and ingest any of the unstructured data that sits out there in shared directories or in private directories. Then they have to buy another product to turn around and support the laptop backup, the edge-based backup, or going all the way out to the iPhone for that matter. They sign up with a variety of different products.
Our whole strategy is one common architecture. It is just that core product. We’ve expanded the technology to be able to support cross platforms into all those areas. We go into environments and we’ll work with their data from a virtualization perspective as well as from a physical perspective. We’ll support their Epic environment, their McKesson environment, and their Allscripts environment, but you can minimize the silos that comes with a number of those solutions from a data perspective.
Too many times McKesson or Allscripts has made recommendations that our organization should buy X hardware and install it and it needs to run on this virtualization platform and run it. You get these data silos that, from an operational aspect, become very challenging in healthcare, which is already challenging when you have hundreds of clinical applications that IT is trying to support. We just minimize that overhead on the back end.
What CIO mindset has to change when they start thinking about using the cloud?
Too many times when organizations are utilizing the cloud, they’re looking at it as just a target for data. Whether they’re going to push data to it to support a disaster recovery scenario or they’re looking to utilize cloud-based solutions so edge-based components can connect. A clinician can push data up from their laptop and access it on their iPhone or access it on their iPad and get other content. This is with unstructured data once again. All the structured data. Everybody has applications. Epic has applications for the phones and all those devices.
Too many times you have cloud vendors that have to create another silo of data. In order to get the data up into those cloud vendors, you’re creating some sort of replicated copy that pushes that data up to the cloud and doesn’t work fluidly with the existing data policies of what you’re trying to do. In a scenario of, you’re trying to archive content off, and before you actually archive the content out of whatever that content might be, you create another copy of it. That copy then gets pushed out to the cloud as opposed to just tiering that content at its root of what you’re looking to send out and putting that other copy fully out in the environment. Not creating multiple sets, multiple copies in the data center local as well as pushing a replicated copy out to the cloud. You want the application to be able to bring it back in fluidly and not just have another copy that’s residing out there.
What will the health system data center of the future look like?
It will have a lot of cloud components. That’s evident by a lot of the solutions are evolving more and more into SaaS-based models. Software as a service is pretty consistent in this space more and more, especially within the EMR space. I don’t ever see that there will be a limitation in the fact of the clinical applications and how they continue to grow. It’s not that you can ever run into just having a server shop. There’s always going to be, in any of the ‘ologies, specialization. Associated with specialization comes specific applications to support the clinical needs of those particular ‘ologies. There’s still to this day constantly new apps that are created that are a little more specific, that are a little more detailed, that a cardiology department would prefer to have in their environment that some of the larger entities won’t be able to take on. It will always be a dynamic growth. There will always continue to be multiple applications.
Infrastructure is back on the strategic list for health systems because of big data needs, system breaches, and mobile workforce requirements. How are CIO’s responding to those needs?
With a lot of those challenges around the infrastructure, organizations are trying to play catch-up. They are challenged. That’s why simplification of the application set is always a positive piece. That’s why people are interested in talking with us and what we do because it is simplification. It is not adding multiple layers to do an operational component. They have enough complexities with the clinical applications and the dynamics of what those pieces need. To add to that mix with an overly complex infrastructure with operational tools that run on top of that infrastructure only exacerbates the problem to the HIT organization that has to manage and operate the solutions to support the clinical environment.
It’s always top of mind and that’s why we’re having so much momentum and so much growth in the healthcare space, not just in the US, but globally as well. We have HIPAA but across the board. Everyone sees that as the direction that they need to manage and maintain from a compliance standpoint in their given country. The EU has their approach just as much as you have the compliance components that they’re attempting to do in South America. That has definitely driven some organizations to want to minimize the issues of operational and infrastructure, to start to simplify that, as opposed to making it more complex like the clinical applications continue to do.
Do you have any final thoughts?
We’re seeing a lot of points around the whole BYOD piece. The bigger concern becomes the BYOC component, the “bring your own cloud.” Everybody can sign up for a free 5 gig of their local provider. We’ve had a number of organizations that want to start to collapse that and start to bring that back inside. It has a lot to do with that compliance component of the unstructured data, because when you have any of those free 5 gigs, it is only unstructured data that usually gets pushed up into there. Spreadsheets with patient information, PHI residing in it, documents that are really more in the unstructured context. We’ve seen a lot of conversations that come up around that.
Another area is retention policies. The challenge with healthcare is there’s a variety of policies that are out there depending on the age of the patient and the retention of the data, but because the policies are so tiered and varied and they’re very specific to a patient, it becomes challenging to turn around and do anything when it comes to retention. With that, the retention policy for basically everybody we talk to seems to be forever. They don’t just have retention policies for the age of the patient or if the patient is deceased after a certain amount of time. This just complicates that data growth in the data center. That means data is never going to pare down –it’s only going to get bigger and larger. The data centers can only house so much. It comes back into that cloud message of how do you drive that one.
I work with the ISVs in the clinical app space. I work with the servers, the Epics, the Meditechs, all these organizations. I will say that the conversations have picked up more to the fact of understanding how to support retention and how to pare data off, where in the past, it was really the brute force approach of, " The data’s going to get bigger, so just throw more storage at it." Now the conversation has shifted to the fact of, "How can we truly start to minimize storage costs for our customers?"
We have more and more conversations that are, in business development, at a partnership level with those ISVs in the clinical app space as well, not only on the EMR but on the PACS space, to come up with an approach of, how do you truly start to let them pare data off? How can we have content-aware policies that aren’t just policies that you set against a date and say, "After three years, we’re going to push it over here?" Specifically, it’s three years old and it’s for a 40-year-old male who tore his ACL because we’ve haven’t seen that particular patient in 10 years — now we’re going to take and move that data.
Comments Off on HIStalk Interviews Jay Savaiano, Director, CommVault
President Obama and HHS Secretary Silvia Burwell announce a new initiative tasked with bringing private and public stakeholders together to broker agreements that will push the industry toward value-based reimbursement models faster. A large cohort has joined the initiative, including Anthem, Cigna, Dignity Health, Kaiser Permanente, Partners Healthcare, Rite Aid, Walgreens, and Walmart.
Representative Phil Roe, MD (R-TN) re-introduces a bill that would establish a $50 million innovation award for anyone that develops an integrated DoD/VA EHR. Oddly, the announcement makes no mention of the DoD’s ongoing $11 billion EHR procurement.
In England, the NHS launches a mobile app library of clinically-vetted mental health apps. The new site is the first in a larger effort to consolidate digital health apps for a broad range of conditions.
Athenahealth reports that 98 percent of its customer base has attested for MU2. The company is also announcing that it will extend its ICD-10 and MU guarantees to also include PQRS and Shared Savings Program support.
Vox analyzes medical research findings over the years, finding that only six percent of published medical studies are well-designed and relevant enough to influence patient care, but that despite this the number of published studies has increased 300 percent in the last 25 years.
Twenty Things Vendors Need to Know About ONC’s New 2015 (Stage 3) Certification Program, But Were Afraid to Ask By Frank Poggio
On March 23, late on a Friday afternoon, ONC published two drafts of the proposed revisions to the 2015 Test Criteria along with new Stage 3 provider MU attestation requirements. Two separate large documents were published:
Electronic Health Record Incentive Program, Stage 3 Draft Rule, (300+ page PDF)
2015 Edition Health Information Technology (Health IT) Certification Criteria, ONC Health IT Certification Program Modifications (400+ page PDF)
The first covers the proposed rules for MU Attestation for Providers under Stage 3. The second addresses proposed test criteria and requirements for vendors and revised operating rules for the Accredited Certification Bodies (ACB).
Already there has been a great deal of discussion on the first MU requirements document since it impacts all providers, while the second document is aimed at vendors and system developers and has received little attention . I commented on the MU provider piece on HIStalk earlier this week and will focus now on the impact on vendors and system developers. Some of my vendor clients have been calling and emailing me asking, “What’s changed for us?” Others are afraid to ask.
Suffice it to say there are some major additions and revisions to the test criteria and process that will give system developers heartburn, or maybe a K51.914 (ICD10=ulcer).
Before I dive into the document, let’s remember that back in 2013 ONC disconnected the MU Stages from the certification test versions. The concept that a vendor is Stage 2 or Stage 3 certified is almost meaningless since a provider could MU attest to Stage 2 using either modified 2011 test criteria or the 2104 criteria. With the eventual issuance of these new 2015 criteria, for a short period providers can Stage 2 attest using a vendor’s 2014 certified product, or if available, the vendor’s 2015 certified product.
All 2015 Test Criteria are now referred to as the 170.315 regulations. At this time, these are just draft proposals that will be formally published in the Federal Register on March 30, 2015. Then after a 90-day comment period, some revisions will be made, with the final regulations issued in the July-August timeframe.
Using the last two cycles of draft rules versus final issued regulations, I predict that some 90 percent of what is now proposed will be adopted into law. So fasten your seat belts — here we go. Some highlights (or lowlights? are:
Privacy and Security (170.315 d1-d7). There are some minor changes in several of these tests, such as access, time outs, integrity, device encryption and audit logs. But now under 2105 testing, they have become mandatory if a vendor wants to test out on other criteria, such as Demographics. The P&S tests were mandatory under 2011 (Stage1), then ONC made them optional for 2014, now they are back in the mandatory column. To paraphrase ONC, it’s all due to the never-ending march of data breaches. An added requirement to P&S which is stated in the MU regs, but not in any specific test criteria, is vendors now must attest to having completed a HIPAA risk analysis of their product whenever they install new releases or updates. Here’s why. In order for providers to be compliant with MU and HIPAA, they will have to get an attestation from the vendor before they install any update, the provider MU regulations state on page 64: EPs, eligible hospitals, and CAHs must conduct the security risk analysis upon installation of CEHRT or upon upgrade to a new Edition of certified EHR Technology.
Demographics 170.315a4. ONC wants coding for language and ethnicity to support all 900 OMB codes and all RFC 5646 ethnicity codes. But ONC acknowledges that a drop-down list of 900 data elements might cause workflow problems, so they have said a full drop-down list is not required. You just need to show in a test you support all the codes and can tailor the list for each provider client.
Vital Signs 170.315 a6. All values must have LOINC codes. Data elements have been expanded and pediatric vitals have separate criteria.
Advance Directive (170.315 a17). Now you have to electronically capture and track the AD. No more just check a box and who cares what file drawer it’s in.
Medical Implants (170.315 a20). Must now be tracked and reported.
Social, Psychological, and Behavioral data must now be captured and tracked using LOINC and SNOMED coding. (170.315 a21).
Clinical Decision Support tools must be linked to Knowledge Artifacts formatted in the HeD standard Release 1.2. (170.315 a22).
New “decision support – service” (170.315 g6) certification criterion requires technology to electronically make an information request with patient data and receive in return electronic clinical guidance in accordance with an HeD 1.2 standard.
New CDA standard (170.315 b1). The C-CDA standard is now the single standard permitted for certification and the representation of summary care records. An updated version, HL7 Implementation Guide for CDA Release 2: Consolidated CDA Templates for ClinicalNotes (US Realm), Draft Standard for Trial Use, Release 2.076 includes the following changes: addition of new structural elements: new document sections and data entry templates: New Document Templates for: Care Plan; Referral Note; Transfer Summary. New Sections for: Goals; Health Concerns; Health Status Evaluation/Outcomes; Mental Status; Nutrition; Physical Findings of Skin, etc.
CDA system performance (170.315 g6). As part of the focus on interoperability, ONC is requiring performance standards for data transfers of CCA/CCR. Data transmission of CDAs will be tested for volume and response times.
XDM packing of View/Download/ Transmit and CCR/CCD with incorporation of industry APIs using the IHE-IT infrastructure standard.
Data Portability has been broken out into Send /Receive as separate components (170.315 b6).
Care plans (170.315 b9). ONC proposes to include the “assessment and plan of treatment,” “goals,” and “health concerns” in the “Common Clinical Data Set” for certification to the 2015 Edition. The “assessment and plan of treatment,” “goals,” and “health concerns” are intended to replace the concept of the “care plan field(s), including goals and instructions” which is part of the “Common MU Data Set” in the 2014 Edition.
CQM (170.315 c1). Has been expanded into separate segments: filters, create, import, and calculate.
Quality Management System (170.315g4-g5). Now includes an “access-ability technical component” in accordance with ADA. The QMS must be mapped to a federal guideline or industry standard. (No more home-grown QMS process/tools.)
Safety Enhanced Design – SED (170.315g3). Expanded and requires specific and detailed usability test documentation. ONC recommends following NISTIR 7804176 “Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records” for human factors validation testing of the final product to be certified. They recommend a minimum of 15 representative test participants for each category of anticipated clinical end users who conduct critical tasks where the user interface design could impact patient safety.
Authorized Testing Bodies (testing agencies) are now required to conduct surveillance (audits) on at least 5 percent of vendor installs (or max of 10) every year to verify that the certified system in fact meets each certified test criteria.
Attestation for Price transparency. ONC wants vendors to disclose on their web site and in marketing materials material system limitations. The vendor must also disclose any material add-on costs such as transaction fees to support interfaces/interoperability, etc. and supply any requesting entity a reasonably accurate cost estimate of total system costs. That’s ANY requesting entity, not just prospects or for bid requests.
ONC wants monthly reports from the testing agencies on provider complaints and counts of vendor updates and modifications. If the number of updates/modifications exceed a set number, ACB is to call vendor back in for re-testing.
ONC predicts the rules and test criteria will be finalized by mid-summer and vendors will work “aggressively” in 2016-17 to modify products and meet the target date of 2018 to support Stage 3 provider attestations, which will require a full year of calendar data from providers.
ONC estimates that all vendors together will have to invest approximately $300 to $400 million to effect all these changes. They calculate there are 81 unique vendors with certified products, hence an average cost of $4-5 million each, which does not include the time and cost to go through the test process.
ONC states they will continue with the “Gap” test process, meaning if you passed a test criteria under 2014 and there were no (or minimal) changes for the 2015 criteria, you get a bye. Given the preceding, my advice is if you’re a vendor that is not yet 2014 certified, you really want to get it done sooner rather than later. My experience tells me that being 2014-certified for as many criteria as you can before the 2015 criteria are cast in stone will be a better place to be.
Lastly, ONC states that the 2105 Test Criteria and Stage 3 Provider MU Attestation rules will be the last Stage for MU, but that the rules and test requirements will continue to be revised and expanded as ONC deems necessary. I guess we can next expect Stage 3.1, along with revised test criteria 2015 dot 1,dot 2 … can anyone see a light at the end of this tunnel?
A brief preliminary statement from the American Hospital Association on the Meaningful Use Stage 3 draft says the government “continues to create policies for the future without fixing the problems the program faces today,” referring to the 2015 flexibility rules. Nobody else has had much to say about the draft, probably because it’s mind-numbingly long, was released late on a Friday yet again, and is increasingly irrelevant to providers who realize the strategic advantages they lost just to collect relatively small taxpayer handouts.
Reader Comments
From Opie: “Re: RelayHealth. Is in negotiations to sell their nursing call center and care management business to a private equity firm. The division has struggled with the business model and profitability for many years. The business has lost several key management members over the past year and they have deployed Rod O’Reilly to make a determination if McKesson can grow RelayHealth or if they should sell the entire business.” Unverified.
From Clinic Director: “Re: MU audit hell update with 96 of our 139 Epic-using providers audited. CMS was responsive and the auditor, Figliozzi and Company, offered to instead perform a fast-track pilot sample. If a EP doesn’t meet MU, the sample will be expanded, but if all EPs in the sample meet MU, the remaining audits will be cancelled and all EP payments will be released. Since we had already gone through so many audits, the remaining audits were cancelled. Great news!” I was impressed with the professional and reasonable response of Peter Figliozzi and CMS following up on the practice’s request. Well done all around.
From HIStalk Fan: “Re: BJC. Their website finally confirms their Epic project.”
HIStalk Announcements and Requests
Let us review 2009’s stellar “HITECH: An Interoperetta in Three Acts” by Ross Martin, MD, MHA and The American College of Medical Informatimusicology. Ross usually makes an inspired appearance at HIStalkapalooza, so perhaps you’ll see him on stage there.
I rarely look at readership stats, but for some reason noticed that Monday’s page views were the second-highest in the seven months since I had to switch stats counters, with 11,084 page views and 8,291 unique visits. January 20 had 13,509 page views for reasons I don’t understand since I hadn’t posted anything unusual.
I don’t consume many healthcare services since I’m healthy (and having worked forever in hospitals, I’m anxious to avoid them), but a recent experience reminded me of why the billing process is so frustrating to consumers. I went to the ED in March 2014 after being urged to go there by the urgent care center doctor (who was of questionable clinical skill) checking out my dizziness that turned out to be nothing, was kept overnight and tested endlessly because I had insurance and the malpractice-wary hospital was reluctant to send me on my way without commendably trying to answer the unanswerable (via a head CT, nuclear stress test, and tons of labs and EKGs, all of which showed nothing abnormal). I received the first bill from the hospital’s contracted ED doctor service nine months later in December 2014, which claimed I needed to pay $1,500 immediately since my account was being reviewed for collection due to the non-response of my insurance company. I left phone and email messages for the ED doctor billing company and was promised a quick response that still hasn’t come. I contacted my insurance company, whose nice lady said the ED doc billing company hadn’t even requested my medical records until nine months after my visit, which violates some sort of policy or law, so they basically told them to take a hike. The insurance company said they would talk to the ED doc billing service, so we’ll see what happens. I have to wonder what’s going on with that billing company that it took nine months to send a bill, but again, inefficiency abounds in healthcare.
What I dread most at the HIMSS conference: as a non-coffee drinker, I’ve always made fun of the mile-long line at Starbucks, which looks like a well-dressed morning rush at the methadone clinic. I’ve started drinking coffee in the morning, so I’ll have to decide if I want or need it badly enough to stand in that line myself. Thank goodness for in-room coffee makers.
The process of getting an HIStalkapalooza invitation hasn’t changed since 2008 – watch for the extensive notices in HIStalk, sign up, and hope you get picked before we run out of spots. Sponsor support allowed me to invite 1,400 people this year vs. 600 last year. Great, I thought – unlike last year, maybe I can get some actual work done instead of arguing with entitled people who think they should have been invited psychically since they didn’t otherwise express interest until after registration was closed. This year’s invitations went out and Lorre has already received over 100 emails from people requesting (sometimes demanding) additional invitations for guests, clients, and executives. They will all be politely turned down as will walk-ins that night – the count has been turned in, badges are being printed, and I’m on the hook personally for the $200 per attendee event cost if we run over our guarantee (like if the traditionally high no-show rate drops unexpectedly below the SWAG estimate we’ve built in). The massive HIStalk organization is maybe two FTEs total and we’re buried in our own pre-HIMSS work, so we don’t have time to individually debate the clearly explained process that 95 percent of people seemed to follow just fine. Last year I was so disgusted I was just going to give some whiner my ticket and hit a bar alone instead, which isn’t off the table for this year either.
I was thinking about the overuse of the word “disruptive,” usually by startups trying to convince investors and prospects that their lack of size and market traction is only temporary. I’d like to see the adjective reserved for companies that not only have the self-assessed potential to disrupt, but have actually done it.
Listening: YelaWolf, small-town rap from Gadsden, AL. I need to listen more to make sure I really like it, but my first impression is positive (other than his apparent need to have his hand planted firmly in his crotch for emotive rapping).
Webinars
March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line.
Acquisitions, Funding, Business, and Stock
Humana reconfigures some of its existing population health businesses under the Transcend name: Transcend, which will offer management services (the former Humana MSO) and Transcend Insights, the IT group (the former Certify Data Systems, Anvita Health, and Nnliven Systems).
Sales
Continuum Health Alliance (NJ) selects Caradigm for population health management.
MedStar Mobile Healthcare (TX) chooses the Infor Cloverleaf Integration Suite.
Maury Regional Medical Center (TN) will implement Professional Charge Capture from MedAptus.
People
Galen Healthcare Solutions promotes Jason Carmichael to CEO , Mike Dow to CIO, Erin Sain to COO, and Justin Campbell to VP of marketing.
Paul Holt (Quality Systems) joins NantHealth as CFO.
Englewood Hospital and Medical Center (NJ) names Dimitri Cruz (North Shore Long Island Jewish-Lenox Hill Hospital) as VP/CIO.
Barnabas Health (NJ) hires Stephen O’Mahony, MD (Norwalk Hospital) as CMIO.
Announcements and Implementations
The Physician Alliance (MI) expands its rollout of Wellcentive’s population health management solution.
Athenahealth says 98.2 percent of its AthenaOne users successfully attested to Meaningful Use Stage 2 in 2014. It also extends its MU and ICD-10 guarantee program to PQRS reporting and MSSP quality measures.
Hearst Health and the Jefferson School of Population Health of Thomas Jefferson University create a $100,000 award for outstanding achievement in managing or improving wellness.
Privacy and Security
SAP fixes bugs in its EMR Unwired mobile clinician app that would have allowed hackers to add phony information or change existing data.
Innovation and Research
I missed this item from a few weeks ago: Walgreens adds information from PatientsLikeMe to its personal health dashboard, allowing people who are taking a particular medication to see what side effects others have reported. Most side effects are subjective and questionably attributed to a drug that has no physiologic rationale (“Tylenol makes me hungry”), so this development is both brilliant and worrisome as patients may fail to consider that every drug has side effects, most side effects are rare and transient, and the prescriber has already weighed the risk vs. benefit. Yelp is great for finding a restaurant based on the sometimes iffy reviews of people you don’t know, but I’m not sure the science of medicine is improved by patients reacting to anecdotal reports.
Technology
Robert Wood Johnson Foundation gives Partners HealthCare a $468,000 grant to help people choose, buy, and use fitness trackers to create a personal fitness plan, which will be followed by a study of volunteer users that will look at outcomes. .
Other
Richmond-based lab vendor HDL will pay $50 million to settle DOJ charges that it gave doctors $20 per blood sample in kickbacks. HDL made hundreds of millions of dollars running cardiac biomarker tests, claiming that it paid doctors only because its competitors did. The company’s three co-founders pocketed $50 million in distributions in three years, while the two owners of its contracted marketing company personally took home $173 million.
Vox questions whether the dramatic rise in medical studies leads to ungrounded public enthusiasm for miracle cures, nearly all of which never pan out. Stats: only 6 percent of submitted single-study journal articles are accepted; of 49 highly cited studies, 14 were later proven wrong or had less impact than originally thought; and 85 percent of annual global research spending is wasted on studies that are poorly designed or redundant. It partially blames news outlets that don’t understand that “new” isn’t definitive when it comes to medical research – it’s the old, unexciting studies that have been validated by further research that change the human health.
Someone tweeted out this brilliant article that has healthcare startup implications, “The Battle Is For The Customer Interface.” Uber doesn’t own cars, Facebook doesn’t create content, and Airbnb doesn’t own real estate. “These companies are indescribably thin layers that sit on top of vast supply systems ( where the costs are) and interface with a huge number of people ( where the money is). There is no better business to be in … Our relationships are no longer with the service providers … In the modern age, having icons on the homepage is the most valuable real estate in the world, and trust is the most important asset. If you have that, you’ve a license to print money until someone pushes you out of the way.”
Sponsor Updates
RelayHealth Financial announces a new version of its RelayAccount online patient billing solution.
Meritage ACO (CA) announces that it has lowered its readmission rate to 10.2 percent using an evidence-based hybrid care model and ZynxCarebook care transition on mobile devices.
Impact Advisors posts “Meaningful Use Stage 3: Summary & Early Impressions.”
ADP AdvancedMD offers “6 facets of patient safety within a small private practice.”
Capsule Tech will exhibit at the HIMSS Middle East Conference and Exhibition March 31 – April 1 in Riyadh, Saudi Arabia.
Clinical Architecture offers the last installment of its blog series on precision medicine, plus a thorough summary of Stage 3 Meaningful Use objectives and measures.
Clockwise.MD Founder Mike Burke shares what he’s learned in the startup world at the #30in30 event at Atlanta Tech Village.
CompuGroup Medical will exhibit at the AMGA 2015 Annual Conference March 23-26 in Las Vegas.
Reactions to MU3 are beginning to trickle out, with AHA’s senior vice president of public policy issuing a statement today saying “The release of today’s rule demonstrates that the agency continues to create policies for the future without fixing the problems the program faces today.”
Former NYC mayor Michael Bloomberg partners with the Australian government to launch a $100 million, four-year project aimed at implementing birth and death registries in countries across Africa, Southeast Asia, and Latin America in order to begin to analyze causes of premature death.
Ignorance of the Major EMR Software Vendors is Not Bliss By Tyler Smith
We in healthcare IT have found ourselves in a pretty sexy industry. You know that is true when Silicon Valley is practically banging down the doors to get in and KPCB’s John Doerr states that he would really like to see an open source competitor to Epic created. Damn, so Valley money admits it is losing to a slowly built behemoth in Madison – not a brand spankin’ new startup it missed an angel round on.
Needless to say, HIStalk’s Startup columns are a quite timely addition to the blog. I particularly enjoyed reading Marty Feisenthal’s explanation of the elite JPM conference. Having heard about the conference from banker friends (not HIT colleagues), his column removed much of the mystique. Being a fellow Atlanta resident and having visited the Atlanta Tech Village before, I also have greatly appreciated Michael Burke’s articles on the experiences of an HIT founder in Atlanta.
I recently co-founded a startup that aimed to bring efficiency to the Epic staffing arena by using very simple tools already in place in other industries. I do not want to call it the Uber of Epic staffing – for fear of sounding like a hack – but the basic idea was a connection platform with ratings for Epic certified consultants. While we have put the project on hold due to some shakeups on our technical team and also due to slow buy-in from provider organizations (our target clients), the pause in the action has given me time to reflect on the current state of HIT startups – particularly those looking to nibble on the enterprise EMR vendors’ scope of services.
Along with Mr. H and most readers here, when anybody from the outside comes and brings a new idea to the HIT table, I am usually skeptical. For starters, most entrants do not understand the complexity of the hospital / provider organization buyer or the provider organizations’ importance in the system. In theory, I love the idea of patient advocacy and patient-centric apps, but if providers or the systems that house them aren’t buying it, you better have something that patients see as life or death (read: an HIV curing drug, not a sleep tracking app) if you want them to fight the entrenched stakeholders for you or with you to make your startup relevant or widely used to truly create positive clinical outcomes.
Secondly and most importantly, many of these outsiders do not understand the current state of the EMR vendor landscape, and if they do, they arrogantly think they can steal market share while the enterprise systems watch from the sidelines. True, Epic and Cerner’s UX can appear very basic from an end user stand point and it often appears that the enterprise systems do not appear to be covering even close to all the functions that could be automated in a hospital or healthcare delivery organization. However, it would be naïve to think that these vendors have no big plans to tackle all of these remaining un-automated functions in the near future. When they do, unlike many of the new startups, these vendors will be able to simply make an additional sale to their already heavy client lists instead of having to undergo the arduous process of breaking down the doors to just get on the approved software vendor list at a major healthcare system.
The truth is that healthcare IT is a B2B market, not a consumer market. Organizations do not make purchasing decisions overnight, and thus while an app may actually do something better than an organization’s EMR, it better be a lot better for a healthcare provider organization to consider even meeting with the startup’s sales team.
This is not to say that I think that clinical apps which could be potentially developed and which will lead to improved clinical outcomes should not be attempted. What I am really saying is that before delving into development, HIT startup founders should take a much more serious look into EMR current state.
Even more importantly, startups should also consider what logical next steps vendors will be taking in their product offerings and research timelines as the massive implementation phase winds down and optimization becomes a priority for the vendors’ in house development teams. If there really is a competitive advantage which the startup has over these behemoths in the development of an EMR related application, then by all means go for it. But if not, it is probably best developing something far outside of the current or near future EMR vendor scope.
Easy for me to say as I sit on the sidelines and consult on EMR projects, I know. And you can object and say I’m siding with the status quo. Regardless, it pays to do your homework on the massive vendors. They aren’t going to crumble and they certainly aren’t going to let their clients get on products that encroach on their turf without a very solid battle.
In closing, I would ask any hopeful HIT entrepreneur: what is your startup doing that an established EMR vendor could not accomplish without a system update or by adding a new application which would seamlessly integrate with their current lineup?
Selling to a Health System Is Like Breaking Your Arm By Niko Skievaski
"Selling to a health system is like breaking your arm." I’m speaking with J. Simpson over a Chick-fil-A in the sticky mist of the three-story fountain at MD Anderson in Houston. Many things purchased for UT System’s health campuses come across her desk at the UT System Supply Chain Alliance, MD Anderson Cancer Center included.
"When you break an arm, the cast will be on for six weeks. There are plenty of things you can do to aggravate it and extend the pain, but there’s really nothing you can do to get rid of it faster. Sometimes you never really recover."
She’s referring to the notoriously crippling 12-18 month sales cycles in healthcare enterprise sales. You crack your ulna on the way into the sales meeting. If you’re lucky, you’ll get a purchase order in 12 months. However, most of the time you’ll be looking at up to 18+ months, if you get through at all. The problem is rooted in one thing that startups know very little about: budgets.
The budget for an upcoming fiscal year is approved about a month before that prior year ends. A month before that, department managers submit their budgets up the chain. And another tick before is when they start making "first cuts," where they generate a wish list of expenses for the next year, rank, then start hacking away. This process highlights the opportunity costs. If you want that toy, you’ll have to put down the others.
What this means for us is that if we haven’t already gotten a resilient thumbs up by first cuts, we’re not going to get allocated in that budget cycle. Hence, 12-18 months. Operational budgets are negotiated by employees at every level, and contrary to entrepreneurial optimism, there is no extra play money in the budget. For the most part, we’re talking about businesses that run an extremely tight ship with increasingly small margins. So what can we do?
Ride the cycle. It’s pretty easy to find out the fiscal year of most of these organizations. Check out Guidestar.org. Most hospital systems operate as non-profits, hence the razor-thin budgets. Search for the hospital, click the “financials tab,” and voilà! Fiscal year-end minus three months gives you your target close date. Use this knowledge to allocate your time effectively as you work your pipeline. If you just missed a lead’s cycle, change your flight and drop in on someone else.
Avoid the cycle. I’ve been describing the operational budget process. Things like that sweet software licensing contract you’re selling end up here. The other way they spend money is in the capital budget. These are one-off, large purchases of equipment or buildings (and the things that go inside them). If you can package up your offering as a one-time expense, you might be able to dodge the cycle. Otherwise, if you can get the purchase under $5K, you can bypass budgets all together. Those purchases can typically get swiped, invoice-free, on the department head’s corporate card. However, those cards are a one-shot-deal, so don’t count on using this for recurring revenue.
The pilot close. The idea is to sell a free pilot, contingent on being written into the budget next time. This is a slight variation on the usual pilots we see pitched. Try to time your pilot so that your evaluated in time to get into the upcoming cycle. The most important part here is that your pilot has a definitive close date (the “initial term” in contract lingo), a point when you can ask them to shit or get off the pot. Identify the metrics, date of measure, and what it will cost you to give it away for free for a while. Negotiate this up front with the pilot terms. This smooths the process along and makes it much more likely to be included next go-round.
Stop selling to enterprise health systems. Think of another revenue model that won’t be fraught with such dire peril. For instance, Lily Truong has an amazing gadget that you shove in your ear to (gently) drill out your ear wax. It’s 100 times better than a Q-Tip and less invasive than the normal saline flushes that pediatricians frequently push on terrified toddlers (and I’m not going to mention that weird candle thing). Wouldn’t all the clinics and children’s hospitals want to get their hands on one? Maybe, but Truong’s business will likely fail before she could get through the sale. Rather, she’ll ditch the cycle and bring her gadget into patients hands directly through sales off her site and consumer retailers. It’s a shame that the best tools won’t be used for the job in the doc’s office, but at least you can pick one up at the corner drug store and the innovation wasn’t wasted. Maybe that was an easy example, but I’ve seen people spend months trying to close enterprise deals when there’s a better buyer just around the river bend.
Hopefully some of these strategies will help. I’d like to thank Jess for dropping some knowledge on us youngsters. And to pad her resume, she’s likely one of the only people in any purchasing department who has actually done sales for a startup. It’s a breath of fresh air knowing there’s at least one out there, right?
March 23, 2015Dr. JayneComments Off on Curbside Consult with Dr. Jayne 3/23/15
Just when I was excited that spring had finally sprung, our friends at CMS and ONC have dumped a load of snow on my proverbial daffodils by releasing the Meaningful Use Stage 3 proposed rule along with the 2015 Edition Health IT Certification Criteria. Although it proposes to “simply the meaningful use program,” I find it hard to believe that the 301-page rule and corresponding 431-page certification criteria can be viewed as simple. As an example, there is a four-and-a-half page glossary of acronyms near the beginning.
Having sat through the first two parts of the trilogy, I know Hollywood would have helped me out by breaking the third installment into two full-length features. Alas, we aren’t that lucky with federal regulations and we’re squeezing it into three parts, much like Shakespeare’s Henry VI. I really did try to get through it, but I think the last five or so years of reading so many regulations have shortened by attention span. I hoped if I delayed into the weekend that Mr. H would read it and provide a pithy digest, but it seems he’s thrown in the towel as well.
Glancing through, they do note that, “Stage 3 of meaningful use is expected to be the final stage” which brings a sigh of relief. However, starting in 2018, all providers would report on the same Stage 3 definition of MU regardless of prior participation. Everyone would be on the same playing field regardless of their start date, which certainly does make things simpler. It makes it nearly impossible, however, for those who have not yet started to play the game.
I liked the proposal on page 15 to remove “topped out” measures, which they believe are “no longer useful in gauging performance, in order to reduce the reporting burden on providers for measures already achieving widespread adoption.” Sorry for the easy “A” grades, folks, you’re going to have to continue to work for it. There will, however, continue to be four categories of exceptions:
Lack of Internet access or barriers to IT infrastructure
Time-limited exception for newly practicing EPs or new hospitals
Unforeseen circumstances such as natural disasters
Exceptions for EPs with limited interaction with patients or lack of control over EHR availability for those of us practicing at multiple locations
The estimated federal cost to continue the incentive programs between 2017 and 2020 is approximately $3.7 billion. They do mention that “we do not estimate total costs and benefits to the provider industry” because those would be difficult to estimate. We all know that our EHRs cost far more than the $44,000 we might be receiving through Meaningful Use. Additionally, I’m not sure what the neck and back pain that some of us experience after hours at the computer might be worth if we asked for compensation. That’s not to mention the anxiety of dealing with all the virtual I’s that have to be dotted and T’s that have to be crossed to receive the incentive payment and/or avoid a penalty.
Pages 20-23 give a nice overview of the regulatory history and if you’re interested in the definitions they start on page 24. I admit, though, that my concentration started flagging around page 30 and I decided to call it a night. The 60+ patients I saw earlier in the day (will flu season never end?) started to catch up with me as did the glass of Simi cab. I’m going to have to work my way through it over the course of the next week, but I’m still crossing my fingers that the Cliffs Notes version will come out soon.
I feel for the vendors that have to read both the proposed rule and the certification requirement documents to be ready for clients who are going to start asking how vendors plan to handle the requirements before anyone has barely had a chance to digest them. Not to mention, this is still just a proposed rule and subject to public comment and potential revision. Although we don’t expect too many changes based on the historical track record, there still might be a few. I always enjoy reading some of the public comments and I’m sure those will be good for discussion in a few weeks.
I’m still a relative youngster in the medical trenches, but reading the proposed rule did make me nostalgic for the so-called good old days that I barely got to experience in practice. I was already nostalgic after a patient encounter earlier this week, when I had the privilege of caring for one of my medical school professors. He retired the year my class graduated and happened to need care while visiting his grandchildren in my city. When I saw the name come up on my census, I couldn’t help but think of my teacher. I’m sure I was beaming when I walked into the exam room and realized it was indeed him. I’m just thankful his issue didn’t involve his specialty of head and neck so I didn’t feel like I was on the hot seat again.
I do miss the continuity of traditional family medicine, so it was nice to make that kind of connection with a patient. I can’t help but think that my class gave him more than a little heartburn and might have contributed at least a little to his retirement decision back in the day. Luckily his problem was minor, but I have to say that seeing him made not only my day but possibly also my week and my month. I went into medicine to connect with people, but I feel that connection is being lost as the healthcare system evolves. After a bright spot like that, sitting and reading government regulations just makes me sad.
I’m sure lots of other CMIOs, medical directors, and informatics pros will be digesting the regulations this weekend. I’m going to finish unwinding and get ready for a big week of budget meetings and discussion about the further evolution of my team.
I asked last week how others unwind after a long day. Several respondents cited wine or other adult beverages, but an equal number mentioned physical activity as a stress reliever. Swimming, cycling, and horseback riding also made the list. As long as the snow stays away I’ll be out in the garden, marveling at the tender shoots and the promise of things to come. For tonight, however, I’m going to close my eyes and count not sheep, but pages in the Federal Register.
March 23, 2015NewsComments Off on ZeOmega Acquires HealthUnity
Population health management system vendor ZeOmega announced this morning that it has acquired HealthUnity, which offers private and public HIE, MPI, referral management, and patient consent interoperability solutions. ZeOmega says the combined products will form a low-cost PHM infrastructure that overcomes EHR interoperability issues and allows payers and providers to drive value-based care.
I discussed the acquisition ahead of the announcement with Nandini Rangaswamy, co-founder, EVP, and chief strategy officer of ZeOmega.
Vendors of EHRs, HIE platforms, and population health management systems are all addressing population health management and analytics and insurance companies have acquired some big HIE and PHM players. What does the competitive landscape look like from ZeOmega’s perspective?
Hundreds of EMR, analytics, and HIE companies are trying to make a name in population health management, but they’re viewing PHM too narrowly. Competitors have some ingredients, but ZeOmega has an end-to-end strategy, anchored by what we call five pillars of PHM that includes the ability to drive an effective PHM program design and governance, aggregate data on the patient across the care continuum and all care settings, derive actionable insights from this data, enable effective real-time care coordination with those insights, and the ability to educate, engage and empower patients.
Acquiring HealthUnity lets ZeOmega close gaps in interoperability and patient resolution to become the industry’s first end-to-end PHM solution. So it’s my perspective that no other company can compete with our comprehensive offerings. That said, we will be competing with other companies who only have solutions for part of the care continuum. We’re so focused on doing what’s right for our clients, most of all eliminating information barriers to achieve real value-based care, so we probably will end up collaborating with come competitors’ solutions. We won’t shy away from that if it means enhancing value for our clients.
How do claims and psychosocial data fit into the set of information providers need to review a patient’s healthcare status?
In absence of interoperability, claims data can tell us about a patient’s health and their care-seeking and care-adherence behaviors. Psychosocial data can be used to determine factors that help influence and therefore predict patient behavior and outcomes. Analytics solutions that consider these variables can better predict the recommended course of action for the provider, which translates to more efficient use of provider resources while maximizing opportunities to impact patient health.
It’s easier to use an example. Let’s say a patient is being admitted for bypass surgery. Claims data can show if the patient has multiple co-morbidities, is taking multiple medications, or has a prior diagnosis of diabetes or a history of depression. Good analytics processes this data and identifies the patient as high-risk for readmission and hospital associated infections, perhaps even ICU psychosis, and may recommend an action plan to mitigate these risks, whether it’s by focusing on infection-risk areas or through medication reconciliation or tighter care transition.
Psychosocial factors can help determine the patient’s readiness to change. If an individual at high risk for diabetes is not motivated to change due to a situation in the family, the best thing to do may be to leave him alone until that situation changes for the better rather than spend costly resources to try to engage that patient.
Managing populations requires not just data, but making that data actionable so that busy clinicians don’t have to pore over records looking for ways to intervene proactively. How well is the industry transitioning to that model?
The industry is starting to see the value of actionable insight as they grapple with the challenge of providing timely and effective care while taking on outcomes risk with fewer resources. The industry is facing an information overload. It now also recognizes that insights from data alone are not sufficient.
Analytic capabilities can provide insights based on the data. However, if that insight isn’t actionable, then an organization may end up using valuable resources to translate that insight into the right action. For example, it’s relatively easy to tell from the claims data that an individual has diabetes but no foot exam and therefore has a gap in care. Actionable insights recommend a course of action. So knowing that the diabetic is a single mom, eligible for Medicaid, and at home with a sick child helps determine that the next best thing to do is to schedule a home health visit to cover the foot exam or provide for temporary child support so that the patient can make it to the doctor’s office. PHM platforms that deliver this effectively will make the industry’s transition to this model quicker.
How will you integrate HealthUnity’s offerings with those of ZeOmega?
HealthUnity’s portfolio of interoperability offerings – whether it’s their private and regional HIEs, patient resolution solutions, patient consent solutions, or referral management — are very complementary to ZeOmega’s solutions and will be offered as part of the Jiva PHM stack. Technologically, the integration between the HIE, master person index, and Jiva PHM platforms lets us develop a rapidly deployable infrastructure that payers and providers alike can leverage to better coordinate care and improve outcomes.
How does the acquisition fit with ONC’s interoperability roadmap?
ONC laid out 10 guiding principles and building blocks in Connecting Health and Care for the Nation. Acquiring HealthUnity helps ZeOmega meet ONC principles even better, whether that be flexibility, configurability, adaptability, reusability, simplification, modularity, privacy and security, or scalability and access.
For example, HealthUnity’s HIE supports multiple industry data exchange standards. Its Universal Patient Consent solution empowers the individual to designate which provider can see specific portions of their health record, while capabilities such as EHNAC-certified direct messaging capabilities enable providers to collaborate even though some may have less sophisticated infrastructure than others.
The HealthUnity acquisition further strengthens ZeOmega so we can continue making investments to keep our company and our clients in lockstep with the ONC’s 10-year vision.
ONC publishes Meaningful Use Stage 3 proposed rules and 2015 Edition EHR certification criteria, with public comments open until May 29. The rules establish a single definition of “meaningful use” that all hospitals and providers will have to meet by 2018, attempts to streamline quality reporting burdens, and introduces a number of new patient engagement objectives.
Vermont Gov. Peter Shumlin acknowledges that despite nearly $125 million in spending, the state’s health insurance exchange may need to be shut down and replaced by Healthcare.gov.
The Wall Street Journal reports that in the last 25 years the healthcare industry has grown to the point that it now employs more workers than any other industry in 35 states.
A local paper covers El Camino Hospital’s (CA) $125 million Epic implementation. The hospital is finalizing its build and will move into system testing next month as works toward a targeted November 7 go-live.
HHS, CMS, and ONC publish proposed rules for Meaningful Use Stage 3 and 2015 Edition EHR certification criteria. The announcement was posted as a Word document, bizarrely, and late on a Friday afternoon as is always the case. The Stage 3 rule is here and 2015 certification criteria here. Your comments are welcome, both here (any time) and at the Federal Register links (by May 29, 2015). I’ll be honest in saying that I’m so sick of the topic that I haven’t even bothered to read either document. I’m sure the many special interest groups will call out the parts they find objectionable and thus are probably the most needed. Feel free to chime in on parts you find interesting or surprising.
Reader Comments
From Yours in Nomenclature: “Re: SNOMED-CT MOOC. It’s going to happen. I might sign up since my work bumps against it.” The College of St. Scholastica offers a free massive open online course (MOOC) called “Exploration of SNOMED-CT Basics” that starts April 20. Registration stays open until May 18 since the student just needs to finish the course by June 15. It offers 12 AHIMA CEUs. The instructor is Mike Grove, PhD of Accenture.
From Paul: “Re: Epic’s Deep Space architecture award. While I must congratulate Judy, I just left Verona with a sense of dismay at what our organization has been putting up with to build this place — north of $400 million by estimates — for a forum we’re only visiting once a year.” I think they should have concerts there. It would be fun to go to Verona for training and then walk over to see Rush or U2.
HIStalk Announcements and Requests
Two-thirds of poll respondents don’t think Congress will insert another surprise ICD-10 delay into SGR legislation, a belief that seems well founded in the draft versions presented so far. New poll to your right or here: which company do you trust least to make information exchange common and inexpensive? Of course I’m fascinated to learn why you voted as you did, so click the “comments” link afterward and explain.
I’ve emailed the 13 CMIOs who expressed interest in attending my HIMSS conference lunch on Tuesday, April 14. I still have a handful of spots left. I don’t often volunteer to pick up the lunch tab, so it’s a rare opportunity.
I’m really getting annoyed at half-wits who think it’s hilarious to use “FHIR” as “fire” in creating a lame pun for a headline or tweet.
Listening, as I was taking an extended drive and used Siri’s “what is this song” option to get the titles of the radio tracks I liked best as I constantly scanned: Christian rocker Matthew West’s “The Motions,” The Smashing Pumpkins with “Today,” a forgotten classic by the indefatigable Butthole Surfers, “Pepper,” new from Incubus, and my favorite song (nearly 40 years old) of the amazing Electric Light Orchestra.
HIStalkapalooza
HIStalkapalooza invitations have been emailed. Spam filter problems are rampant these days, so I’ve added a second level of checking: see this page, which lists who was invited in a somewhat de-identified format (first three letters of the last name, comma, and first two letters of the first name). We cannot accommodate walk-ins or guests, so the security people will admit only those who are on their full registration list. Some sponsors didn’t submit their guest lists in time, so if you’re being invited by one of the event sponsors and aren’t on the list, you should be getting an invitation directly from that sponsor.
I’ll take a second to again thank the HIStalkapalooza sponsors that are making it possible for a large number of folks to attend the event. Several of those listed are going above and beyond, with Sagacious, for example, running guest check-in and badge printing and Elsevier managing the traditional red carpet entrance. These companies are springing for dinner, drinks, and entertainment, so it seems reasonable that you click their links in return to see what’s new with them.
Speaking of red carpet, here are skeletal details of the ever-popular HIStalkapalooza fashion awards, where your hot shoes will be burning down the avenue (Dearborn Street in this case). We’ll have four winners: best shoes male and female and then best overall appearance, also male and female, which will earn the HIStalk King and HIStalk Queen sashes, since like high school, we overly emphasize appearance because it’s all we have time to evaluate. Plan to enter early (maybe 6:45 to 7:15) via the red carpet, where our distinguished judges will cast their critical eyes feetward and then full body. Your regular host Jennifer Lyle of Software Testing Solutions serve as expert along with one of our patient scholarship winners Amanda Greene, who was involved with the red carpet at the Oscars this year and who works with fashion magazines. We’ll bring the four winners up to the stage to be sashed.
Last Week’s Most Interesting News
A proposed Congressional SGR “doc fix” bill would make health IT interoperability a national priority to be achieved by the end of 2018 and proposes to penalize those who intentionally obstruct it.
A contracting billing company’s employee falls victim to a phishing scam, exposing the information of 14,000 patients of Sacred Heart Health System (FL).
Cerner and Athenahealth chide Epic via Twitter for its non-participation in CommonWell following its negative comments about the organization in congressional testimony.
Premera Blue Cross discovers that hackers have had access to its 11 million patient records since May 2014.
Meditech reports full-year 2014 results that include an 11 percent drop in revenue and profits that were reduced by 7 percent, although the company had previously restated its financials and that change may have affected the totals.
CHIME offers a $1 million prize for an idea or technology that increases patient ID matching from the current 80 percent to 100 percent, although presumably members of Congress who could enact national patient identifier rules are not eligible.
Implementation of New York’s mandatory e-prescribing law is delayed for a year, to March 27, 2016.
Webinars
March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line.
Acquisitions, Funding, Business, and Stock
Vince Ciotti has been tracking vendor annual revenue for decades. Here’s the first installment as he introduces the episodes to follow. He confirms the feeling I’ve had that HITECH goosed company revenues for a couple of big years, but that has tailed off and left a lot of software and consulting vendors scrambling to resize themselves appropriately.
People
Valence Health hires Kai Tsai (PwC Consulting) as EVP of consulting services and strategic initiatives and Mary C. Anderson, MD (Rush University Medical Center) as medical director of population health.
Karen Wavra (Allscript) joins Beacon Partners as Cerner practice director.
Announcements and Implementations
The headline “El Camino says goodbye to paper medical records” wasn’t written during its TDS implementation in the 1970s – it describes El Camino Hospital’s (CA) $125 million move to Epic.
Surescripts names 24 health systems and technology vendors for its “2014 White Coat of Quality Award” for electronic prescribing.
Government and Politics
This is a scary graph. Healthcare is the highest-employing industry in 35 states.
An editorial in the Burlington, VT paper applauds an announcement by the governor that if Optum can’t get the state’s insurance exchange working by October, he’ll shut it down and move to the federal exchange. The state will have spent $198 million in federal taxpayer dollars by the end of 2015, with unimpressive results following screw-ups by CGI that resulted in its replacement by Optum.
Acting VA CIO Stephen Warren says that even though the DoD is shopping for a commercial EHR, the VA will stick with VistA because it was developed for patient care rather than built around billing as were commercial systems.
Technology
Good Morning America goes inside Apple’s secret fitness lab, where employee volunteers tested various sensors and technologies over the past two yeas without knowing their work was for the development of Apple Watch.
Other
A Virginia Peninsula newspaper points out that the region is one of the first in the country in which all competing health systems (Bon Secours, Riverside, Sentara, and Chesapeake Regional Medical Center) use the same EHR, Epic in their case. Like a lot of newspapers and marginally informed pundits, this article mistakes HITECH as being part of the Affordable Care Act, but this one takes it a step further in proclaiming that hospitals didn’t start testing EHRs until the 1990s and that just two major players remain (Cerner and Epic, forgetting about still-common but somewhat fading Meditech).
UnitedHealthcare runs a cute commercial that features an ICD-9 code and virtual visits.
Bob Wachter, MD, pitching his new book, writes a New York Times editorial whose content he summarizes via Twitter as “Why health IT is so bad and how to make it better.” The former was mostly anecdotes and I didn’t see much of the latter: his suggestions are: (a) train doctors to focus on the patient, not the computer; (b) create new ways to practice provider teamwork in the absence of a shared chart; (c) create federal policies that promote interoperability; (d) increase collaboration between academic researchers and software developers. Doctors may hate EHRs, but all it took was $44,000 in federal money to get them to use them. My argument would be that doctors should redesign the encounter system so they don’t need to use computers at all unless they need its help — doctors are the only professionals (accountants, lawyers, psychologists, plumbers) who key their own information into the computer instead of focusing entirely on the paying client sitting in front of them, and not only that, do most of their keystroking for the benefit of someone other than themselves. You could argue that medicine is the only profession that is practiced as a team, which might hit Bob’s second point, but I’d still say bring on the scribes and let doctors be doctors and not the medical equivalent of the grocery store checkout clerk. Everybody agrees that the information needs to be recorded, but it’s not reasonable that the highest-paid professional in the medical food chain be the one doing it.
Bob Wachter tweeted out an interesting excerpt from his book as he quoted National Coordinator David Brailer responding to the question if ONC would shrink itself as the HITECH money runs out. “Bureaucracies don’t retrench,” Brailer said. “ When a bureaucracy that starts out as the Candy Man runs out of candy, it goes dark and turns into Regulatory Man.”
Anyone who attended HIMSS09 in Chicago saw the weather change from a near-blizzard on Sunday to pretty good later in the week. Here’s what the not-so-bad weather looked like at O’Hare on April 12 of previous years (the Sunday opening day of this year’s conference):
2014: low 42, high 69, rain 0.43 inches. 2013: low 34, high 45, trace of snow. 2012: low 40, high 66, no precipitation. 2011: low 36, high 68, no precipitation. 2010: Low 48, high 63, no precipitation.
The family of a Virginia radio personality who died after routine hernia surgery is awarded around $2 million from the hospital and its PCA pump manufacturers. Nurses mis-programmed the pump and delivered five times the ordered dose of narcotic, which just about everybody agrees was because of the device’s complexity, although the manufacturer claims the nurse hadn’t been properly trained, didn’t monitor her patient, and waited eight minutes after finding the patient unresponsive before calling for help.
This photo, which a paramedic took surreptitiously as a California ED doctor grieved after his 19-year-old patient died, has received a lot of Internet attention after being posted on social media. Minutes later, the doctor had moved on to his next patient with his game face on. It’s a good reminder that a hospital is just a very clean hotel with a lot of expensive executives and non-clinical hangers-on – lives get saved, as they do on the battlefield or in an ambulance, by a well-trained fellow human who is willing and able to help.
Sponsor Updates
Shareable Ink’s ShareQuality technology is featured in Nashville Medical News.
Voalte CEO Trey Lauderdale shares his belief that “With Apple ResearchKit, mHealth Springs Forward.”
Zynx Health will exhibit at the 2015 Population Health Colloquium March 23-25 in Philadelphia.
The SSI Group and ZirMed will present at the Region 4 Mid-Atlantic HFMA Education Conference March 24 in Baltimore.
Verisk Health will exhibit at the AMGA Annual Conference March 23-26 in Las Vegas.
A new bill in Congress calls for the permanent repeal of the SRG, but also names health IT interoperability a national priority to be achieved by the end of 2018.
AHRQ publishes a study comparing the differences in how laboratory results are displayed across eight EHR systems. The study was based on 11 criteria for the proper display of lab data. None of the vendors met all 11 criteria, and some deficiencies were misleading enough to have a significant, negative impact on patient safety.
Apple reportedly began working on ResearchKit in 2013, having been inspired by a MedX presentation by Stephen Friend, MD on the future of medical research. During his presentation he describes his ideal platform, “Here you have genetic information, and you have what drugs they took, how they did. Put that up in the cloud, and you have a place where people can go and query it, [where] they can make discoveries.” Apple VP of medical technologies Mike O”Reilly was in the audience.
It was good to get away from my day job last week. I spent my days off seeing patients and intentionally not checking my hospital email account. I’m aggravated at how things are going with our upcoming EHR migration and how my team is being treated, so I thought unplugging would be therapeutic.
Initially we were told that our team would be transitioned to the new project and placed in similar job roles. Our ambulatory group continues to acquire new practices and a small team would remain to continue implementing at those sites as well as to support existing sites. We communicated this to the team and they were comfortable with the approach.
About a month ago, the plan changed. Leadership decided that they want to structure the team more consistent with what the vendor recommends. Now we’re looking for a fairly large number of project managers and plan to hire a completely new training team.
I’m reading between the lines and thinking that perhaps they don’t want people with experience because they’re worried about preconceived notions of how an implementation should look. New trainers will certainly be easier to mold to a new paradigm, but I have serious concerns about throwing away as much cumulative experience as our team has. In addition to being solid trainers, they understand our physician base and how our offices run. The offices trust them and see them as advocates.
Before I left for vacation, our leadership informed the staff of this new plan and essentially told people to get their resumes in order. If they want to move to the new project, they will need to apply for the project manager positions. Most of my team members thrive on the front lines and on working directly with users. If they had wanted to be project managers, there have been quite a few opportunities during the last couple of years. On the other hand, they don’t want to be stuck turning the lights out on a dying project and risk being let go at the end.
Because of flip-flopping by the leadership, the team is nervous and scared. At this point, I don’t know what to tell them. I’m still in limbo regarding my own position. I’ve seen at least half a dozen variations on the proposed clinical leadership structure and none of the positions have jumped out at me as being a good fit for my particular skill set. Like the team, I’ve been told to get my resume in order. Once the positions are posted, I can apply along with the rest of the CMIOs that are being consolidated.
We’ll have three days for internal candidates to apply before the positions are posted externally. It goes without saying that they’re going to hire a new system-wide CMIO who has experience with our new vendor, so at least we’re not all fighting each other for the top job. Postings are supposed to go up next week, but they’ve already been delayed several times, so I’ll be surprised if they are there before HIMSS. Once I see what is available, I’ll make my final decision on whether I’m going to stay or fly the coop.
Most people find uncertainty to be disconcerting. For me, it’s been somewhat liberating because I’ve given up on trying to figure it out. This might be the first time in my life that I haven’t had a plan. I’m starting to understand how my colleagues that fly by the seat of their pants feel every day.
After my week off, I came back to work much more relaxed and ready to see what the next curveball might be. We’ll see how long that lasts, based on the craziness that we’re thrown on a daily basis.
In the mean time, there’s always room for pastry therapy. In honor of St. Patrick’s day I made some outstanding cupcakes that a friend had suggested I make. I just may have found my new favorite buttercream frosting recipe. Slainte!
It’s surprising that the therapist admitted to the patient the AI was used, although the therapist was so obviously frustrated…