Morning Headlines 1/20/15

The Role of Health Information Technology in Care Coordination in the United States

A study evaluating the role that health IT systems play in coordinating care finds that a higher percentage of physicians using HIT received patient information necessary for care coordination than those who did not use HIT

ACOs make progress in using big data to improve care

Modern Healthcare takes a look at the slow progress being made as ACOs work to roll out effective data analytics systems.

2015 Top 10 Hospital C-Suite Watch List

ECRI names 3D printing, Google Glass, telehealth, and alert fatigue to its 2015 hospital c-suite watch list.

Cleveland Clinic joins 5 Ohio health systems to form statewide healthcare collaborative

The Cleveland Clinic, along with five other Ohio health systems, have formed the Midwest Health Collaborative, which will share information in an effort to improve quality and reduce costs within the state.

Curbside Consult with Dr. Jayne 1/19/15

Several readers have sent words of encouragement after reading about my last few weeks in the CMIO trenches. I definitely appreciate all of my virtual colleagues, even those who just write to say they understand and to wish me calmer seas. It sounds like many of us are going through the same trials and tribulations even though some of ours may be a little messier than others.

Our hospital is part of a larger health system that has announced its intent to replace all the clinical systems with a single vendor platform. I’m taking a couple of days off this week to really put my thoughts around whether I want to stick around to watch it happen.

I understand the need to consolidate systems. Our IT department is larger than nearly any other except for nursing. The budget for maintaining this “ultimate best-of-breed nightmare” is exorbitant. Many of our systems feel like they’re held together with duct tape, baling wire, and bubble gum. Some of them are just plain old. And several hospitals are on a platform that is being sunset by the vendor, so their systems simply have to go.

Being part of the larger project to turn this new single-platform vision into a reality is potentially exciting. But it also looks a little bit like a bottomless pit of long hours with not enough staff to work at a pace that would allow us to deliver a quality system without burnout. It’s also difficult to know that the health system has plans for how they plan to handle legacy clinical data that will not make our ambulatory physicians very happy.

Those of us that are “in the know” about the strategy have to keep quiet until it’s formally announced. I’m not used to being told what I can and can’t say to the physicians I serve.

It’s also bittersweet to watch systems be torn out when you’ve spent the better part of your professional career building them. We’ve held our users’ hands while they learned them and while they coped with upgrades. We’ve been at the other end of plenty of angry phone calls, but we’ve also heard the appreciation when we started to provide data to help proactively manage complex patients and to identify gaps in care. Of course our new system will also do this, but it was special to see how physicians reacted the first time they realized it was possible. Now those features have become old hat.

In addition to consolidating systems, our leadership also plans some pretty radical consolidation among hospital leadership and medical executives. We’ve always functioned as a federation, but this is taking us much more towards a centralized clinical and financial model and it’s not entirely welcome. A couple of chief medical officers have already moved on and I suspect a couple of hospital-level CMIOs and CNOs are planning to move as well.

On the non-clinical side, however, mid-level administrators seem to be proliferating. The number of buzzwords in an average hour of meetings has skyrocketed. We have four different consulting companies involved and they’re stepping all over each other with contradictory advice.

I’m not sure I want to leave the provider aspect of the CMIO game. There are definitely opportunities out there, but I really don’t want to relocate unless something pops up in Hawaii, in which case all bets are off – the idea of living in a place where the difference between winter and summer is 10 degrees does have a certain appeal. I just started clinical work with a new group that has a lot of promise and an extremely low chaos factor, which is a welcome change. I also spent the fall doing a ton of work on my garden and can’t imagine walking away.

There are some interesting vendor opportunities that don’t require relocation, but I’m not sure about crossing that bridge. My friends in the vendor space seem less stressed than those of us on the provider side (except during Meaningful User certification testing, in which case I recommend either steering clear or providing copious amounts of wine and moral support). It will be interesting to see if any new opportunities arise as we get closer and closer to Meaningful Use Stage 3.

Consulting is also an option, but I’m not sure I can handle being on the road as much as most of the larger firms expect. I’ve also heard the horror stories about being on the billable hours hamster wheel. I’ve dabbled in consulting over the last several years and would consider going out on my own as long as I have some ongoing clinical work as a financial safety net. I’m not enamored of what clinical practice has become in the last decade, however, so going full-time is not an option.

Today was my day to relax and think about nothing work related, but tomorrow is my day to sit down, run the numbers, and see if I can come up with a business plan that might fly. Wednesday I’m getting together with a couple of colleagues in the same boat, where we can trade ideas and see if anyone else has come up with a better plan. Thursday I’ll be back in the office, and it will be interesting to see how that plays since I’ve pledged not to touch my email or answer my phone while I’m out. Appropriate backup resources are in place, but I know my boss isn’t used to being unable to reach me. He’ll just have to get over it.

Here’s to crunching the numbers and hopefully to some new ideas about my next career move.

If you could do anything you wanted, what would it be? Email me.

Email Dr. Jayne.

Startup CEOs and Investors: Brian Weiss

Common CommonWell Thoughts (or, Who is Working on A National Social Being Identifier?)
By Brian Weiss

Did you read the CommonWell piece on HIStalk?

Mr H. did us all a great service in providing a platform for directing HIStalk reader questions to the CommonWell alliance from Cerner and company. Yes, I know that only 60 percent of the panel responding to the questions actually works at Cerner, but my articles are too long already without listing the full membership of CommonWell. I hope you’ll forgive me if Brightree isn’t the first vendor that jumps to mind when I think about CommonWell.

Given the fact that CommonWell is not consistently spelled “Commonwell,” we need to be especially appreciative that Mr. H gave them publishing space. I’m only allowed to write this article because I named my company “Carebox” even though I’m still waiting for the first person not related to me to spell it that way rather than “CareBox.”

Now, if you’re reading this article (clearly you are) and you still didn’t read that one (and you’re not related to me), you need to do a better job prioritizing what parts of HIStalk you read. We’ll all wait for you here while you go read that piece.

The Alliance

CommonWell is an “alliance.” I’m pretty sure that was selected over “empire” in the tight balloting in the CommonWell name-calling subcommittee because of the whole “Star Wars” context. For those who slept through the relevant decades, the “Alliance” is what you call the good guys, and if you’re reading this article and never saw “Star Wars” (even if you’re related to me), you really need to work on overall life balance.

By the way, I’m not 100 percent sure they have a formal name-calling subcommittee at CommonWell and, yes, I’m aware that the term “name-calling” has other connotations that have little do with HIT (OK, maybe a little).

From the questions that appeared in that article and the comments building up afterwards, it appears that there’s a bit of debate among some readers of HIStalk as to whether this alliance really gets to wear the orange jumpsuits and fly the Y-wing fighters. I’m not interested in getting into that debate. However, given my recent self-appointment as the voice (representing nobody) of innovative (self-labeled) startup companies that are seeking to leverage consumer healthcare data in various applications and services, duty calls! Give me just a minute here to adjust my cape. OK, ready …

Is a Patient in HIT a Subordinate Clause of Their Provider?

The quote I want to focus on from the CommonWell article is this one:

A single connection to the CommonWell network will enable providers and the patients they serve to access to [sic] their health information at all those various systems and organizations and won’t require peer-to-peer contracting for each provider you need to reach.

I was busy doing my math homework when we were in English grammar class so I don’t know if “and the patients they serve” is actually a subordinate clause or not. I’ve got a sinking feeling, though, that the high-sounding “serving the patient” expression doesn’t change the fact that whoever wrote that sentence views patient access to their own data as “subordinate” to the healthcare IT vendors and their healthcare provider customers. And nobody can mistakenly think that the “you” in “each provider you need to reach” from the quote above, refers to the patient/consumer.

The Missing Patient Service

I went to the CommonWell services page and I couldn’t find the service whereby a patient can request a copy of their healthcare records from everyone on the CommonWell network.

Interestingly, the word “patient” appears seven times on that page. There is talk of how to “link patients across organizations” and “patient identification” and even “patient-authorized.” But as far as I understood, that all seemed to be in the context of how providers exchange information with each other behind the patient’s back.

In both the body of the article and the comments section, there was quite a bit of back-and-forth about payment models and how the revenue pie should be shared among CommonWell members (vendors), the doctors who contribute the data, and McKesson (the company that got picked to provide the service).

There were also some interesting analogies made to financial transactions. Indeed, I believe there is a whole world of “behind the consumers’ backs transactions” that take place across financial institutions and in other EDI contexts. But at the end of the day, as a consumer, I can get a (free) copy of all of my transactions from all of my financial providers. And I can use a service like mint.com to act on my behalf and make it easier and more valuable for me to do that.

I’m not saying that’s the ideal model, is consumer-centric enough, or (conversely) is directly/fully appropriate for healthcare. But it’s interesting to think about how it works relative to how things are intended to work – and not only in CommonWell – when it comes to healthcare networks.

Curiously, I don’t recall that there was a need for Congressional involvement in order to establish a National Banking Identity for everyone. If I want to establish a mechanism to transfer money from my checking account to my mutual fund account, I set that up and provide the authorizations. As far as I know, the mutual fund company and the bank aren’t part of an “alliance” that provides “identification and linking services” to make sure they correctly match my bank account with my mutual fund account so that they can move information about me between them once they get me to sign a consent form I don’t fully understand while I’m at the bank teller.

What’s Your National Photographer ID?

Given how tough it is to do patient matching (I have a little MPI experience and it really is pretty tough), I’m amazed that Instagram has manage to get as far as they have without a National Photographer ID. How come LinkedIn doesn’t need my National Employee ID and Facebook doesn’t need my National Social Being ID (or my National Annoying Communicator ID for WhatsApp?)

It seems that by some miracle, armed with nothing more than an e-mail address, I can securely and reliably authorize any sharing network I want about my most sensitive information. Oh, wait, there is one catch — I have to be a little involved in process.

If my mom and my wife want to share information about me without me being involved (scary thought) then I suppose they would indeed need some kind of ID and matching process to ensure they aren’t sharing information about someone else when they use their “record locator service” to access each other’s database of information about me. But if I have my information stored with each of them in my e-mail-keyed (and easily validated) account that I maintain with each of them (hey, it’s an analogy, relax) and I authorize the sharing, it doesn’t need an act of Congress to get the information flowing.

This is Not Just a CommonWell Issue

Now if it sounds like I was being disingenuous above about not taking sides on CommonWell while adjusting their Darth Vader helmets, that’s a mistake. As far as I can see, CommonWell is mostly providing a more practical and commercially effective model for what the US government said it wanted to do all along in terms of national health networks – with the usual vendor politics and dynamics in play, as is to be expected.

Whether it’s FHIR as per my previous article, CommonWell in this one, Epic openness debates, or evaluation of data interoperability strategic roadmaps, I think one of the litmus-test questions has to be something like this:

How does your (standard, service, alliance, network, system, strategy, roadmap) empower a consumer to exercise their HIPAA-mandated right to get an electronic copy of their healthcare data and share it with (family, caregivers, providers, research groups, pharmacist, clinic, employer, people who will pay them for it, whoever) whenever they want?

CommonWell may have a better answer to this question than most, but it isn’t shining through yet clearly enough for me in their article on HIStalk or on their web site.

Is that a question from the noble, bright, and good part of the Force? Not necessarily. It’s as self-serving as anything in the CommonWell materials or anything else. I have a smaller company than Cerner to try and make successful, so if anything (deliberately using that word a third time in this paragraph – and breaking the flow of the paragraph – again – so I can generate some loyalty from the commenter who critiqued my problematic writing style in my last article), I can afford to be even less altruistic.

In the interest of transparency, I’m working on a draft resolution for my upcoming board meeting to have our name-calling committee allow me to swap out “CEO/Founder” for “Emperor.” I’ll let you know how it goes.

Brian Weiss is founder of Carebox.

HIStalk Interviews Ted Reynolds, SVP, CTG Health Solutions

Ted Reynolds is senior vice-president of CTG and is responsible for CTG Health Solutions. 

Tell me about yourself and the company. 

I’ve been in healthcare since the 1970s. My first go-round was in June 1979. I started off working for a hospital, the last of which was Stanford, and worked for a couple of vendors. Then I went to the dark side and went to consulting.

CTG is a long-established firm, having been around 48 years. I lead the healthcare division, which includes payers and providers. We’re one of what KLAS used to call Tier 1 firms. We provide a full breadth of services — advisory, planning, implementations, technical services, and application management. People know us a lot for legacy support since we do as much of that as anybody in the country.

CIOs are getting pulled in a lot of directions. What are they focusing on most?

Oh, boy, they’re getting pulled in all directions. A lot of them have been chasing Meaningful Use dollars trying to get EMRs implemented. But in the future, it’s going to be very confusing as people start to transition from volume- to value-based payments, whether you call it an ACO or population health or whatever. Those are going to be very complex. It’s going to change the paradigm to where you’re going to be reimbursed for not doing work. It’s going to be very interesting to see how they evolve. I think it’s going to be difficult for them.

What projects are requiring people to call you for help?

Because we work on the payer side, we help a lot of organizations as they move into the ACO world. We’ve been helping a lot of them set up patient-centered medical homes. We’ve been doing planning for that — getting tied into the physicians, helping them do evaluations of systems they should look at. We’ve worked for some of the payers in looking at what they need to do to help them manage the populations.

This is kind of like HMOs II. In the early 1990s, it didn’t work very well. A lot of them, candidly, really didn’t have the data. Most of them were trying to manage their populations using claims data. That’s like trying to drive a car looking in your rear-view mirror because the data is two months old. Now with EMRs, I think they will have more success.

But there were still some early successes back then. Kaiser and some of the large group models actually succeeded and survived, but a lot of them did fail because they couldn’t manage the risk. I’m hoping that we can see something that will drive the cost down. That’s going to be a lot of the challenges we’re seeing with the groups. 

A lot of the hospitals and large physician groups are looking are mergers and acquisitions. Who do you play with, how big do you need to be to absorb a risk. Because if you start going in some sort of capitated risk arrangement, you’ve got to have a pretty large financial base to survive.

Interoperability isn’t just a technology problem because hospitals don’t have much incentive to share risk with competitors. What are they telling you about their desire to exchange information with other health systems?

You hit the nail right on the head. A lot of them are competitors and they do not want to share their information. I don’t want to make it easier for you to steal my patients from me.

But I think you’re starting to see more and more of that break down as we go forward. If they go with some sort of at risk where they share any risk for a population, they’re going to have to share their information. I think that’s going to break down the barriers. That’s what we’re seeing. It is a technology issue, but also there’s a lot of issues I think socially we’ve got to understand and get over.

For example, in the United States, nobody wants you to know anything about them until they’re unconscious on the ER table. Then they want you to know all the information. Maybe it’s too late then. Whereas you’re seeing in Europe things like national patient identifiers. We’re not willing to step up and do that yet from a political perspective. It’s quite interesting.

I spent a third of last year over in Europe. They have big advantages. Most of them have a single-payer system, socialized medicine. I’m not sure that’s the way we need to go over here. I’m not sure that would be the solution.

But what they’ve done is that everybody has a national health identifier. They have issues with some certain percentage of the population like we do with immigrants, but they’ve addressed that. If you look in some of the northern parts like Denmark, some of them have a national patient identifier. They have national patient portals so they can look at the information. They have a national registry that has all the drugs, all the hospital visits, all the physician visits. They can inquire into those. The technology is not very conducive to use because it’s not one integrated system, but at least they do have access to it.

Some of them legislated that all the primary care had to implement an EMR about six years ago now. Because of that, they have a lot of information. Most of the care both here and there is provided in an ambulatory setting. That’s where you’re missing a lot of the information. Same thing here in the states. Hospital EMR implementation is further along than the physician offices, but it’s getting there very quickly.

Are providers here supporting the idea of empowering patients or are they resisting it?

They are moving to where more and more of them are encouraging it. But if you look at healthcare, it compares to the banking industry. In some ways, we’re back years and years ago when the banking industry started rolling out ATMs.The local banks could not afford to roll out an ATM network, so you started with the regionals buying out the local banks and then the nationals started buying out the regionals. This is very analogous. You wouldn’t go to a bank today where you didn’t have electronic banking or an ATM.

In the future, I think you’re going to see the same thing with what patients are going to expect. You’re going to expect to see your lab results within a day or two by the time you get home. You can schedule your appointments online. You can pay your bills. You can do your medication refills. Why wouldn’t you?

I’ve seen our employees and my previous employees switch which providers and hospitals they’re going to based on who had the patient portals. You’ll see that that’s going to put a lot of pressure. Regardless of what happens with the political situation, patients as consumers are going to expect that, especially the newer population. You have it with banking, which is a lot less complex. Why wouldn’t you have it with your healthcare? We’re starting to see that pressure. Some of the providers aren’t pushing as fast, but in some of the large metropolitan areas, this is already happening, where they have large EMRs already installed.

After the Sony Pictures breach, are you getting a lot of security-related inquiries from hospitals trying to figure out how to make themselves more secure?

Yes, we are. Not as much as I would expect, though.

How do you think cybersecurity fits into all the other things that are on the CIO’s plate today?

It’s a huge risk. The question is, is how much effort and cost do you put into it to prevent it? You see some organizations where it’s getting to become a larger part of their budget to actually try to put all the prevention in. 

A lot of it is just the basics. A lot of it is changing human behavior. Some of the breaches that you see is where people download the information on laptop and it gets stolen. You’ve seen it time and time again and that seems to be a lot. It’s just a matter of continuing education. I think it’s not only a technology issue, but it’s also an educational issue throughout the entire organization.

Health systems aren’t only helping each other with consulting, but also hosting systems such as in the Epic Community Connect model. Is that a threat to your business?

We just finished one of the largest region connects that Epic has done last year. They used us to help them install it because it was an hour and a half. They brought up six hospitals very quickly. I think it was 10 months and ten days from the date they signed the contract.

But it was an hour and a half away from their facilities. It’s hard to ask somebody who’s got a family to drive an hour and a half each way. They didn’t sign up for a travel job. They didn’t sign up for consulting. They want to be home with small kids, participating in their family’s activities at night and things like that.

We helped them what that deployment. Very successful. I think you’ll see more and more of that. However, some of them are starting to get teams who will travel and they’re starting to change expectations of some of their employees, too.

You worked for Epic during some of its biggest ramp-up years. What did you learn there?

That was a lot of fun. What I learned and what I always appreciated is that Epic always seemed to have the client’s interests first and foremost. I got to appreciate the integration that they’ve done between the hospital and the physicians. They’ve done quite well as they deploy that model across the country. 

I had tried to lead a development effort for that back in the 1980s for a company that McKesson now owns. They saw the integration dream. You’re seeing a rise of a lot of the integrated vendors. Cerner’s doing well, Epic’s doing well, and then probably Meditech. A lot of the other ones are struggling as they’re trying to integrate the packages. You’re seeing that in the market today.

What do the best health system CIOs do that the others don’t?

The ones that are the most successful see IT as an enabler and can help the organization drive value from the system. You try to drive it to where it has a true return on investment. It may be clinical quality, it may be patient safety. But also, you have some quality indicators and you involve the operational organization in trying to drive benefits from the system.

I’ve always been a believer that you don’t put in technology just for technology’s sake. You put it in to try to help improve your business operations. Clinically, financially, attract patients to your facility, one of those. The ones that have engaged the operational organization do the best and they take it out of the framework of being a pure technologist.

Do you have any final thoughts?

HIStalk is one publication I read religiously. It’s timely, it’s accurate, and I really enjoy it. It’s to the point. I love Dr. Jayne — she’s got a very pragmatic approach to things.

I think healthcare is going to change a lot. We’re finally getting automation to the degree to where we really can make a difference. With the advent of genomics, we’re going to see a pretty dramatic change in the next five years over personalized medicine to where you can really, truly provide the best, cost-effective care. A lot of the things we treat today don’t provide the highest quality for the least cost. I think we’ll get there, hopefully very quickly, because now we got the information that we didn’t have before.

Morning Headlines 1/19/15

Official Who Led Medicare Through Insurance Shakeup Is Resigning

CMS administrator Marilyn Tavenner resigns, telling staffers in an email that February will be her last month. Tavenner joined CMS in February 2010, just before President Obama signed the Affordable Care Act, and went on to oversee the troubled rollout of Healthcare.gov in October 2013.

Electronic Medical Record Provides Dartmouth-Hitchcock Pathologists Powerful Tool to Push Best Practices in Transfusions

A new EHR alert implemented at Dartmouth-Hitchcock Medical Center (NH) has significantly reduced the improper use of two-unit blood transfusions for non-bleeding patients.

ER visits still rising despite ACA

At ERs with traditionally high patient volumes, annual visits have only gone up since the rollout of the Affordable Care Act, with one physician speculating that “More people have insurance, but the cultural norm has been to wait until they’re sick to seek care. As they get educated, ER use will go down over a period of years.”

New Department of Biomedical Informatics

Harvard opens a new Department of Biomedical Informatics that will work to leverage new biomedical data streams to develop new methods for research and clinical care. The new department’s advisory board includes digital health pioneer, and Rock Health founder, Halle Tecco.

Monday Morning Update 1/19/15

Top News

CMS Administrator Marilyn Tavenner, most known for her key role in the botched rollout of Healthcare.gov and for miscounting its enrollees to the White House’s embarrassment, resigns. Former Optum executive Andy Slavitt will take the role as interim. Trivia: Tavenner worked her way up from staff nurse at an HCA hospital to president of a 20-hospital HCA division. 

Reader Comments

From VeeDub: “Re: McKesson. Our system uses Horizon Clinicals at several of our hospitals and is just beginning the conversion to a new EMR. McKesson has told us that the last day of support for Horizon Clinicals will be March 31, 2018. I don’t know if this also applies to the rest of the Horizon product line.” Unverified, but McKesson has sent strong signals that sunset is on the Horizon.

From Dollar Short: “Re: CIO salaries. You used to run these. Bring it back!” Since I’m a pleaser, I put together a few for you. I used to calculate the CIO’s salary vs. the non-profit organization’s revenue, but big health systems started gaming that number by setting up management corporations to hide executive salaries and reporting revenue in not very digestible ways. I chose a few big-name CIOs. Who’s up for names and pictures of the million-dollar club? (probably not members of the million-dollar club)

TX: $689,993
MA: $702,153
FL: $616,330
VA: $965,552
FL: $415,676
MA: $812,817
NY: $922,942
NY: $1,206,457
VA: $470,783
TX: $817,753
NC: $674,896
CA: $1,527,838
MA: $415,172
WI: $330,573
AZ: $1,084,140
FL: $1,091,266

From Hold the Mayo: “Re: Mayo Clinic. Will announce its EMR selection (Cerner or Epic) on Tuesday.” Unverified. One of the companies will get a lot of mileage out of that decision, and not long before the Department of Defense is making its choice besides.

HIStalk Announcements and Requests

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

My most recent poll  responses can be sliced and diced in a few ways. Forty-six percent of respondents overall will attend HIMSS15, while 22 percent who went to HIMSS14 aren’t coming this year (but those are outnumbered by readers who didn’t go last year but will this year). Based on that I would ordinarily project a slightly higher attendance for HIMSS15, but I’m not so sure the industry isn’t contracting a bit overall and attendance may not get that boost. New poll to your right or here: has technology significantly empowered patients? I would enjoy hearing your comments – click the link after voting and share your thoughts.

Listening: The Subways, a hard-rocking British three-piece band that puts on a hyper-energy live show (the bravest crowd surf ever is at 45:00 in the video). They’ll be touring to support their new album starting in a couple of weeks, but only in Europe. I’m rehearsing now for my US-based desk-drumming and air-guitaring support.

Last Week’s Most Interesting News

• Google joins the Department of Defense EHR bid team of PwC, General Dynamics, Medsphere, and DSS.
• A whistleblower lawsuit brought by two former NantHealth executives claims the company is “engaged in a multitude of fraudulent activities.”
• Athenahealth acquires small hospital EHR vendor RazorInsights.
• ONC’s numbers show that 77 percent of Meaningful Use Stage 2 eligible hospitals have attested along with 60 percent of eligible practices.

Acquisitions, Funding, Business, and Stock

I’m fascinated by the continued share price decline of former high-flyer Castlight Health, which closed on its first day of trading last March at nearly $40, took a sharp slide immediately afterward, and now sits at less than $9, down nearly 80 percent. The company will announce full-year and Q4 results on February 18, which will be interesting.

Sales

In the UK, Sheffield Teaching Hospitals NHS Foundation Trust selects HP Enterprise Services UK to implement Orion Health’s clinical portal with Imprivata’s single sign-on.

People

The SSI Group names Jay Colfer (Surgical Information Systems) as EVP of sales.

Atul Butte, MD, PhD (Stanford University School of Medicine) will join UCSF to run its new Institute for Computational Health Sciences.

Announcements and Implementations

Practice Fusion adds an online check-in module that collects patient information via practice-customizable online forms, then sends it to its EHR.

Wolters Kluwer Health enhances its Sentri7 surveillance system to support creation of antimicrobial stewardship programs.

Government and Politics

FDA releases draft guidance for “General Wellness: Policy for Low Risk Devices.” FDA says it isn’t interested in treating low-risk wellness products as medical devices. Apps and devices are fine as long as they (a) address general wellness such as weight management, mental acuity, physical fitness, or sleep management without claiming to treat a specific disease or condition, or (b) use accepted medical knowledge to promote lifestyle management to reduce the risk of specific diseases or conditions.  

Privacy and Security

Sensato announces its Hacking Healthcare 2015 cybersecurity conference, March 24-26, 2015 at Ocean Place Spa & Resort in Long Branch, NJ for health systems, payers, technology vendors, and physician practices. It will cover top healthcare security threats (including those involving biomedical devices), dealing with business associates, and developing strategies for addressing current threats. 

A New Jersey goes into effect that requires insurance companies to encrypt patient information on both desktops and laptops.

Innovation and Research

Massively overexposed Mark Cuban, mostly known for being irreverently obnoxious before and after he made a ton of money, will emcee the Impact Pediatric Pitch Competition for pediatric digital technologies on March 16 at SXSW Interactive in Austin, TX. The event will be hosted by Boston Children’s, Cincinnati Children’s, Children’s Hospital of Philadelphia, and Texas Children’s.

Technology

Fascinating: an astronaut needed a wrench, so NASA emailed up a CAD drawing and he 3D printed the tool on the International Space Station.

Samsung offers software developers and researchers a free prototype and development kit of its Simband wrist-based sensor. A tutorial steps through the writing of a heart rate variability algorithm in C, while the company also offers de-identified vital signs test data it will be collecting from research participants. 

Berkeley, CA-based startup Eko Devices announces the $200 Core 1, which clips onto a standard stethoscope to record its sounds to any smartphone or tablet via Bluetooth, allowing doctors to share the sound file in consulting with a remote specialist.

Stride Health launches a Healthcare.gov type medical insurance app that targets 1099 workers, claiming its app is easier to use and suggests insurance options that are more tailored to the user. The app is free since the company gets a commission on the insurance users buy. Mayo Clinic is an investor.

Other

The Seattle paper covers what it calls the “OpenTable for medical appointments” patient scheduling apps, mentioning ZocDoc for medical appointment scheduling and InQuicker for ED scheduling. It quotes a New York dermatologist who says he couldn’t compete without ZocDoc, which sends him 15 patients per week, which seems unnecessary given the stats I’ve seen on long waits to get a new patient derm appointment, but he knows better than me. An ED patient who used InQuicker reports, “There must have been 50 people there, and they took me in 10 minutes,” which surely delighted those other folks who actually showed up and waited as the happy InQuicker user skipped the line for her “emergency.”

Speaking of EDs, Modern Healthcare reports that annual visits keep rising sharply despite the Affordable Care Act, with one ED doc saying, “We’re seeing a failure of access to care” as primary care practices close or stop accepting Medicare. Others say the newly insured just haven’t gotten used to the idea that they can be seen in places other than the ED.

Dartmouth-Hitchcock (NH) uses an EHR best practice alert to improve its blood transfusion practices, reducing the number of questionable two-unit transfusion orders from 47 percent to 15 percent.

Harvard Medical School announces the formation of the Department of Biomedical Informatics, to be led by Isaac Kohane, MD, PhD of Boston Children’s Hospital who co-founded the predecessor organization, HMS Center for Biomedical Informatics. The department will have five core faculty members.

Weird News Andy nominates this as his quote of the year: “Being a corpse was the most bizarre experience, but I’m so glad I managed to get out alive.” An Alabama teen with the rare mental illness Cotard’s Syndrome, in which those afflicted believe that they are literally dead, recovers three years later after psychiatric help and watching Disney movies (insert commercial skepticism or promotional opportunities here, especially since she says she and her boyfriend now want to work for Disney World). Those with the condition believe they are dead and/or immortal, that their body parts are missing or decomposed, or that they can relax only in cemeteries.

Sponsor Updates

• Liaison Technologies CEO Bob Renner dives into five micro trends that will define big data over the coming year.
• Versus client Dan Chambers, MBA, COE, of Key-Whitman Eye Center writes in the January issue of Ophthalmic Professional magazine about RTLS and how the technology improves patient flow.
• Healthwise SVP Molly Mettler reflects on the opening of Healthwise 40 years ago in a new blog.
• The local Fox News affiliate mentions Healthgrades in a story on keeping New Year’s resolutions.
• Healthfinch makes “Another Case for Strategy, Not Just Tactics” in its latest blog.
• Harris Corp. will exhibit at the iHT2 conference in San Diego January 20-21.
• Impact Advisors publishes a white paper, “Optimization: The Next Frontier.”
• Healthcare Data Solutions lists five things to love about pharmacists in celebration of National Pharmacists Day.
• Extension Healthcare blogs about channeling change and your inner Florence Nightingale in 2015.
• Health Care Software Inc. will exhibit at the LeadingAge California meeting in San Diego on January 23.
• DocuSign shares tips on enhancing employee productivity in its latest blog post.
• Hayes Management Consulting shares “Everything You’ve Wanted to Know About Keeping Employees Happy During System Implementations But Were Afraid to Ask” in a new blog.
• SCI Solutions offers a new blog on “Eliminating the Blind Side in Care Coordination.”
• Sagacious Consultants offers insight into improving sepsis detection using Epic in its latest blog.
• PMD’s Siavosh Bahrami offers a new blog on “Mediums of Thought and How I Approach Problems.”
• Phynd CEO Thomas White offers insight into the company’s ROI model in a new blog post.
• PeriGen doubles its PeriCALM customer based in 2014, bringing total estimated number of births supported to 140,032.
• The local paper profiles Perceptive Software’s office in a roundup of Johnson County’s coolest offices. (nice pic, too)
• Nordic releases the third episode in its series on Epic’s Cupid application, covering differentiators and implementation stumbling blocks.
• NVoq shares the top three providers should know about its SayIt speech-recognition technology.
• Netsmart releases two new white papers: ”The Recovery Movement” and ”In Transition: How Electronic Data Sharing Enables Improved Health Outcomes and Reduced Costs.”
• MEA I NEA publishes a new blog entitled, “Connected practices may be hindered by lack of a website; yes, a website.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Reader Survey Results 2015

Thanks to everyone who completed my reader survey. Congratulations to the three winners of $50 Amazon gift cards I’ve sent (I had fun writing an Excel randomization routine to make sure I wasn’t biased in any way in choosing the winners).

I run the survey once per year. It helps me plan going forward. I always like to share some of the interesting feedback I get from it.

I’ll chime in on a few of the comments and suggestions. I should mention that the most common recommendation was, “Don’t change anything.” I appreciate that.

I have a diverse readership, and while it might seem obvious that I should make a given change, that’s from one person’s viewpoint. People have different motivations for reading HIStalk – some want just the top news boiled down, some are scouring for competitive intelligence, and many want to be entertained along with their news. I don’t want to get in the trap of writing by committee no matter how well intentioned the advice, where I please nobody in trying to please everybody. My audience is self-selecting – you either like what I write or you don’t, and I have to make you want to come back every day. It’s harder than it looks sometimes given all the distraction that’s out there.

Some major points from the survey:

• Readers mostly work for hardware or software vendors (47 percent); hospitals, health systems, and practices (27 percent), and 68 percent have at least 11 years of experience in healthcare IT and healthcare.
• The most common job function is IT or vendor staff or management, nine percent are clinicians, and about six percent of readers are CEOs and the same percentage are CIOs.
• The most-appreciated elements of HIStalk are (in order) news, morning headlines, rumors, humor, and Dr. Jayne. The least-liked element is Readers Write.
• Eight-five percent of respondents say they have a higher interest in companies when they read about them in HIStalk.
• The most important survey result is this one: 91 percent of readers said reading HIStalk helped them perform their job better last year.
• More than a third of readers recommended HIStalk to a peer in the past month.

Here are some of the recommendations.

Separate out Dr. Jayne’s Thursday night contribution into its own post for easier reference.

Good idea. That’s easily done. Long-time readers may remember that when Dr. Jayne started five years ago, I ran her post at the end of Tuesday night’s news. Then I had the brilliant idea (that’s not exactly true – a reader suggested it in the reader survey five years ago) of moving her post to Monday nights on its own. Dr. Jayne is a busy lady, so I’ll have to coordinate with her schedule.

Don’t write so much about startup funding.

More people said I should write more about it. I haven’t changed my threshold for what seems interesting or newsworthy about funding — there’s just more of it to cover these days as investors chum the waters. Clinical readers sometimes yawn at the business news and vice versa, but at least the business section is easily skipped (the idea of breaking out posts with subheadings also came from a long-ago reader survey, in fact).

Stop putting so much emphasis on the HIMSS conference and the events you have there.

I agree, although many readers follow that closely. I’ll try to find more substance at the conference to write about, but it seems to be in short supply.

Don’t be so snarky.

The “be more snarky” camp has you outnumbered in their responses, I’m afraid.

Stop promoting Epic so much.

I’ve analyzed my mentions of Epic and they are balanced. Most of the time I’m reporting something newsworthy or that would interest my Epic-using provider readers (of where there are many), and in those cases where I editorialized, it was a pretty even split between positive and negative. Writing about Epic is a challenge because any time I mention them, people who (a) compete with them; (b) aren’t Epic users; or (c) tried to get a job there and failed scream “favoritism.” I write about Cerner’s new campus and nobody says a word, but I mention Epic’s new campus and smoke starts coming out of the ears of some readers who react to the word “Epic” as a bull does to a matador’s red cape. If you think something I say is biased toward Epic, say so in the comments and see if others agree. I do pay attention.

Stop calling Epic’s Judy Faulkner “Judy.” It’s demeaning because you don’t do that with males.

Sure I do. I write about Neal, Farzad, Vince, Ed, and JB (for Jonathan Bush) using only their first names for the same reason – just about everybody knows who I’m talking about because their names are uncommon, unlike Paul, Robert, or John. When I hear people talking about Judy Faulkner, 90 percent of the time they just say “Judy.” I’ve never heard anyone respond with, “Judy who?”

Expand the contributor group – not everybody seeks the spotlight.

The problem is that many people shun the spotlight. I’d greatly appreciate more contributors with different viewpoints, but the single best lesson I’ve learned in 12 years of writing HIStalk is that everybody likes to read, but almost nobody likes to write. I’m always encouraging different people to write Reader’s Write articles, submit their own series of articles, or be interviewed — what you see on the page is what I get (usually vendor people interested in the exposure, which is why people don’t like Reader’s Write). Non-vendors and lesser-knowns, get in touch if you are willing and able to contribute because I’m up for it.

Start a column with new perspective from a pharmacist, lab director, nurse, and others on the front lines.

See above. I’ve asked before, especially for a nurse who writes well and has interesting points to make, but nobody has volunteered and I can’t force them to do it.

Get the contributions of government contractors since they know what’s going on.

Dim-Sum’s contributions about the Department of Defense EHR have been outstanding. I would be thrilled to run more government-oriented pieces, even anonymously, if someone is willing.

Get the contributions of patients and consumers.

I’ve tried getting people for that too with no luck, but at least I’ll have something from HIMSS since I’m providing several scholarships to patients who will attend and write about their experience on HIStalk (more details to follow).

Offer a column, interview, or other collaboration with HIMSS.

We each tend to do our own thing, but I’m willing if they are, assuming it’s interesting to my readers and not just promoting HIMSS.

Offer a column to incubators like Rock Health.

I’ve started with startup CEOs and investors and an incubator or accelerator column would be fun, limited again by the willingness of someone to actually do it. And the complaints of those HIStalk readers who say they’re tired of hearing about startups.

Put on more non-commercial webinars like the Dim-Sum and Vince ones.

The rate-limiting factor is presenter willingness, not mine. All the presenter needs is a bit of time and expertise – we lead them through the process from abstract to delivery and of course I bear the expense gladly. Dim-Sum’s webinar on the DoD EHR has had 1,531 views on YouTube and Vince’s Siemens-Cerner presentation has been viewed 1,807 times, so demand exists for webinars that are more educational than commercial, which I had in mind from the start. I have the forum and platform if you have something educational to offer readers.

Perform more analysis of informatics literature.

I love doing that myself when I have the time and have the full-text of an interesting article. I’ve asked before for an academic type to be a “literature scout” to find good journal articles and summarize them, but I haven’t had any takers. I’m feeling like a looping recording in saying repeatedly that I don’t get volunteers, but I’m just explaining why it’s not quite like the engaged community anxious to contribute that you might envision.

Stop using blue font for the reader quotes.

I’ll have to think about how to best indicate that I’m quoting a reader.

Improve the search function.

That comes up in every year’s survey, but I don’t have a solution. It’s already a Google search that works well, but what some folks want is to be able to click on a word like “Cerner” or “genomics” and have a perfectly sorted list of articles by date pop up. It just doesn’t work that way with the format I use, which is intended for an easy summary read rather than to support discrete searches. HIStalk, technologically, is just a bunch of web pages with one per post, not a massively indexed database (it’s kind of like a free-text chart entry vs. individual EHR data fields). I’m open to technology suggestions if anyone has some. Lots of  health IT vendors offer tools that convert free-text documentation to structured and searchable, so maybe this is their test case.

Spell Meditech as MEDITECH.

No. There’s just no reason to make it all capital letters. I go by the AP Stylebook, as does the Boston Globe, which spells it Meditech. Companies can go marketing crazy with cute capitalizations and symbols within their names, but that doesn’t mean publications have to buy into it. Hospitals are getting into the act, such as NewYork-Presbyterian (no space) and Partners HealthCare. Apparently spelling a word correctly following civilized rules doesn’t sizzle enough to stand out.

Stop being so picky about grammar.

No. I hate it when people make up their own rules because following society’s rules is inconvenient. Many people worked hard to teach me English, so I feel no shame in using it correctly. Americans are bizarre in passing along to their children their bemused indifference to competence in English and math, so we’ll see where that gets us in a competitive world market.

Some of the interviews feel scripted – mark those that are done live.

I do every interview live by telephone. Also, the subject hasn’t heard the questions until I ask them and doesn’t get to approve the final transcription. Two exceptions: (a) the “HIT Moment With …” where five-question interviews are done by email, and (b) a couple of times over many years, my interview subject did not speak easily understood English and I knew both the subject and I would have to work a lot harder to complete the interview, so I begrudgingly allowed email answers. I’ve done many hundreds of interviews and all but a handful were me talking on the phone asking off-the-cuff questions (I do edit out the many times the subject says, having become accustomed to low-quality reporter interviews, “What a great question …”). It would probably be fun to listen to the actual recording that gets transcribed – I interviewed Premier CEO Susan DeVore while having fajitas and a Tecate in a Mexican restaurant since I was super busy that day. I started off by telling her that she was hearing my private mariachi band serenading me in the background, which she found amusing.

Respond when someone leaves a stupid comment on a post.

I don’t want to talk over a reader who leaves a comment, even one I don’t agree with or that is factually incorrect. I let other readers correct them as they see fit. If they don’t, then I assume the comment is at least somewhat justified even if it stings a bit (my skin’s not as thick as it might seem).

I would like to have a quick way to see quickly the comments left on a post and then jump to them.

I will look into commenting options. I had a good cloud-based tool that seemed perfect, but it didn’t work for reasons I never could figure out in multiple attempts.

Send the email blast in the middle of the night instead of at around 8 p.m. EST. It creates pressure to read and I’d rather have it pop up in the morning with the other news I read.

Readers in Pacific times zones jump on HIStalk as soon as the email goes out, so I would hate to hold it until the next morning, plus some people want to see the news as soon as they can. I remember clearly when Todd Cozzens ask for a show of hands from the stage of HIStalkapalooza in Chicago how many people drop everything when the HIStalk email arrives – a frightening number of them went up.

Develop a mobile app.

I’ve been looking into that, although the existing mobile format works OK. Real-time notifications might be useful, though.

Ed Marx never did write anything about the Ebola debacle. The omission makes me think that maybe HIStalk is not as impartial as it says it is.

Let’s be realistic: would your employer give you permission to speak off the cuff to a media outlet about an issue of great human, corporate, and legal sensitivity? Or if your spouse died of Ebola, would you want to see the hospital CIO prattling on about that tiny piece of the case that he knows something about? Ed contributes articles, but he’s not free to talk casually about his employer or the patients they see, no different than when nearly got fired by my hospital when I started writing HIStalk and a loser vendor complained to my boss that I was saying bad things about them (leading to my immediate interest in anonymity).

Keep up the music recommendations.

I’m heartened by several such comments since usually someone complains about anything even slightly off topic, always in the form of, “I don’t read HIStalk for …” as though I’m an HIT-posting robot banned from going off script. Sometimes I fantasize about starting a new, unrelated site about some topic I know next to nothing about just to see if I could make it interesting while learning about the topic.

Write shorter posts or write news daily to shorten the individual posts.

Both are tough for me. I only include items I think are interesting and I cover a lot of ground succinctly, so I’d have to cut something I think is worth reading. I used to write news daily, but readers observed that HIStalk wasn’t particularly special any more when it hit their inbox every workday. Lt. Dan posts morning headlines each weekday if you just want a quick skim to see the major news items without the usual commentary and snark.

It sounds like you think you need to change something. Whatever you do, keep the news, juicy gossip, and sly, somewhat jaundiced humor.

I’ve been writing HIStalk for 12 years, so sometimes I get the urge to try something different. Occasionally I see all of the movers and shakers out there doing cool stuff (starting companies, developing products, running think tanks, etc.) and feel a pang of regret that I’m a sideline reporter rather than a full-contact participant in those high-profile or society-benefitting activities. That usually passes quickly, though, and every day when I face that blank screen yet again with excitement and hopefully some creativity, I realize I how lucky I am to be able to something I enjoy in whatever way I want. I’ve learned to be happy with my place in the world.

CommonWell Answers HIStalk Reader Questions

David McCallie, Jr., MD, SVP of medical informatics for Cerner and co-founder of CommonWell Health Alliance, invited HIStalk readers to submit their questions about CommonWell. He obtained answers from the most appropriate CommonWell resource. These replies were provided by David along with Dan Schipfer (VP/GM of government for Cerner and CommonWell operating committee chair); Nick Knowlton (VP of business development for Brightree and CommonWell membership chair); Bob Robke (VP for Cerner and CommonWell treasurer); and Jitin Asnaani (director for Athenahealth and CommonWell operating committee co-chair).

How do organizations like CommonWell promote interoperable transfer of health information to non-members? If our goal is a national infrastructure for transfer of PHI, don’t these aggregations of health partners create barriers to a national solution?

From a strategic point of view, CommonWell’s founders created the network because they did not believe that any of the existing approaches met the need for national-scale federated query based on robust identity management and record locator services. CommonWell’s founders believe that regional and vendor-proprietary networks won’t meet the demand for universal query connectivity. In contrast, CommonWell membership is open to all HIT suppliers and their customers, nationwide. However, if other networks emerge that cover substantial portions of consumers, CommonWell is open to creation of bridging services that could interconnect with other networks.

More tactically today, we feel that CommonWell has already promoted interoperable transfer of health information by publicly calling out the important issue of the lack of a common patient identifier in US health care. Second, to advance the state of the art, CommonWell members have designed and published specifications that address the problem of the missing patient identifier. These specifications are available for any and all (i.e. members and non-members) to evaluate, improve, implement, and use under common open source licensing. 

Does CommonWell have any plans for taking the initiative outside of the US?

We’re taking it one step at a time. Currently, CommonWell’s focus is to deliver real-world interoperability services across the US.

Why did some folks refer to CommonWell (in its early days) as the "HIE killer" and is that still a valid point? Accordingly, do entities like Aetna (who has invested in Medicity) and Optum (with their Axolotl acquisition) consider CommonWell to be a threat?

It is difficult to speculate on behalf of “some folks,” but CommonWell is not attempting to “kill” any type of exchange. CommonWell is designed to offer a national-scale service because we believe that a patient’s provider should have access to that patient’s information regardless of where the information lives. Through this approach to “universal plumbing,” members can expect an increase in the access to health information for their providers and a decrease in the cost and time for providers and their patients to gain access to their health information.

By addressing shortcomings in existing exchange models (such as imprecise standards that inhibit vendor to vendor connectivity), CommonWell is drastically reducing time and associated expense to achieving health information exchange. Furthermore, in a world driving towards the triple aim, interoperability initiatives such as CommonWell are aligned with goals common to payers, patients, provider networks, and national healthcare delivery objectives.

How does CommonWell relate to the Argonaut project?

There is no formal relationship. The Argonaut Project is an industry-funded initiative to accelerate the development of technical standards (FHIR and OAuth) in conjunction with HL7. On the other hand, CommonWell is a trade association that is deploying a national network. The results of the Argonaut Project should complement CommonWell’s existing use of standards, which are partially based on FHIR, as well as on standard IHE profiles like XCA (for document-based exchange). The standards work stimulated by the Argonaut Project will be important to HIT in general. CommonWell hopes to leverage these new standards to provide enhanced services as they become formalized.

What fees will be collected for using CommonWell’s system, who pays those fees, and where does the money go?

CommonWell is a non-profit trade association that relies on two different fee sources to operate.

One is membership dues, as are common to most not-for-profit trade associations. The dues schedule is based upon an organization’s annual US HIT revenue and provides for the organizational expenses of running the Alliance. A more detailed breakdown of the membership fees is available on our website.

The second fee, a Service Fee, covers the cost of the core services provided by CommonWell to its members to facilitate data exchange and includes the identity management and record locator services. By doing this at the vendor level, CommonWell is able to achieve unprecedented economy of scale gains for streamlining connectivity. Members who provide access to CommonWell to their customers are free to charge (or not charge) for those services as they see fit. As a non-profit trade association, CommonWell has chosen not to mark up these costs to membership.

CommonWell cannot set the fees charged by member companies to their customers. However, our expectation is that those fees will be modest compared to the value of the services delivered and will be assessed in the “commodity service” philosophy espoused in our founding principles. As noted in CommonWell Board Chairman Jeremy Delinsky’s recent blog, athenahealth’s service fee equals about one-tenth of one-percent of their annual revenue.

What’s costly for everyone is the need to build numerous point-to-point interfaces and reinvent the wheel of patient identity management for every exchange scenario. Connecting once to a nationwide network, as the health care industry has done in other instances, has proven to be a better model for widespread data exchange.

Will EHR vendors pay a competitor (McKesson and CommonWell’s IT provider RelayHealth) to exchange information with other systems?

CommonWell Health Alliance delivers the services to the HIT members. RelayHealth is CommonWell’s initial contracted network service provider. As with any service offering that requires hardware and software, the services fees paid by the member to the Alliance help to offset the Alliance’s network service provider investment and compensate them for the costs of providing that service.

I heard it costs $2 million to become a member of CommonWell. What is the ROI for those members?

As noted above, if a vendor chooses to offer CommonWell Services to its clients, the vendor is charged a Service Fee in addition to the Membership dues. The Alliance currently charges an annual Service Fee to cover the cost of the core services. The Service Fee is based upon the Member’s annual HIT revenue. This annual fee allows the Member to onboard an unlimited number of clients onto the CommonWell Network.

CommonWell plans to publically post the Service Fee schedule on our website later this year, but for the vast majority of members, the costs will be far below that amount.

If I’m an Epic shop, what can CommonWell do that I can’t already do through Epic? What are the cost comparisons?

CommonWell provides a national-scale identity management service, nationwide record locator service, and universal connectivity to any vendor that offers the service. A single connection to the CommonWell network will enable providers and the patients they serve to access to their health information at all those various systems and organizations and won’t require peer-to-peer contracting for each provider you need to reach. The identity management and record locator services reduce matching errors and make it seamless for the provider since the patient does not have to remember the places where they have records. We don’t know of any single vendor network that can enable access to a patient’s health data regardless of where they have been seen.

Why would providers want a few publicly traded vendors running a fee-based backbone instead of pushing the government to create freely usable standards available to all vendors?

CommonWell’s founders believed that identity management and record locator services were necessary for effective national-scale query connectivity. Those services have to be organized and paid for by someone and the existing government-related approaches were not committed to delivering those services. Additionally, the founders believed that the vendor community was in the best position to “build in” support for efficient, seamless connectivity. The standards on which CommonWell is based are indeed freely available, but the national scale services that make those standards useful require an organization and appropriate organizational governance.

How are health plans and payers represented in the CommonWell alliance? Medicare’s risk adjustment have always demanded better access to and merging of administrative and clinical data. Now that the ACA demands risk adjustment for commercial population the need for this marriage is even greater. The ability for health plans to better assign risk to their members and the ability for providers to help close care gaps and meet their CMS-mandated obligations for data exchange can be greatly facilitated by providing improved attribution mechanisms for identifying members, providers, and specific encounters. And there should be a common means for plans to provide care gap info.

Right now, CommonWell is made up of 17 health IT vendor organizations, but we encourage membership to any organizations, including payors, that share the association’s values and vision for interoperability. In the early days of the Alliance, we had to remain focused on designing, building, and deploying our core services. These existing services offered by the Alliance are well aligned with offering improved delivery of healthcare for the nation, and that inherently provides benefits for all stakeholders – including patients, providers, and payors.

While this is a great start, we recognize that there are other opportunities to provide value for how healthcare is delivered and CommonWell certainly has an opportunity to build upon the established model to provide additional value. The Alliance welcomes participation from and conversations with payors and other healthcare stakeholders outside of the core EHR community. We have engaged early conversations with several payors that share our vision and understand how crucial interoperability and data liquidity are to improving care.

To complement this, the Alliance has established a process for reviewing member-proposed potential service line extensions and welcomes payors to help determine if the identity management and record locator services offered could add additional value to the patient populations represented by the members in the Alliance, through examples such as care gap closure, without compromising any of our core principles.

What factors convinced Cerner to join the CommonWell and what is Cerner’s play after the three years of free services?

The early days of CommonWell have been focused on getting the network deployed as widely as possible to ensure that meaningful health information is delivered. We understand that the value of the network depends upon how widespread the usage is. Cerner wants to remove as many barriers as possible to help speed deployment. Removing financial barriers to early adoption was a straightforward decision for us. After the initial three years, we expect that the costs associated with the services will be in line with other EDI like transactions and will be considered minimal in comparison to the value a client receives.

Morning Headlines 1/16/15

Google joins PwC’s Vista-based bid for military health records

Google will join PwC, General Dynamics, Medsphere, and DSS in their bid to install VistA as the DoD’s next EHR.

Whistleblower Lawsuit Calls Billionaire Patrick Soon-Shiong’s Healthcare Startup ‘Fraudulent’ And Dangerous

Two ex-employees of physician billionaire Patrick Soon Shiong’s startup NantHealth file a whistleblower suit alleging that the company is “engaged in a multitude of fraudulent activities.”

The new 10-year standard: Find a more accurate EHR total cost ownership

Becker’s Hospital Review calls for a change to the way total cost of ownership is calculated during EHR procurements, saying that five or seven year timelines are not long enough when in reality a successfully installed EHR won’t be replaced for ten years or longer.

Philips and MIT investigators collaborate to give researchers unprecedented access to critical care patient data

Philips is collaborating with MIT to provide researchers access to the de-identified medical records of 100,000 ICU patients that received care in one of Philips’s eICU centers.

News 1/16/15

Top News

PwC adds Google to its Department of Defense EHR bidding consortium that is pitching the VA’s VistA. Google joins, PwC, General Dynamics IT, DSS, and Medsphere. Google’s contribution would be collaboration and search tools, which seems to be more sizzle than steak as PwC tries to make VistA sound sexier to the DoD, whose contempt for that system is legendary. The group has also put up a web page to make its case.

Reader Comments

From Weird News Andy: “Re: Iowa health insurance startup, the second-largest co-op in the country and heavily funded by the federal government, fails. The key is in this quote: ‘CoOportunity Health’s pool of people was larger than expected, was sicker than expected, so their risk became much greater than the funds that were available.’ That’s an economics lesson. Sicker people spend more and choose the one that saves them the most money, so you end up with a pool of sicker, more expensive members. If the founders of the organization did not see this going in and did not charge enough for their service, the fault is theirs. But then if they charged more, fewer people would select them and …” That’s a big problem with medical insurance. The fingers of insurance company actuaries fly over their Excel worksheets in their attempt to assemble a customer base that includes lower-risk, healthier patients to offset the expensive ones so they can bid competitively. However, individual patients sign up expecting to use more services than they’re paying for, to the point of not even buying insurance until they’ve accumulated enough problems to make it worth their while. It’s like a buffet restaurant eyeballing prospective diners at the door in trying to choose a profitable mix of picky eaters and starving chowhounds for a predetermined price, but their downfall is that few picky eaters will pay for an all-you-can-eat buffet knowing they’re subsidizing those who inhale everything in sight.

From RVA: “Re: concierge medicine. My PCP is moving to concierge practice, saying he doesn’t want to use Epic and that he can’t provide good care because his face is always in the computer ((FYI, he cashed his MU check). The concierge company touts their USB chart that allows you to take your important clinical information anywhere — apparently MyChart was not good enough (the guy sitting next to me joked that when they run out of USB drives, they’ll switch to 8-track tapes). He has approximately 1,200 patients (mostly Medicare) and a poorly-managed practice. They showed a scary video about how doctors are ‘forced’ to give up their practices and referenced the use of ‘mid-level providers’ in a negative way. A lot of people ate it up and started pulling out their checkbooks – oh, he has limited capacity, so it’s first-come, first-served at $2,500 per year. I’m worried that we’re creating a class system where those who can’t afford the fee get less than premium care.” It’s tough to ignore economics by suggesting that those who pay less should receive equally generous, excellent, and responsive healthcare services, even though we as decent people wish that were possible. All of us working in healthcare expect to be paid, so unless we turn it back over to the nuns and counties that ran hospitals as true non-profits using cheap and volunteer labor, those days are likely gone. The ED is the last foothold of healthcare democracy, where everybody is treated the same based on need, but then again, it’s a cost cesspool for that reason and hardly a poster child for open access to all. Healthcare economics is like a balloon – squeeze it in one place to cut costs and another part bulges out as providers who are understandably unwilling to reduce their personal standard of living figure out new ways to charge for their services. We’re at three tiers now: (a) those who use ED and public clinics or who don’t buy insurance because they don’t see the immediate value; (b) the large middle class who have insurance but are getting hit hard by out-of-pocket costs and sometimes facing bankruptcy because of huge and often questionable bills, with that group subsidizing the first one by paying excessive charges and taxes; and (c) those whose assets are adequate to self-insure and whose time is valuable enough to make it worth finding the best and most customer-friendly providers who don’t take insurance. It’s unrealistic to expect the care and outcomes to be identical across all three groups. It’s also reasonable to expect people in the middle group to move down rather than up, and it’s the loss of that group that threatens to implode the system. It’s just like the tax system: some percentage of people pay nothing, the wealthy pay a low overall percentage because of their small numbers and large accounting tricks, and those in the middle foot most of the bill.

HIStalk Announcements and Requests

Last year right before the HIMSS conference I supported Donors Choose by offering companies a large, short-term banner that appears beside the HIStalk title on every page, using the proceeds to fund a bunch of projects for classrooms in need. It felt good and it was fun, so I’m doing it again this year. Contact Lorre if you’d like to book the most prominent ad on the page and help needy students in the process. Like last year, I’ll write up the projects we funded and share the student comments and photos that result.

I followed through on a reader’s suggestion of an HIStalk Book Club sort of thing where I review an HIT-related book and invite readers to share their thoughts. I reviewed Eric Topol’s “The Patient Will See You Now” and next up is “America’s Bitter Pill.” Read along, add your thoughts, and suggest what book I should read next. I have a copy of John Halamka’s “GeekDoctor: Life as a Healthcare CIO” that HIMSS sent me in return for completing a survey, so maybe that should be next.

I’m sure we’ll see this at the HIMSS conference: every hip meeting now includes a “graphics facilitator” who documents everything on a flipboard, compelling attendees to proudly tweet out photos of the drawing afterward. I don’t want to attend a conference where a cartoonist understands the presenter better than I do.

Here’s one last appeal for you to complete my once-per-year HIStalk reader survey, which takes just a couple of minutes but helps me immensely.

This is a fond farewell to Agilum Healthcare Intelligence, whose marketing person told us, “I’ve never even heard of HIStalk” in declining to renew their sponsorship after many years. They’ve been supporters for a long time and I appreciate it. I also appreciate the service of the marketing guy, who though he has zero health IT experience, is a former Army infantry captain who led a field artillery battery in Iraq, according to his LinkedIn profile.

This week on HIStalk Practice: Telehealth reimbursements are set to go live in New York. Tulane University Medical Group implements eCW’s CCMR. Etherapi takes advantage of the Kaiser strike in California. HHS breaks down its own silos, and enjoys flying first class. Dr. Gregg looks into the future of healthcare IT, circa 2037. Third-party patient portals go head to head with vendor-specific options. Thanks for reading.

This week on HIStalk Connect: 23andMe finds a new source of revenue as it closes a $60 million deal with Genetech in which it will use its dataset to support Parkinson’s disease research. Athenahealth acquires cloud-based inpatient EHR vendor RazorInsights, and confirms that it will move into the hospital space. Augmedix raises $16 million to scale a promising Google Glass-based telecharting business. 

Acquisitions, Funding, Business, and Stock

Todd Cozzens of Sequoia Capital is featured on Fox Business’s “Opening Bell” live from the JPMorgan Healthcare Conference. He mentions his firm’s investment in Health Catalyst (analytics) and MedExpress (retail clinics). A Forbes profile of Sequoia Capital mentions its 40-plus year history, including its 1980 investment in Apple’s IPO (the founder thought the 22-year-old Steve Jobs “looked like Ho Chi Minh”) and its recent gains from Airbnb, Dropbox, and WhatsApp. The firm’s partners make a fortune, apparently, as the article mentions a 2003 fund that returned gains of 41 percent per year for 11 years, with the firm’s partners pocketing $1.1 billion as “Sequoia is turning its own partners into billionaires while keeping outside investors purring.”

I mentioned that Athenahealth has acquired small-hospital EHR vendor RazorInsights for a rumored $40 million to give it an inpatient foothold. I really like what RazorInsights is doing in giving small hospitals an inexpensive, cloud-based system that covers both clinicals and financials, but I don’t see the benefit to Athenahealth in buying a four-year-old company with only a couple of dozen small customers. RazorInsights has much larger competitors (Meditech, CPSI, Medhost, NTT DATA, McKesson Paragon, etc.) with established infrastructure and most hospitals have already spent their money on a Meaningful Use dance partner, some of them even choosing to run Epic or Cerner as provided by another hospital (or to be acquired by those hospitals). Athenahealth has choked on its previous acquisition Epocrates, which is highly regarded but is stumbling even more than before under Athenahealth’s ownership. I think Athenahealth wants desperately to crack the inpatient market (after insulting that market for years), realizes it doesn’t have the expertise to build a new hospital system from scratch, and decided to spend money instead of time to get a name-plated product quickly to market and then ramp it up. The challenges are many:

• RazorInsights is small for a reason and not being owned by Athenahealth may not be it.
• Both product and company scalability are unknown.
• Few big companies have low-enough overhead to profitably roll out products to cash-strapped 25-bed hospitals.
• Expected synergies may (as they often do) prove to be elusive.
• Companies have been historically lured into unwise acquisitions because the product aroused them technically and filled a perceived immediate need at high expense (Allscripts buying Eclipsys).

I think Jonathan Bush will talk this up as though Athenahealth is the next Epic (or Salesforce or whatever high-flying comparison comes to mind), but the acquisition is just another distraction as the company tries desperately to keep its Wall Street plates spinning in the air despite concerning profits and a year-long share price stall.

Aetna announces that it will raise its minimum wage to $16 per hour in April and will offer an enhanced insurance plan for employees who participate in wellness programs starting in 2016.

Two former NantHealth executives file a whisteblower lawsuit against billionaire doctor Patrick Soon-Shiong’s company, claiming that NantHealth is “engaged in a multitude of fraudulent activities,” violates HIPAA requirements, has failed mock FDA audits, and offers products that harm patients. Stephanie Davidson (former SVP of professional services) and William Lynch (former senior director of marketing) also claim that several customers were prepared to stop using the company’s Clinical Operating System, citing an internal report that characterized that product as “10 years behind in technology capability” that “runs on LUCK.” The pair claims that NantHealth’s marketing material is misleading and that Soon-Shiong’s charitable foundation defrauded Medicare by donating millions to a hospital that would then use CMS matching funds to buy NantHealth’s products. NantHealth’s responds that the employees, who are in a romantic relationship and had worked for the company for only a few months, demanded that NantHealth pay them $2 million to prevent them from launching a pre-IPO smear campaign after NantHealth fired Davidson. Perhaps it’s not a coincidence that the lawsuit was filed just as Soon-Shiong gave the company’s investor pitch at the JPMorgan Healthcare Conference.

Craneware says second-half sales for 2014 increased 10 percent and its board is confident of meeting 2015 expectations.

Sales

Good Shepherd Health System (TX) chooses Strata Decision’s StrataJazz for decision support and cost accounting.

Healthfirst (NY) selects InterSystems HealthShare as its HIE and clinical portal.

Providence Health & Services expands its relationship with Kyruus, which offers a doctor web search tool. That’s how I would describe their business, anyway, but if you don’t get enough buzzwords, here’s theirs: “Kyruus is an enterprise healthcare provider solutions company that helps health systems optimize their Patient Access, Referral Management and Care Coordination operations. Leveraging the cloud and a proprietary Big Data approach, the company enables the integration of massive amounts of information to create a single source of truth of providers. Kyruus helps health systems create customizable protocols for referral and scheduling across all channels of patient engagement to improve patient access and patient experience.”

People

Ralph Keiser (Deloitte) joins Recondo Technology as chief growth officer.

John Glaser (Siemens Healthcare) joins the board of the American Telemedicine Association.

Hayes Management Consulting hires Gay Fright (Coastal Healthcare Consulting) as VP of strategic services.

Huntzinger Management Group promotes David DiChiara to CFO.

Sachin Jain, MD, MBA (Merck) joins care plan CareMore as chief medical officer. He worked for ONC for a short time a few years ago. He said in a talk last week that most health IT startups offer products that are interesting but not really useful because (a) they’re trying to make a quick buck, and (b) they are mostly run by young, prosperous, healthy people and develop products in the context of their peers rather than for the sick, expensive patients that need help. He also said HITECH came about because everybody knew EHRs were good for patients, but hospitals put the interest of their resistant doctors first because they’re the ones who admit patients.

Ken Pool, MD, co-founder of OZ Systems and co-chair of the HL7 Public Health and Emergency Response Work Group, has died, according to a posting on the group’s listserv.

Announcements and Implementations

An article by Brad Swenson of Winthrop Resources Corporation suggests that the total cost of ownership of hospital EHRs should use a 10-year forecast rather than the more common five or seven years. It quotes The Valley Hospital (NJ) VP/CIO Eric Carey, who used a 10-year timeframe to make an upgrade-or-buy decision: “We felt no one should be replacing an EHR platform in less than 10 years unless a catastrophe happens. Also, probably the most expensive part of an EHR project is the army of consultants, staff, and project managers you need to have to pull everything together. Our implementation has involved 20 FTE over at least one year. Most organizations can’t afford to do that more than once.”

McKesson announces Paragon Community Plus, a package that includes its Paragon system, implementation, training, and remote hosting.

Government and Politics

A House Committee on Energy and Commerce work group creates a draft policy that would require HHS to pay for telehealth services at the same rate as in-person visits within four years.

Innovation and Research

Philips gives MIT researchers access to the de-identified records of 100,000 ICU patients who were monitored via its eICU program. The records, which represent about 10 percent of all US adult ICU beds, include vital signs, medication orders, lab results, and severity of illness scores.

Technology

Google stops public sales of Google Glass and moves the product from its research lab to a separate business unit led by former fashion and eyewear designer Ivy Ross. Companies and developers will still be able to buy Glass units after the January 19 cutoff date. Google was supposed to release a new version of Glass in 2015 but hasn’t provided specifics. People seem to think this is the beginning of the end for Glass, but I’m not so sure: it desperately needed a reboot, graduation from beta status, and design help for its ugly form factor (which is true of most things Google), so perhaps this is its graduation into the real world, or even away from the consumer market and into the enterprise one.

A guest newspaper article by the CEO of a Missouri public policy organization says the state is still #49 in economic growth despite being one of nine labeled as “the corporate welfare kings of America.” He says of the Missouri’s $1.6 billion subsidy of Cerner’s $4.3 billion new campus, “If Cerner needs a corporate pleasure dome, it should pay for it on its own nickel.”

I thought sure this was a spoof since it was heavy with Star Trek puns and one of the pictures features a nurse wearing a 1970s-style cap, but apparently the just-started IndieGoGo campaign for the $3,500 Warp 3 Medical Tricorder is for real. It’s not the X-Prize, Scanadu-type consumer Tricorder, though – this China-based one will be just for doctors and will provide vital sign, ultrasound, and EHR functions.

Other

The local paper says that MultiCare Health System (WA) is not only represented on the advisory group IBM and Epic put together to help make their case to the Department of Defense as it selects its $11 billion EHR, but MultiCare will also serve as the pilot site should the IBM-Epic bid be chosen.

A physician’s New York Times editorial observes that 24 of the 141 medical schools in America are now named after big donors, causing graduates to be “embarrassed that there was a rich person’s name on their diploma, with the university name tucked below in small print.” Naming rights cost from $8 million (East Carolina University’s Brody School of Medicine) to $200 million (UCLA’s David Geffen School of Medicine, above). 

Sponsor Updates

• Imprivata integrates its Cortext secure communications platform with the Citrix XenMobile enterprise mobility management solution.
• HealthTronics selects AirWatch for enterprise mobility for its 500 employees.
• ZeOmega is named as one of the 100 fastest-growing Dallas companies.
• John Stanley of Impact Advisors is quoted in a San Diego newspaper’s article on the pros and cons of EMRs.
• Divurgent will participate in the HIMSS East Tennessee Summit in Knoxville on January 22.
• DataMotion covers the important role e-mail plays in file sharing in its latest blog.
• CompuGroup Medical will participate in the Critical Care Congress in Phoenix, AZ from January 17-21.
• CommVault expands its relationship with NetApp to offer integrated data protection solutions.
• TechGig outlines CitiusTech CEO Rizwan Koita’s predictions for 2015 healthcare technology trends.
• CareSync publishes a new blog on the importance of taking charge of a family’s health records.
• Dignity Health VP/CMIO David Lundquist, MD offers insight into how to keep patients in mind when discussing the future of healthcare at AirStrip’s Mobile Health Matters blog.
• ADP AdvancedMD offers “4 surefire signs you need a new EHR for MU2 and beyond” in its latest blog.

EPtalk by Dr. Jayne

It’s been a strange couple of weeks for me. We’re getting ready to go through some major changes at our hospital and everyone is on edge. Teams are being consolidated and it feels like the directors and VPs are playing a giant game of “Go Fish” only instead of cards, they’re playing with people. This comes right on the heels of our hospital’s push to reduce the number of accrued vacation days on the books, which had almost half of our employees taking significant time off during the last month or so.

Everyone is overworked and cranky as we try to make decisions based on forecast scenarios and half-developed plans. Sometimes we start to feel not only like the sky is falling, but that the world is burning down around us. We imagine it can’t possibly be this bad in other places. It’s difficult to reach out to colleagues at other organizations because we don’t want to admit that our own organizations are in frantic disarray.

It was in that frame of mind yesterday that I was trying to catch up on the ridiculous thing that is my inbox. I’m on staff at another hospital that’s not part of my health system. I almost got whiplash doing a double take at one of the emails I received. It was discussing the final steps of a system conversion they’ve been working on for years. They’ve been running dual platforms for the last six months during the transition and are finally pulling the plug on the legacy application.

Despite the robust features of the new system, the email wording left something to be desired. “Many fixes and enhancements have been done to NewApp to make it usable.” The email was sent out under the CMIO’s banner. Knowing him as I do, I’m pretty sure that’s not what he intended. I forwarded it to one of my colleagues – not as a way to humor ourselves at someone else’s expense, but as a confirmation that the people at our competitor across town are likely under the same pressures as we are. No matter how hard and how many long hours we work, things are falling through the cracks.

I thought about how fortunate I’ve been that during most of my time as a CMIO I’ve been surrounded by colleagues who are competent, confident, and motivated. I’ve always felt like they have my back and in turn I’ve had theirs. Over the last year and a half, however, it seems that everyone has been stretched thinner and thinner. We’re to the point where we can barely support ourselves, let alone each other. Although we’re certainly experienced in delivering the impossible, it’s become harder and harder to make it a reality.

Looking at the last few months in particular, not only has our energy been sapped, but we’ve lost some of our support structures. Our standing team meetings have been fragmented as we’re pulled in countless directions by competing demands. Those were our opportunity to update each other on our projects, potential risks, and needs. We received feedback and encouragement as well as ideas to remove blockers or handle difficult situations. Colleagues who had been in similar situations provided pointers and tips and lists of “gotchas” to look for.

I should have taken that email as a warning to stay vigilant. By the end of the day today, I watched one of my key projects go off the rails. In hindsight, I should have seen it coming, but I didn’t. Although ultimately it’s no one’s responsibility but mine, I can’t help but think that if we weren’t all so scattered and overwhelmed that someone else might have picked up on subtle signs that I missed. I spent most of the day with an impending feeling of doom and heartburn that made me want to eat a box of chalk.

I realized that given our current state of being overextended, under-resourced, and fatigued that it’s likely this isn’t going to be the last time something like this happens. This is an uncharted place that I’ve never had to operate in before. I’m officially working without a net and it doesn’t feel very good. But given the state of our industry today, I’m sure I’m not alone.

Do you have tips for how to work without backup? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 1/15/15

Athenahealth Acquires RazorInsights

Athenahealth acquires RazorInsights, an inpatient EHR vendor that has been selling its cloud-based system in the critical access and community hospital market since its 2010 launch.

BT to Offer Medsphere’s OpenVista Electronic Health Record

Medsphere announces that it will partner with BT to begin offering hosted OpenVista systems.

GAO kicks off review of HIE performance

Senators Lamar Alexander (R-TN), Richard Burr (R-NC), and Mike Enzi (R-WY) have asked the General Accounting Office to evaluate the effectiveness of state health information exchanges as the federal government’s $600 million effort to support their implementation winds down.

Book Review: “The Patient Will See You Now”

I enjoy reading articles and tweets by technology fanboy Eric Topol, MD. He’s focused and intense. He’s always whipping out a smartphone-equipped EKG gadget on a plane or sticking a smartphone otoscope in Steven Colbert’s ear on TV. A lot of the tools he digs up seems to be of the “hammer looking for a nail” category and he’s created a nice gig for himself as a geeky critic of the medical establishment (even taking the AMA to task), but sometimes he comes up with ideas that might make a difference someday.

Topol is an undisputed thought leader. I like what he has to say even if I’m often skeptical.

Topol’s new book, “The Patient Will See You Now,” is an impressive (some might say “undisciplined”) romp through the healthcare technology garden. However, it fails to live up to its title, which suggests that savvy, responsible patients armed with cool smartphone EKG devices and fitness trackers have quietly wrested control of healthcare from the government, corporations, and providers of “eminence-based medicine” that make up the plodding and oppressive medical establishment. It’s a cute and gimmicky title, but it contains more hype than the book can deliver.

In fact, it sounds a lot like his earlier book (which I didn’t read) called “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.” That one is three years old, so maybe everything in it came true and he moved on.

The book wanders around so much that the only overall sense I could make of it required me to summarize each chapter, as follows:

1. Technology is widely adopted. Patients know their own bodies better than anyone.
2. Doctors are trained to feel superior and to control the flow of medical information.
3. The smart phone is like the Gutenberg press in democratizing and disseminating knowledge.
4. Angelina Jolie’s decision to undergo a double mastectomy because of genetic testing was earth-shattering, but the FDA tried to shut down 23andMe because that testing completely ignored FDA’s inquiries about its marketing and its offer to help the company comply with US laws.
5. I glazed over on Chapter 5 because it was a complex and questionably relevant primer on how genes work and how they can be used to personalize medicine. The bottom line: we should be doing more genetic testing for research and individualizing treatments.
6. Silicon Valley darling Theranos is revolutionizing lab testing. People have the right to see their own information. They should also be informed about the radiation dosage in diagnostic imaging.
7. Patients should be able to see their medical records. OpenNotes and Blue Button give that capability, but only 36 percent of patients can access their records and EHRs are primitive.
8. Prices for hospital services and drugs are irrational and vary widely, especially when comparing high US prices to those the rest of the world pays. We have a lot of waste and spend a lot on treating complications.
9. Telemedicine is cost effective and convenient, but doctors resist new technology just as they did the stethoscope when it was invented.
10. Hospital stays, which are expensive and error-prone, are declining as surgeries move to outpatient. Technology allows care and monitoring to be moved to the home.
11. People are willing to share their medical data for research, which will allow collecting and collating information to discover new research and best practices.
12. People are selling and stealing medical data.
13. Sensors can predict and track medical conditions.
14. Cheap smartphone-connected technology will democratize medicine to less-developed countries.
15. People own their medical data. Big employers should be using it to squeeze big insurance companies, but none have actually done that. Consumers haven’t mobilized. CMS and other administrative waste takes a lot of resources out of the system. Other countries will do better because of our archaic payment and regulatory model.

My frustration is that while the exhausting scattershot of technology nuggets is interesting (although hardly original since I’d heard of nearly all of them), it doesn’t prove the title’s hypothesis. It may well be that a few tech-savvy and demanding patients can convince their individual providers to let them get more involved in their care, but nothing suggests the presence of an unstoppable movement. In fact, while healthcare takes heat for being episode-based, a significant portion of consumers are even more episodic – they pay attention to their health mostly when something is bleeding, hurting, or swelling and then show up expecting a TV-like quick fix. The majority (especially the medically expensive ones) aren’t quantified-selfers or fully engaged participants.

A lot of people have smartphones, health apps, and fitness trackers, but those gadgets haven’t proven to make them healthier. Capturing and tracking information is just a tiny and easy part, as evidenced by the significant penetration of bathroom scales in the homes of overweight people. Patients (or consumers or whatever you want to call the 100 percent of us who will seek medical care at one time or another) can make consumer-like demands on their doctors, hospitals, and insurance companies, but I’ve heard few examples of where that actually accomplished anything other than possibly getting themselves labeled as a troublemaker.

People who receive medical services aren’t really pure consumers, so it’s not realistic to assume that the healthcare cheese can be massively moved by technology as happened in banking and entertainment. Patients don’t usually pay all their own bills. They go to whatever doctor and hospital the party that does pay (the insurance company) dictates, so threats to take their business elsewhere are usually hollow no matter how unpleasant or Luddite their doctors may be. Strap 10 smartphones with cool apps on your belt, pass out OpenNotes articles in the waiting room, and warn hospitals that they had better not make a medical mistake during your admission – your influence is still minimal despite being informed.

Topol’s broad observations and complaints aren’t really actionable. Patients have little control over the items listed above. The book title suggests that patients are in charge, and yet it’s still insurance companies authorizing payments, doctors entering orders and performing procedures, and the much-maligned medical establishment standing between patients and their maker. The healthcare system (or more correctly, the healthcare industry) was built around everybody except the patient. That establishment isn’t just going to step aside because patients carry iPhones. Any plan that requires people to voluntarily stop doing what they’re well paid to do will fail.

A few tech-powered concierge practices, retail clinics, and drug chains are threatening the status quo. They aren’t really scaring anyone. They may cherry pick a tiny bit of profitable business, but they aren’t much of a threat to health systems that keep buying up more providers and using their political influence as big employers to make sure they aren’t pushed away from the table. That’s the best hope for quick innovation that will reverberate through the hallowed walls, such as the real threat that Theranos will force high-margin hospital labs to either increase their efficiency or survive on a fraction of their current business.

Healthcare is like your car (at least if your car was built in this century). Your car is loaded with sensors (some of which, like the speedometer, you may conveniently ignore) and requires a computer to analyze its internal computer data stream. You can’t diagnose and fix it yourself when the idiot light comes on. You can study up all you want, but your only real decisions involve (a) whether you want to get it fixed, and (b) who you choose to fix it given your available options. You sit impatiently until the mechanic hands over a grease-stained list of procedures he or she performed along with a bill (as in hospitals, the computer that creates the bill is the most powerful one). All of that technology and data didn’t benefit you very much – it just generated more business for the mechanic, allowed him or her to work more effectively, and maybe avoided even more expensive repairs down the line. That’s pretty cool, but it’s hardly a revolution in empowering car owners.

That’s my takeaway from the book. Most of the technologies listed help doctors provide better care, assuming they are willing and able to use it. The role of their patients is, at best, to push for them to actually think about using genomics, following evidence-based medicine practices, reviewing their own outcomes information, and staying current on new medical developments. Patients, however, won’t usually voluntarily leave a doctor just because they don’t use an EMR or other gadgetry – that’s the art rather than the science of medicine – so it’s not really much of a threat.

Consumer choice in healthcare involves choosing the “best” provider to interpret, order, and perform procedures (or at least the “best” one willing to see you that your insurance covers). A doctor might be willing in the seven minutes you’re allotted for a return visit to look at your fitness tracker information, sit beside you as you Google your condition, or describe their charges to the price list from the MinuteClinic down the street. Don’t count on it. You’re only as empowered as is convenient for them.

Cardiologists make a great living and Eric Topol is no doubt excited to see his Scripps patients embracing technology and participating in their care, but it just doesn’t work that way for most doctor-patient encounters. People don’t get as broadly excited about health-related technologies as they might with social networking or music since the personal payoff is slower and less certain. Fitness trackers motivate and inform people who are already motivated and informed. Those aren’t the folks running up most of the country’s medical expenses.

Topol’s confidence that abundant technology will upend the US health system in favor of patients seems wildly simplistic. We can all – as patients and industry insiders – make a long list of what’s wrong with healthcare. That doesn’t mean we can change it through our individual actions. Healthcare is like the government in that it’s easy to identify what’s wrong, but hard to even agree on a solution, much less impose it against the will of far more influential people and corporations who are pretty happy with the present arrangement.

That doesn’t mean the book isn’t worth reading as a concise overview of what technologies are on the horizon. It’s good for that, at least for the next six months until it becomes outdated. It also doesn’t mean that Topol isn’t a passionate visionary because clearly he is. However, he could raise an army of fist- and smartphone-waving readers of his book who are upset with how most of us are treated as patients and health-seekers, but that alone won’t get our broken healthcare system fixed.

That’s my disappointment with “The Patient Will See You Now.” Reading it makes it easy to see what the future could be while knowing it probably won’t really happen, at least not in this country. I give it 3.5 stars out of five, docking it a half-star for an unrealistic title. Each chapter would have made a great blog post or magazine article, but I’m not finding them as compelling or entertaining in aggregate.

CIO Unplugged 1/14/15

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Leadership and the Paradox of Shame

Ninety percent of successful business executives are driven by shame. Psychology Today defines shame: the painful feeling arising from the consciousness of something dishonorable, improper, ridiculous, etc., done by oneself or another. It’s an attitude toward self. Nobody needs to look long to see the roots and vines of shame snaking through my life.

Shame is a powerful motivator. I was afraid to being a failure, so I graduated in the top 20 percent in the corps of engineer officer academy. I dreaded being last in any race, so I drove my body until I reached Team USA status. I feared disappointing my parents, so I strove to be a senior vice-president. One boss told me I wore the wrong clothes, so I revamped my wardrobe to keep from being harassed. Shame became my identity.

It begins in youth. We are shamed by parents, educators, coaches, friends, and clergy. If we chose to believe the lies, our identity falls prey to …

The paradox of shame. On one hand, it’s an emotional prison. On the other, it’s a fuel for success.

I was led to believe I was never good enough. Never as smart as my eldest brother and sister. I never could score as many soccer goals as my middle siblings. For every mistake and failure to meet his expectations, Dad shamed me. If a scoop of ice cream slid off my cone, Mom called me an idiot. They labeled my adolescent tomfoolery criminal. They didn’t know any better.

The year I earned my master’s degree and got promoted to Army captain was a big deal for me. Yet my mother exclaimed, “You still have to prove yourself.” Shame was my parents’ subconscious method of motivation.

Following their ingrained model, I leveraged shame to my advantage. I had to prove to men that I was a man. I had to prove to women that I was desirable. I had to prove to the world that I was worthy of accolades. Shame drove me to accomplish some amazing things. In order to feel good about myself, I had to be number one in everything. All false beliefs.

I even used shame in my leadership practice. I’d shame others to get the results I desired. I subtly made people feel bad under the label of motivation. While the intent was OK, the technique was pitiful. I would belittle and criticize others openly. Often, it was not so much what I said but my body language. I would make others feel bad until they relented and did things as I wanted them done.

The day someone exposed my shame, I embraced it. Twisted thinking! I loved the benefit. The power. If I let go of shame, what would happen to my drive? How would I motivate my staff? Would I still be number one? Would I still accomplish great things? Would men still admire me and women find me attractive?

Crazy, right? It’s called deception.

Shame infiltrated my DNA. Can I reverse the curse? Yes! But at what cost? At what benefit? Is it worth the risk? What if I fail? What if I lose the admiration of friends, family and industry? What if it costs me all that I have gained?

I’ve really been searching and examining myself. How do I escape shame? How do I stop shaming others?

It comes down to releasing myself and others to be who they were created to be. If that means I’m not president of the United States, so what? If I don’t make the team, so what? If people no longer seek me out, so what? Easier said than done.

Truth: better to live in freedom than in bondage to a lie. Shame creates a void that will never be filled despite the drive it creates. And for a leader, the higher status you attain, self-deceit can spiral out of control. The only way to escape this vortex of deception is to jump. Forget what others think. It is about you and me being who we really are, despite title.

Then how do we fill the void once we denounce shame? It zeros back to identity. Figure it out and live who you were created to be. To be self-reliant is to dig a deeper hole and still never be good enough. Instead, reach out for help. Continuously explore faith. You’ll be a work in progress, as am I. Messy, yet loveable. Redeemable. Worthy.

Thoughts on work relationships and the keys to escape:

• Acknowledge shame-driven ways (you might need to ask a friend).
• Apologize for manipulating through shame.
• Replace shame with sincere encouragement.
• Do not tolerate shame from others.
• Exhort your teams to be all they can be, no strings attached.
• Tell them it’s OK to be something different than what you may have wanted
• Surround yourself with truth-tellers who will call you out on shame tactics.
• Hold fast to your true identity.
• As you become free, they will become free
• When you remain imprisoned, so do they.

One more thing. I believe it is probable that by operating in the opposite spirit of shame, your teams will shine brighter than you ever envisioned! They may not look or act like you, but they’ll be free to be their best. Better to be mortal and free rather than super successful and emotionally imprisoned.

Shame is the new “Hotel California.” You can check out any time you want, but you can never leave.

Thankfully, there is an escape route out of the vortex. Break free with me.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

HIStalk Interviews Peter Smith, CEO, Impact Advisors

Peter Smith is CEO and co-founder of Impact Advisors of Naperville, IL.

Tell me about yourself and about the company.

I’m the CEO of Impact Advisors. We are a consultancy that’s dedicated to healthcare process improvement and technology consulting. That’s pretty concise, right? [laughs]

Many people say there’s flux in healthcare IT consulting as firms that are focused on staff augmentation and implementation work are are finding reduced demand for their services. How would you characterize the industry?

That observation is absolutely true. The market has shifted over the last year, and for reasons you don’t suspect. We went from an environment where the industry was doing large, foundational projects, particularly EMR replacements and revenue cycle replacements. The market shifted over the last year as those projects wound down. It’s now moving towards post-implementation optimization and scrappier, more nimble projects. Things like optimization, back to advisory services.

The quick answer is that observation is exactly what I think the market’s feeling. It’s hurt a lot of consulting firms.

What’s the future for those companies that are scrambling to find something new to keep their people busy?

Their evolution will go something like this. They’re going to try to weather this market to the best they can. They’ll probably downsize. They’re going to explore alternative channels through subcontracting relationships and things like that. They’ll try to hold on to their business as best as they can. But at the end of the day, I think it’s going to diminish for them.

The ones that can transform themselves from single, staff augmentation kinds of services into the next generation firm will survive, but it’s not going to be easy for them. I would suspect that the next year or two is going to be challenging for a lot of those firms.

Everyone who has been in healthcare IT for a while knows that the pendulum always swings back. Will it swing back from EHR implementation and Meaningful Use to something else?

Yes. The pendulum is definitely swinging. There will still be an EMR replacement market out there, but it’s just not going to be as robust as it was. The core business will still be there, but the market is going to shrink. There’s going to be a lot of merger and acquisition activity. 

There are replacements of a number of systems out there. The dominance of core players – Cerner, Epic, and Meditech – is fueling potentially a replacement of some other vendors. That dynamic will continue — it’s just not going to be as crazy as it’s been the last couple years. That’s one component of the market.

The other one is the shift to optimization services, although that’s a wide definition. Basically optimizing the EMRs and clinical systems already put in is going to be a continued emphasis for a lot of organizations and a continued business for a lot of consulting firms. Rev cycle replacements will be another key driver.

Those are things that will continue to fuel the consulting market. But I don’t think we’re going to see the kind of growth we have in the last couple of years. It will be slow and steady. That’s healthy for the market and for the industry. We’re looking forward to that.

Impact Advisors is an Epic partner. Does Epic have weaknesses it needs to fix or that other vendors can exploit?

Epic’s a really strong company. They’re doing a lot of things right, as are a number of other companies such as Cerner. I don’t see necessarily any weaknesses.

Our clients are typically concerned about Epic’s tremendous growth over the last couple of years. It’s both an asset and something to watch as you think about implementation with Epic, but they’ve been able to mitigate that risk pretty well. For the services that they typically provide and implementation, they still do a very good job.

Clients still have to be focused on their side of the work in terms of understanding the process and the operations of a hospital. Those are things that any vendor is not going to bring to the table. That’s a void that the client has to step up and fill as well as the third-party consulting marketplace, and that’s where a lot of folks have spent their time.

I don’t know if I necessarily see any weaknesses. I think you’re seeing the emergence of a couple of players in the vendor space that are going to continue to be very successful, Epic being one of them.

Are clients happy that they invested what it costs to implement those expensive systems from Epic and Cerner, especially with the ongoing maintenance costs?

The basic answer is yes, although it’s certainly a topic of conversation in the C-suite about the level of investment that they’ve made and the level of expense. Given the dollars and the prominence of these decisions in the executive and board level, it is clearly top of mind.

But at the end of the day, if you look at the last five years, the clients that have been through the implementations and are in steady state and now reaping the benefits of that investment are extremely happy. In fact, I think there’s even a sense of appreciation that they’ve been through it already.

It’s the clients now that are looking to just start that journey. There’s a lot of anxiety because they know they have the investment ahead of them. They know they’re getting to the tail end of the curve. Their competitors in the market have gone before them and they’re a little bit on the outside of the bell curve. That’s where the anxiety is right now, not necessarily on the people that have already done it.

It seemed a few years ago that we had nearly figured out interoperability, but it’s probably more contentious and more frustrating to people now than it was then. Where does it stand and where is it going?

It’s one of my personal disappointments. I had expected this industry to mature a lot faster, particularly around the technology associated with interoperability.

But at the end of the day, interoperability is a very interesting concept or philosophy because it’s not just technology. You’re getting to the core of whether organizations really want to interoperate. You get into the competitive dynamics in a marketplace. You get into what’s in the best interest of the patient. This is bigger than just technology.

By and large, the technology is starting to work. Arguably, there’s not that set of standards in the industry that’s implementable, and I would agree with that to some extent. But the ability to interoperate is technically feasible, and in some cases, organizations are doing it very well and some regions are doing it very well.

It’s bigger than just technology. It’s bigger than applications. It’s also politics. It’s a competitive aspect between providers and hospitals and having the incentives aligned to really interoperate. It’s a big one. Personally, it’s I think one of the disappointments of the industry that we haven’t been able to do a better job of doing that.

Given that providers have little incentive to share information with competitors and patients don’t have much of a say, should ONC be bolder about dictating interoperability standards or requiring that providers actually practice interoperability?

I generally think the market should dictate some of this more so than the government. The government can certainly give us a good head start, whether it be ONC or any other agency, and set the direction. You’ve obviously seen a lot of indirect influences and incentives by the government just through Meaningful Use and ICD-10 changes and all that that is clearly steering our industry in the right direction.

I think personally as an opinion that the market, our providers, our clients, and our consulting firms have a market-based obligation to take it to the next level. That’s getting it down to the tactics and the technology and the specifics around making it work.

The other dynamic is that patients are getting much more savvy, demanding, and customer-centric. I hope that that side of the market influence will be a catalyst to dictate some change in the industry. You’re already seeing that and it will continue to accelerate as patients are demanding more from their electronic experience with their providers. I think you’re going to continue to see it.

In essence, long-winded answer, but all the dynamics need to converge, whether it’s the government, whether it’s the market, or whether it’s patient and consumer influences that are going to take us in the right direction. The signs are there. Now we’ve just got to finish the journey.

Epic users in specific regions seem to talk a lot about sharing information with each other. Is it really that much different compared to, say, Cerner users?

I really don’t think there’s a difference. Just because the two vendors that you cited, Cerner and Epic, have such a large market share, you can find examples of really good interoperability between not only organizations with the same technical platform — whether it be Cerner or Epic — but even among Cerner and Epic. Just given their percentage of the market share in this country, you find good examples of both. I can’t necessarily say there’s a difference.

I know that there’s a lot of debate on that, certainly in the Epic world. But I think Epic would tell you that they interoperate better than any other vendor just based on the volume of transactions going back and forth. It’s a delicate balance, but you’ll find good examples all over the country. You’re starting to see that the influences that are going to dictate integration are probably less about technology and applications now and more about the competitive climate that you’re in.

Cerner has built an amazing business and is expanding into areas such as health management. The company is so big now that it has to find new ways to keep growing. Where do you see them going?

I give Cerner a tremendous amount of credit for their business strategies over the last couple of years. Not only are they tremendous competitors in their core space of EHR and now emerging revenue cycle and ambulatory products, but they also diversified their service portfolio. They got into consulting. They do a good job with their consulting environment. They also got into remote hosting and application management services. They’ve expanded internationally.

That’s an example of a company that not only is doing what they did well from a core standpoint, but also diversified their service and business model and continued to be very successful. I think you’re going to continue to see the same. I think what you’ll see with Cerner is a continued refinement of some of their core products, particularly around revenue cycle and their ambulatory and physician practice management applications, and that will be part of the next generation. 

You’ll also see a tremendous refinement of their business analytics capability. Their partnership with places like Intermountain Health will give them a tremendous opportunity to improve that side of their portfolio. I think all good things ahead for Cerner.

We seem to have an overwhelming number of startups, accelerators, and companies nobody’s ever heard of that suddenly claim they’ve figured something out. Where do you see them being successful in enterprises as opposed to the consumer side?

I see a lot of startups in the area of, obviously, analytics and business intelligence. You’ll see them in patient engagement. You’ll see them in products around revenue cycle. Those seem to be the cottage industries of these pop-up software and consulting firms.

This will follow the same trend as the HIS or EMR markets over the last 20 years. The market will rationalize. There will be winners. It will slowly self-select down to a set of players that will be viable market contenders.

Let’s take the business analytics space. I call that the Wild West right now because you have so many of these products out there that are generally focused on solving one component of business analytics. They might be doing Meaningful Use quality indicators or they might be doing patient engagement statistics. They all come into this space at a different place. What they’re trying to do is broaden their portfolio to be a full-service provider of business analytics and analytics capability. 

You’re starting to see some winners in that space right now. As they broaden their portfolio, as the market rationalizes, you’ll see a handful of winners in any one of these markets. That’s what I think will happen and I think that’s going to accelerate quickly. The market condensing right now is going to put a tremendous stress on the players that don’t have a viable business model or a viable product and they’ll wash out. You’ll see a rationalization of the market relatively quickly.

People seem less enchanted with Meaningful Use. Is ONC’s influence diminished?

Diminished is probably a strong word. They’re obviously going to be a major player in trying to not only shape policy, but the incentives and dynamics moving forward with subsequent releases of Meaningful Use. Diminished is probably the wrong word.

But market influences will accelerate. ONC’s direction, the government’s direction, and market influences are, I hope, aligned. You’re starting to see that they are aligned. Perfect storm is the wrong word, but you’re going to see a series of influences — whether it’s ONC, market forces, or consumerism — that are going to drive the industry in the same place.

So not necessarily diminished, but you’re going to see the prominence of the consumer side, particularly around employers. Employers are going to take a much bigger stance. Payers are going to take a much bigger stance in influencing the market and certainly the provider side. You’re going to see not so much a diminishing of the government influences, but an increasing of the other influences that are shaping the industry and a consistency on the other influences.

What do you read into the acquisition by pharma services vendor Quintiles of your consulting competitor Encore Health Resources?

It surprised us. We obviously watch the market and we watch our competitors and Encore has always been a great competitor with great leadership and great talent. So quite honestly, it was a surprise to us.

I’ve seen other of our competitors, friends, and colleagues on the consulting side that have taken different directions, which I applaud because there’s synergy in terms of some of their acquisitions and mergers. But quite honestly, the synergy of that acquisition wasn’t as apparent as others, I guess I would say. So yes, it surprised us.

Impact Advisors is part of the Epic-IBM bid for the DoD’s EHR contract. What effect will that project have on the overall industry?

It’s obviously a huge project, so I think it has the ability to be a very big influence.

First of all, it’s going to be a tremendous opportunity to influence healthcare in our country for the patients, the military families, and the military personnel that that system serves day in and day out. We’re excited to be a part of that bid. At the very utmost, it has the opportunity to be transformational for the healthcare service of our armed services. That’s number one.

Number two, on the industry side, I think it’s an $11 billion project, moving probably north of that over the next 10 to 15 years. As I think someone in the military told me, they said it’s going to be the largest government award that doesn’t involve steel or putting something into space. That gives you a sense of the magnitude of the project. 

We’re very excited to be part of it. I think it has the opportunity to be a major game changer, certainly for the armed services and the families that they serve. We’re proud to be part of that bid and we’re looking forward to hearing about that award.

What trends are you seeing from your broad exposure that might not be obvious?

The influence of the reimbursement market will have a tremendous impact on what happens in a technology space. What many of my clients call a tipping point or a pivot point is about to happen. That’s the true conversion from volume to value. You hear a lot of buzz terms around that, but basically the concept of being paid for quality rather than volume. That’s going to happen. We’ve been predicting that over the last couple of years, but we’re accelerating towards that.

When that pivot happens, it puts a tremendous premium on two things. One, provider organizational leadership. The leaders of the hospitals, IDNs, academics, and children’s hospitals are going to have to lead in a way they’ve never lead before. They’re also going to have to have a set of partners that they’ve never had before, primarily the payer side as well as other partners in their region and community. It’s going to be very interesting to see how that all manifests itself.  Not only will be an organizational change, it will be a structural change. It will require leadership change and ultimately all the way down the line to technology changes.

We’re excited about it. We think that kind of change is good for the industry, it’s good for healthcare, and ultimately it’s good for the firms that are serving that industry.

Do you have any final thoughts?

This is going to be a tremendously fun industry over the next couple of years. I don’t think we’re going to experience more change than we are in the next couple of years. It’s going to be fascinating and fun to be part of that. Healthcare is the most fascinating industry out there because of the dynamics and influences.

Athenahealth Acquires RazorInsights

Athenahealth announced this morning that it has acquired inpatient EHR vendor RazorInsights, which primarily serves rural, critical access, and small community hospitals. Terms were not disclosed, but an HIStalk reader who tipped me off early to the announcement says the acquisition price was $40 million.

Athenahealth says it will “leverage RazorInsights’ inpatient expertise and award-winning technology to extend its presence into the 50-bed-and-under inpatient care environment, which accounts for approximately one-third of the US hospital market.”

The announcement cites the RazorInsights customer base of 25 hospitals, the success of some of its customers in attesting for Meaningful Use Stage 2, and its cloud-based delivery model.

Athenahealth Chairman and CEO Jonathan Bush said in the announcement, “Today’s hospital market is woefully underserved when it comes to IT systems and IT partners that are accountable for reducing costs, increasing quality, and enabling a better patient experience. With RazorInsights, athenahealth will immediately be injected into the inpatient care environment; this is a natural extension for our cloud-based services, will tremendously grow our network knowledge, and will accelerate our introduction of results-oriented, inpatient solutions that hospitals can confidently invest in and demand accountability from.”

Morning Headlines 1/14/15

Data Analytics Update: Health IT Policy Committee Meeting

At this week’s Health IT Policy Committee meeting, ONC reports that 77 percent of eligible hospitals and 56 percent of eligible providers scheduled to attest to Stage 2 Meaningful Use have done so. Hospitals still have a month left to attest, while providers have three months left.

Ellmers Reintroduces the Flex-IT Act

Congresswoman Renee Elmres (R- NC) reintroduce HR 270, the Flexibility in Health IT Reporting Act of 2015, a two-page bill that would reduce the Meaningful Use reporting period from 365 days to 90 days.

Clinical Documentation in the 21st Century: Executive Summary of a Policy Position Paper From the American College of Physicians

The Annals of Internal Medicine publishes a paper investigating the effect EHRs have had on the structure and usefulness of clinical notes, concluding that EHRs have real room for improvement, but that the primary driver of change in clinical notes has been the documentation requirements imposed to support an increasingly complex billing process.

Why We’re Picking Walmart And CVS Over Doctors’ Offices

The Huffington Post covers the rise of retail clinics, whose numbers have seen a sevenfold increase since 2007, driven largely by CVS and Walgreens.

News 1/14/15

Top News

Pundits and associations won’t stop banging the “Meaningful Use is a failure” drum in pointing out low participation numbers, but ONC partially contradicts their grim calculations in reporting that 77 percent of MUS2-eligible hospitals have attested, as have 60 percent of MUS2-eligible practices. Those providers still have another one month and three months left, respectively, to attest. Those aren’t great numbers, but they’re a heck of a lot better than you might think, and as a taxpayer it’s nice to know that my money at least has minimal strings attached.

Reader Comments

From Poignant Moment: “Re: non-disclosure agreement. If a vendor requires a hospital to sign one for beta testing, how long does the vendor have to keep the NDA after testing is complete?” I’ll ask knowledgeable readers to help out, but I would say the signed copy should be retained at least until it expires since an NDA should cover a stated time period. That’s for making sure the agreement is followed – I doubt there’s any legal requirement to keep a copy at all.

HIStalk Announcements and Requests

I’m enjoying the articles written by startup CEOs and investors (Brian Weiss of Carebox, Bruce Brandes of Martin Ventures, and Marty Felsenthal.) Those authors and others will contribute ongoing articles on their experiences and lessons learned when working directly with startups. I appreciate their contribution. I’m learning from them since I’ve mostly only worked for non-profit hospitals and theirs is a foreign land to me.

Please take a couple of minutes to complete my once-yearly reader survey. I plan my entire year around the responses, so your time will be not only appreciated, but also well spent in my never-ending quest to reduce my level of suckitude.

Webinars

John Olmstead, RN, MBA, director of surgical and emergency services at The Community Hospital of Munster, IN delivered an absolutely perfect HIStalk webinar on Tuesday, “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” He was interesting, informative, and funny in describing technology used in his ED, including RTLS from Versus (who sponsored the webinar without turning it into a sales pitch), Epic EHR, Ascom phones, and Rauland nurse call. It did something that few webinars do in holding my rapt attention throughout and it wasn’t just me – the webinar’s control panel showed that 98 percent of attendees were hanging on to his words instead of checking email or web browsing. The average is more like 60 percent of people paying attention (and for companies that decline our webinar improvement suggestions, it’s as low as 15 percent). I’m confident that anyone with the slightest interest in ED challenges, quality improvement, and what happens when CDC shows up to investigate an infectious outbreak will enjoy this one a lot.

Acquisitions, Funding, Business, and Stock

Athenahealth adds two companies to its More Disruption Please Boston-based accelerator program: CredSimple (credentialing) and RubiconMD (referred remote consults). Athenahealth also announced that the accelerator will open a San Francisco office.

Augmedix, which offers Google Glass-powered physician documentation system, raises $16 million in Series A venture capital.

Kit Check, whose OR medication kit tracking system is live in 144 hospitals, raises $12 million in a Series B round led by Kaiser Permanente Ventures, increasing its total to $22 million.

Digital mental health solutions vendor Ginger.io raises $20 million in a Series B round.

Cary, NC-based SmartLink Mobile, a spinoff of referral coordination software vendor Infina Connect,  raises $2.5 million in funding for its secure patient-doctor texting platform.

Israel-based startup MediSafe, which offers a medication reminder app, raises $6 million and opens a Boston office. One of its new investors is 7wire Ventures, run by former Allscripts executives Glen Tullman and Lee Shapiro.

IT services provider Syntel sues Cognizant and TriZetto over the former’s acquisition of the latter for $2.7 billion last year, with a Syntel business unit saying TriZetto refuses to pay rebates to which it is entitled because of the acquisition. Syntel claims contract interference and misappropriation of confidential information and wants $3.4 million plus $6.1 billion (with a “b”) in punitive damages.

Alere completes the sale of its Alere Health business to Optum for $600 million in cash, announced in October.

Madison, WI-based population health software vendor Forward Health Group raises $5.7 million in funding.

AARP issues a call for startups with apps targeting the “50 and over” market for its May 14 pitch meeting in Miami. Applications are due by February 20, 2015 with no fee required. Companies will deliver a four-minute pitch, answer six minutes of questions from judges, and then have their idea voted on by consumers in attendance based on need, marketing, usage, and value.

Sales

Zwanger-Pesiri Radiology (NY) chooses the Visage 7 Enterprise Imaging Platform for its 58 Long Island radiologists, integrated with the practice’s vendor-neutral archive and enterprise workflow engine.

Eisenhower Medical Center (CA) chooses Mobile Heartbeat’s CURE clinical communications platform following its pilot project.

Good Samaritan Hospital-Southwest (CA) chooses Medhost’s remotely hosted clinical and financial solutions.

Mercy Health (OH) selects ProVation Care Plans from Wolters Kluwer Health for evidence-based care plan management.

People

Jamie Coffin, PhD (Clarify Healthcare) joins SourceMedical as CEO.

Announcements and Implementations

Wellcentive releases an analytics and reporting solution for providers participating in CMS’s Delivery System Reform Incentive Payment (DSRIP) program for Medicaid population care improvement.

HealthLoop releases an iPhone app that sends push notifications to a physician when a patient triggers a clinical alert or when another physician sends a triage handoff. It’s part of the company’s package that costs $199 per physician per month.

Bon Secours St. Mary’s Hospital (VA) goes live on Vox Telehealth’s OrthoCare program, which sends hip and knee replacement patients daily pre-op education and reminders and allows them to relay questions or concerns afterward.

Iatric Systems announces Auditor’s Desktop, which performs a daily risk analysis of potential privacy violations across multiple IT system audits.

Surgical Information System’s  anesthesia information management system is ranked #1 in a new KLAS report.

Government and Politics 

Congresswoman (and nurse) Renee Elmers (R-NC) reintroduces the Flex-IT act that would reduce the 2015 Meaningful Use reporting period from 365 days to 90.

A Washington Examiner investigative report finds that HHS spent $31 million on first-class flights between 2009 and 2013, including 253 trips that cost more than $15,000 each way. HHS executives taking the first-class flights claimed 70 percent of the time that it was necessary because of a medical disability. CMS officials paid $1,000 each for first-class tickets to fly from Charlotte, NC to Charleston, SC, which is a three-hour drive.

Other

Odd: Sentara Healthcare (VA) launches a web shop selling books, vitamins, exercise equipment, and non-prescription drugs, explaining it as “a branded option that offers a higher trust factor and unique patient experience.” A 200-tablet bottle of Advil is $27.99 vs. Walgreens online at $16.49; an Omron 5 blood pressure monitor is $95.99 vs. $45.95 on Amazon; and the book “Yoga Heals Your Back” is $19.99 vs.  $11.69 on Amazon (or $2.99 for the Kindle edition). Anyone smart enough to find and use Sentara’s site will also be web-competent enough to check prices elsewhere, so the site’s success will depend on how highly those people value the “unique patient experience” of clicking the “buy” button there vs. mainstream sites they’re already using. The underlying technology is from Paquin Healthcare, which also offers a system that integrates with EHRs to generate “lucrative new revenue streams” to “monetize major investments made in mandated EMR systems” by using the patient’s information to suggest that the doctor upsell items such as vitamins, wearables, and books. As the company explains, “If a patient’s medical record shows they have had heart disease, Embrace automatically recommends vitamins, pedometers, weight management tools, blood pressure monitors, and other such products suitable specifically for patients with that condition. When a patient purchases the recommended products or services, revenue from the sale is paid to the care provider.” 

Alibaba Health Information Technology settles its licensing dispute with Oracle. NYSE-traded, China-based e-commerce vendor Alibaba Group, whose shares are worth $255 billion and which has been predicted to be the world’s most valuable company in the next few years, bought and renamed the former Citic 21CN drug information business in early 2014.

A clinical documentation position paper from the American College of Physicians published in Annals of Internal Medicine says that EHRs provide minimal improvement over paper records because they were designed around billing and regulatory requirements and the practice of defensive medicine rather than improving patient care. It warns that the EHR is as overloaded with useless information as its predecessor paper chart (and will get worse with data from patient wearables) and that narrative entries are being unjustly devalued in favor of discrete data entry. The authors add that E&M guidelines forced data formatting rules that caused “coding and compliance trumping clarity and conciseness, as well as a harshly negative ‘gotcha’ mentality that saps the professionalism out of physicians.” The position paper says CMS overreacted in its condemnation of copied-pasted information, explaining that while copy-paste causes documentation bloat and perpetuation of originally incorrect information, physicians should not necessarily be required to create every new EHR entry manually – in other words, it’s the user and not the EHR function that should be of concern. The paper expresses tepid support for the Open Notes concept of letting patients review clinical documentation, saying it’s too early for a big rollout and that providers should be able to hide individual notes that could cause patient harm.

Huffington Post covers the growth of retail clinics. CVS alone plans to have as many MinuteClinics in operation by 2017 as exist overall today. Meanwhile, mall operators expect to fill empty spaces left by dying retailer chains such as Sears and RadioShack with walk-in clinics, of which more than a third of the 9,400 total are located in shopping centers.

I enjoyed these tips for making meetings more productive:

1. Don’t invite more than 10 people.
2. Schedule meetings for only 15 minutes, set a timer, and stop the meeting when the timer goes off.
3. Take away the chairs to encourage creativity instead of passivity.
4. Don’t allow laptops or phones – studies show taking notes by hand leads to greater understanding.
5. Assign every task to a directly responsible individual.
6. Take a two-minute silence break to think about a decision or issue.
7. Ask each attendee to answer the “why are we meeting” question in five words or fewer to make sure everyone expects the same outcome.

Weird News Andy understands that, “It’s hard to re-member.” A woman in China cuts off her husband’s penis after catching him sexting with his lover, but surgeons successfully reattach his manhood. The wife, obviously still unhappy, sneaks back into her recuperating husband’s hospital room and cuts his penis off again, this time throwing it out the window of his hospital room. The couple was caught on camera fighting in the street outside as the man was naked and bleeding, but he won’t be reorganized a second time – the hospital says a dog or cat must have run off with his severed penis because they couldn’t find it. However, he may yet have a happy ending since his lover says she will marry him anyway.

Sponsor Updates

• TransUnion unveils a new brand identity platform and logo.
• MedAptus joins Athenahealth’s More Disruption Please program.
• Forbes profiles the use of Strata Decision’s StrataJazz to reduce hospital costs.
• Zynx Health will exhibit at the HealthIMPACT Southeast event on January 23 in Tampa.
• Huron Consulting Group’s efacs software is selected as University Business Readers Choice Top Product.
• Voalte offers advice for setting goals in 2015 in its latest blog post.
• Verisk Health blogs about why value-based care will work.
• T-System Director of Documentation Solutions Robin Shannon, RN offers tips on how to maintain efficiency and throughput during high patient volumes in flu season.
• CEO/CFO Magazine interviews SyTrue CEO Kyle Silvestro on transforming medical data into refined smart data.
• Surgical Information Systems will participate in the MUSE Executive Institute in Amelia Island, FL on January 19-20.
• Summit Healthcare blogs about its preparations for the IHE North American Connectathon, taking place January 28 at the HIMSS Innovation Center in Cleveland.
• SRSsoft offers four key ways to make and keep resolutions in the new year.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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