News 5/1/15

Top News

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

Sales

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

Announcements and Implementations

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

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

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

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

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

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

Government and Politics

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

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

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

Privacy and Security

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

Innovation and Research

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

Technology

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

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

Other

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 4/30/15

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

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

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

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

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

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

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

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

HIMSS15 Patient Advocate Recap–Melanie Peron

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HIStalk Interviews Jake Morris, Managing Director, McKinnis Consulting Services

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

Tell me about yourself and the company.

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

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

How has the Affordable Care Act impacted the revenue cycle?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What are hospitals doing to address plans with narrow networks?

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you have any final thoughts?

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

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

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

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

Morning Headlines 4/29/15

Vanderbilt to replace clinical IT systems

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

CareCloud announces new CEO, $15M in funding

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

What Health Care Will Look Like in 2030. Maybe.

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

Validic Tracks Down $12.5 Million to Gather Medical Data

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

HIMSS15 Patient Advocate Recap–Amanda Greene

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

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

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

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

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

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

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

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

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

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

"Connected Patient" Learning Gallery exhibit at HIMSS.

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

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

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

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

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

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

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

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

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

News 4/29/15

Top News

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

The Chicago business paper profiles referral management software vendor Fibroblast.

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

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

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

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

Sales

Consolidated Laboratory Services chooses McKesson Business Performance Services for billing.

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

People

  

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

Announcements and Implementations

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

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

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

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

MedAptus releases Premium Analytics for its charge capture suite.  

QPID Health is named a Gartner “Cool Vendor.”

Government and Politics

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

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

Privacy and Security

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

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

Other

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 4/28/15

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

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

Advancing Breakthrough Devices for Patients Act

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

DoD To Start Its Own Digital Service Team

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

Readers Write: Chicken or Egg?

Chicken or Egg?
By Niko Skievaski

HIStalk recently released these poll results: “Which #1 reason would cause you to avoid doing business with a startup?” (*n=350):

• Fears that the company isn’t financially viable (47 percent )
• Offering a product that solves a non-strategic problem (21 percent)
• Lack of integration with existing IT systems (17 percent)
• Lack of comparable reference sites (10 percent)
• A CEO who doesn’t have poise, polish, or healthcare experience (5 percent)

These embody much of the technology adoption barriers facing healthcare. Startups are perceived as being unable to commit to long-term contracts and lack reference sites to build confidence in buyers– just as the first chicken couldn’t have been hatched without the egg from which it came. These things combined make for a very difficult landscape for healthcare technology startups to thrive in. So who lays the egg?

Fears that the company isn’t financially viable. It’s extremely costly for a health system to adopt new technology. Beyond the price tag, there are real costs associated with implementation and training necessary to successfully go live. The last thing they want is to be left hanging if your company goes under. Jason Bornhorst, who exhibited the last two years in the HIMSS startup neighborhood, said, “I’d estimate that about two-thirds of the companies that were here last year aren’t around any more.” The fact of the matter is that you need to have the resilience to ride the bone-breaking sales cycle. They’ve been practicing medicine without your software for 100 years; they can wait another 1-2. How do you bootstrap financial viability to last the long sales cycles and combat this perception? Raise more money, find alternative revenue sources, join an accelerator or two to buddy up with health systems, and surf the cycle efficiently.

Offering a product that solves a non-strategic problem. This isn’t so much a market failure as it is a customer development failure. Start a better startup. Don’t start a bakery because you’re a good baker. Start a bakery because there is excess demand for baked goods. I just hope that the buyers at health systems are delivering this intuition directly to the startup in addition to anonymous HIStalk polls.

Lack of integration with existing IT systems. Integration is a must. It’s not enough to say, “Use our product in a standalone capacity during the pilot and we’ll figure out integration later.” Providers hate double documenting and clicking. Forget switching windows. Their complaints bog down IT teams. Both of these groups will throw a block at your pitch if you don’t have a solid answer for interoperability with existing systems, both from a technical perspective as well as implementation. There’s a new wave of startups out there providing modern integration strategies for startups attempting to interoperate with the EHR.

Lack of comparable reference sites. One of the mantras I learned back at Epic is that every single customer should be able to be considered a reference site. It’s that level of customer service and do-anything-ness that makes them stand apart as a vendor. The space is too small to simply write off any customer as a lost cause. If a health system chooses to work with us, we need to do everything possible to make sure they’re a good reference site for future customers.

A CEO who doesn’t have poise, polish, or healthcare experience. Have you met Judy Faulkner, Chris Patterson, or Jonathan Bush?  Just a few examples of eccentric, throw-caution-to-the-wind type personalities who oversaw a successful EHR startups. But you need to know the audience of decision makers. If you’re new to healthcare, welcome to the wild world of buzzword bingo. Get conversational stat (yep, that’s a healthcare word). Read books, blogs, HIStalk.  Listen to podcasts. Go to HIMSS and actually listen to some sessions that relate to your domain. You wouldn’t buy a car from a guy that didn’t know the difference between a carburetor and catalytic converter. Be sure that you can demonstrate that this isn’t your first rodeo. Manufacture your “experience” by becoming an expert in the domain.

Mr. H, maybe a survey on top reasons to work with a startup next time?

Niko Skievaski is  co-founder of Redox.

Readers Write: The Journey to Value-Based Care: Lessons Learned from Aviation

The Journey to Value-Based Care: Lessons Learned from Aviation
By David Nace, MD

The Affordable Care Act (ACA) and healthcare reform have impacted providers in all aspects, from the way they are and will be paid to how they engage patients. To meet the deadlines and demands of an industry shifting to value-based care (VBC), physicians must change their thinking from independent to team-oriented in order to succeed in this new world.

VBC is empowering an evolution within the overall healthcare community, especially amongst physicians. This is enabling a focus on delivering high-quality of care to patients. The Meaningful Use and EHR certification programs have helped all provider organizations get closer to the more meaningful use of information technology, but the requirements also pose many challenges for providers.

These challenges should not be met with resistance. The physician community should embrace the call for change. Similar to the revolution of the aviation industry, reform required them to adapt to new methods of communication and technology to ensure safer flights.

Traditionally, physicians are independent and competitive in nature. They didn’t go through rigorous selection and testing over nearly eight years of higher education to merely coast by – they have an innate drive to be successful and help people. Value-based care, in theory, plays to their personality traits and gives them the motivation to achieve even higher goals.

However, physicians have a hard time trusting data or measures that they do not understand, especially when their evaluation is out of their control and input. For example, a 2014 survey of 4,000 physicians found 78 percent reported patient satisfaction ratings moderately or severely affected their job satisfaction and 28 percent considered quitting their job or leaving the medical profession.

To add to this statistic, most organizations do not have the appropriate communication, technologies, and data collection sources and processes put in place to understand the measurements being imposed on them. To tackle this challenge, hospital executives and physicians need to improve physician communications and transparency in regards to measurement.

Pilots faced a similar disconnect during the 1980s. Training a pilot occurred in an apprenticeship model — you learn from a “master” and through them learn their personal techniques and strategies. It really was a “master craftsman” mentality of mentorship.

This method of training and learning lead to a variations in practice and high accident and death rates associated with aviation. The practice was not based on teamwork or leveraging technology for standard operating procedure. There were no Global Positioning System (GPS) and Cockpit Resource Managements (CRM) utilized – it was all based on the techniques and approach of pilots. To understand the technologies imposed on them and to improve quality of flight, the way pilots were taught changed to a team-based approach that focused heavily on communication and transparency, data, and standard operating procedures.

There is a similar revolution coming to the world of medicine. Many of the physicians of tomorrow are beginning to prepare through team-based, information driven training. Young physicians in training are being proactive in understanding the methodologies and technologies of today and starting grass root movements — for instance, Primary Care Progress — to inform and inspire newcomers to the industry. Medical students are increasingly being trained in groups (versus one-on-one) to leverage the concept of teamwork and to better understand the evolving healthcare industry and their role in the transformation.

Change is inevitable in any organization. New rules, methods, and technologies will always cause a shift. These transformations should not and cannot be met with resistance, but with an open mind, as everyone needs to work together toward the end goal.

Pilots needed to adapt and alter their training and methodologies during flight to fly in a safer, more efficient manner. Similarly, providers must do the same with value-based care. The more collaboration, the smoother the ride will be.

David Nace, MD is vice president and medical director of McKesson Technology Solutions.

Curbside Consult with Dr. Jayne 4/27/15

CMIOs Gone Wild

One of the challenges of being anonymous is missing out on get-togethers at HIMSS. Sometimes vendors invite me to participate in events as myself, but other times the invitations come to Dr. Jayne. Even though most of them promise to either maintain my anonymity or allow me to register under whatever name I choose, attending such invitations has risk. Plus, I generally don’t attend events that I didn’t get invited to as my “real” self (or at least couldn’t tag along as someone else’s +1).

Although I trust Lorre and Mr. H to protect my identity, I had mixed feelings about attending the HIStalk CMIO lunch at HIMSS. I was excited about meeting other CMIOs outside the settings where we normally cluster in the wild – symposia, conferences, and of course the AMIA Clinical Informatics board review course. I get together with other CMIOs in my health system at least quarterly.

But it’s different when you have the opportunity to talk to people from other parts of the country that may be facing challenges that haven’t hit your market yet. It’s also different when you get a group of CMIOs who face the same pressures every day and they’re put in a relatively “safe place” where they can speak their minds.

My original plan was to cruise by, see who was at the table, and drop in if feasible. Most of the time though the table was packed and Lorre reported that they had to swipe chairs from the McKesson table because more people kept arriving. She was gracious enough to take notes on some of the discussion so that I could attend vicariously, as well as some pictures.

I thought about running the photos, but then I remembered my own hospital’s rules about vendor interactions and I certainly don’t want to get anyone in trouble by calling them out. I’ll keep the attendees anonymous, but here are the group demographics:

• University hospital or major health system – 4
• Physician group or IPA – 2
• Government or public health – 3
• Industry or vendor – 6
• Other – 2 (multiple roles, consulting, etc.)

Since women in technology leadership has been a hot topic on HIStalk lately, I’ll give the breakdown: two were women, the rest were men. There were more vendors than I had expected, but several were either notable personalities or had been CMIOs in a previous position.

Although I had given Lorre some conversation starters in case the group was quiet, from her notes, it sounded like the discussion did just fine on its own. Hot topics included:

• Patient portals. What strategies are CMIOs using to increase patient portal use? Most agreed it needs to be more valuable to the patient to get them to engage. One mentioned that at Duke the only way to pay a bill is through the portal. Others agreed that the ability to schedule appointments was key. There are different strategies to gradually add the appointment piece to the portal since physicians are sometimes reluctant to allow patients to self-schedule. Appointment cancellation is also important. The topic of no-shows came up and the general thought was that if patients are willing to go online to schedule, they’re typically willing to go online to cancel.
• Physicians opting out of MU. Several felt that MU is not useful. One commented that, “There are no opt-outs in malpractice.” Another commented that the penalties aren’t high enough to force providers to engage – some have done the math and if they can see one more patient a day and do less work, that’s more economically favorable even with the penalty.
• Board certification. CMIOs discussed fellowships vs. on-the-job training. Many would not choose to spend time in a fellowship if it was required. There was discussion about Maintenance of Certification and the fact that the American Board of Preventive Medicine has not certified enough relevant content for Clinical Informatics. One CMIO is going to take a dive medicine trip because those credits count and she gets to SCUBA dive.
• Various CMIO challenges. New problems seem to crop up daily. One physician found that lab analysts were rounding the numbers for lab values rather than displaying them as they were reported from the analyzer machines. Another cited the difficulty getting clinical photos into the EHR and the problem of physicians taking photos on their iPhones and sending them around. They also noted the problem of dealing with operational issues that are uncovered by an EHR implementation. For example, labor and delivery nurses that could no longer “preorder” for physicians before the patient was admitted. Since there weren’t any formal standing orders, the nurses were ordering on paper what they knew the physicians would want. When they couldn’t do it in EHR, it became an issue, requiring discussion of their scope of practice.
• Documentation was a hot topic. Attendees felt that what EHRs are putting out isn’t clinical documentation — rather it’s all about billing documentation. They’d like to ask CMS whether clinical documentation should be required to support clinical decisions rather than billing decisions. Evidence-based documentation is necessary and needs to be pertinent. CDS should be a major part of documentation, but it needs to be filtered to the situation and actionable. Context is key. Alerts should be standardized. Use of documentation templates and order sets is increasing. One site is using Lean Six Sigma principles and Kaizen events to create disease specific clinical note templates to help communicate information to help nurses and social workers with post-discharge care. We need to better identify what parts of the documentation need to be discrete. What is the important information? What is the minimum needed?
• Global healthcare models are being examined. One attendee recently visited hospitals in Japan. He liked their clinical pathways, where grids are used for each day of the treatment plan. Each role had guidelines on what should be documented.
• Interoperability. FHIR was discussed as was the use of SNOMED and LOINC. What will the next standard be? There are still problems between systems. We need to broaden interoperability for problems like visual diagnostics. Providers should be able to take a photo and send to dermatologists behind the scenes for decision support. Another wants to be able to take a photo and have it count for documentation and billing/coding bullet points – rather than describe the rash inadequately, put a picture in the chart. But CMS doesn’t allow providers to do that.
• Retail healthcare was mentioned. Some CMIOs are having interactions, receiving referrals, and being part of the feedback loop. One mentioned his experience with a specific retail clinic, saying that working with them was “as complex as working with the Department of Defense.”
• HIPAA Omnibus Rule requirements were discussed. If patients declare they are paying cash, the encounter data can’t be reported to payers. How are various vendors handling this? Some are suggesting providers use a “shadow chart” for the protected content. Others are just starting to discuss tagging the data. There is concern that allowing patients to choose which portions of the chart can be shared will interrupt care and cause possible misdiagnosis if physicians don’t have all the information.

Although I’ve mostly summarized from Lorre’s outstanding notes, one of the quotes caught my eye. I’m not sure who said it, but, “The CMIO is the face of dysfunction” might just be my new mantra. We (or our respective EHRs) certainly get blamed for everything. We’re also expected to figure out how to solve it without hurting anyone’s feelings while helping the operational, clinical, and technical teams play nicely together.

Based on the number and caliber of attendees who stuck around for a fairly long time during a very busy HIMSS week, it sounds like they found the event valuable. I hope Mr. H will consider doing it again in Las Vegas.

Email Dr. Jayne.

Morning Headlines 4/27/15

Health and Human Services Fiscal Year 2016 Budget

HHS Secretary Sylvia Burwell faces tough questions from Sen. Lamar Alexander (R – TN) over the EHR Incentive program which Alexander says is driving physician dissatisfaction.

Scientists are skeptical about the secret blood test that has made Elizabeth Holmes a billionaire

Business Insider covers Silicon Valley-based lab test vendor Theranos and its 31 year old billionaire founder Elizabeth Holmes. Despite its incredible early successes, the process Theranos uses to run its lab tests is still being kept secret and the company has yet to publish peer-reviewed studies comparing its results to traditional ones.

MEDITECH Announces Avera Health Moving Forward with 6.1 Web Release

MEDITECH announces that it has been selected to implement its “groundbreaking, completely Web-based EHR” across Avera Health System’s (SD) 33 hospitals and 208 clinics.

Monday Morning Update 4/27/15

Top News

HHS Secretary Sylvia Burwell, testifying on the department’s $84 billion 2016 budget request, is challenged by Sen. Lamar Alexander (R-TN) who stated that half of doctors don’t like their EHRs to the point that they’ll accept Medicare penalties rather than deal with workflow disruption, adding that the AMA found that 70 percent of doctors say their EHRs weren’t worth the cost and that EHRs are the leading cause of physician dissatisfaction. Burwell responded that HHS will work with Congress on a list of administrative action items related to EHRs, which seems to refer to the work of the HELP committee that most recently talked about interoperability and interviewed Epic’s Peter DeVault. What worries me most about the entire exchange is that nobody questioned whether HHS or Congress have any business involving themselves with how doctors use EHRs, where Burwell’s response might have logically been, “Respectfully, our job is making taxpayer payments to providers who choose to participate in Medicare and HITECH, but otherwise the EHRs that providers buy, use, and complain about really aren’t under the government’s purview. We should be monitoring the outcomes, not prescribing the process, which is how government works with all other industries.”

HIStalk Announcements and Requests

Poll respondents grade the HIMSS conference with somewhere in the C-plus range. A consulting company vendor says it was successful in meeting with clients and networking with peers, while a CIO observes that the HIMSS conference is all sizzle and no steak as it keeps growing and ratio of vendors to providers seems to be going up as well. New poll to your right or here: what do you think about the fact that most health IT vendor executives are white men? (“I’m not thinking about it at all” is a poll option as well). Add a comment to support your position if you like.

We were signing up for our microscopic booth for HIMSS in Las Vegas and were surprised to find that nearly all of the exhibit spaces have already been taken in the booth signup frenzy that occurs even before the previous conference is over. I don’t have the money or HIMSS points to play with the big boys, but even the 10×10 spaces in weird locations were mostly booked up. The tiniest parcels run around $5,500 and I declined the $2,500 extra HIMSS wanted for a corner space (they didn’t charge extra for our corner spot the past two years). We’ll be in #5069, with our presence probably annoying our next door neighbors Varian Medical Systems and Patient Prompt even though we’ll keep their area busier than it would be otherwise as we have a fun cast of characters running around. At least we don’t have much stuff to stick in there – we brought everything we used in our McCormick Place booth in one large duffel bag and set it up in maybe 20 minutes. There’s no ROI since we don’t have anything to sell, but we like just saying hello and giving our boothless friends a place to hang out.

Speaking of our McCormick Place booth, patient advocate Regina Holliday wrote a nice summary of the time she spent there and her HIMSS experience in general.

I forgot to mention an unpleasant encounter Lorre had with the “HIMSS police,” who were a little bit snippy in confronting her at our booth and demanding that we stop using the name “HIMSS Bingo” in referring to a contest that we had nothing to do with other than allowing winners to pick up their prizes there. The HIMSS person was too busy scolding to hear that she had the wrong scoldee.

Most people think of Epic first on the list of Madison-connected companies. Here’s another that just came to me: John Holton, who graduated from UW in 1975, founded Atwork in 1983 and then Scheduling.com (now SCI Solutions) in 1999, although both operated out of California rather than Wisconsin.

DonorsChoose Project Updates

Feel free to skip this section if you aren’t following our project as it winds down – the normal stuff follows.

Thanks to new participant The Breakaway Group, who donated $500 to get on Centura SVP/CIO Dana Moore’s dance card. I’ve funded $10,478.21 in projects, including these new ones, including some I chose in Colorado since that’s where Dana lives:

• A printer, tablet supplies, and early literacy books for an elementary school teacher’s graduate courses in education, Los Angeles, CA.
• A camera and photo printing equipment for creating a time capsule for a high school in Atlanta, GA.
• Math games and learning activities for a second grade class in Garland, TX.
• An iPad case and AV adapter for English language learners at an elementary school in Las Vegas, NV.
• A TV and flash drive to promote newly arrived books in the library of a high school in Walden, CO.
• Drums for rhythm and movement activities for special needs students at an elementary school in Centennial, CO.
• Six iPad keyboard cases for a fourth grade class in Lone Tree, CO.
• Globes, maps, and books for a K-2 class in Denver, CO.
• A tablet with keyboard for English as a second language students at an elementary school in Fort Lupton, CO.
• A Chromebook for an earth sciences class at a high school that can’t be accredited due to lack of hands-on learning tools in Norfolk, VA.
• A complete library of high-interest, low-readability books for a class of severely intellectually disabled students at a middle school in Conway, SC.
• Four boom boxes and 12 sets of headphones to create a literature listening station in the reading area of an elementary school in Seattle, WA.
• A library of classic books for a third grade class in Clarksdale, MS.
• Hand sanitizer and tissues for profoundly mentally disabled K-5 classroom in North Charleston, SC.
• Baby wipes, diapers, a food blender, wheelchair supplies, and insect repellent for a handicapped K-2 students at an elementary school in North Charleston, SC.

Webinars

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

Last Week’s Most Interesting News

• Infor signs an agreement to distribute its hospital data integration products in Cuba.
• A RWJF study of personal health records finds that consumers value their own subjective narrative entries more than anything else, while doctors rarely even look at them.
• Seven disabled veterans sue the VA for failing to deliver copies of their disability-related medical records for up to 25 months after their requests.
• LabCorp announces a direct-to-consumer testing program.
• Kaiser Permanente announces plans to open a 900-job healthcare IT campus in Atlanta.
• A judge orders MyMedicalRecords to pay the legal defense costs of Allscripts and WebMD after those companies prevailed in two of a nearly endless number of questionable MMR patent infringement lawsuits.

Acquisitions, Funding, Business, and Stock

Business Insider runs the first skeptical article I’ve seen about Silicon Valley lab darling Theranos and its $4.5 billion net worth, 31-year-old founder Elizabeth Holmes. Experts say they have no idea how the company’s technology works because Theranos won’t publish peer-reviewed studies about its tests, won’t let independent experts review its labs, and doesn’t acknowledge whether it’s actually using the same analytical machines as other labs in addition to its small-sample size equipment that other labs use as well. The article also questions whether can scale given its plans to perform 1 million tests in 2016, less than 0.2 percent of the number performed by Quest. Quest and other competitors are questioning whether tests performed by Theranos using capillary blood (microfluidics) are accurate.   

Sales

Children’s Hospital Association chooses Clinical Architecture’s Symedical for global terminology management for analyzing comparative data.

Avera Health System (SD) selects Meditech 6.1 Web EHR for 33 hospitals and 208 clinics. The press release isn’t clear as to whether this is an all-new product and Googling the term “Meditech Web EHR” brings up a non-specific mention on the company’s website, which used to be a no-nonsense list of information but is now maddeningly glossy and detail-free, with artsy scrolling pages and oversized type crying for Internet attention without providing much value in return. Click “EHR Solutions” and you won’t see a list of them. I don’t fully understand how a product can be “groundbreaking” if it’s in version 6.1 or whether this is just a new Web front end for the same old products.

People

Mark Young (StayWell Health Management) joins PatientSafe Solutions as COO.

Announcements and Implementations

Phynd Technologies will analyze the cost to Nebraska hospitals of managing their provider information manually vs. using its provider information management platform in a project funded by the state.

Government and Politics

The VA forms an 11-member medical advisory group to advise it on healthcare delivery issues.

Here’s a pretty funny tweet from CMS Chief Data Officer Niall Brennan.

Technology

Healthcare is always a lagging chaser of consumer technologies, so I’m not quite sure what to make of the just-announced Amazon Dash, a WiFi-connected, product-specific stick-on electronic button that lets users restock a particular product with a single press. It’s either a brilliant time-saver that creates even more loyalty to Amazon and the products it sells or, as The New Yorker opines, “an uneasy image of our homes as giant Skinner boxes, and of us as rats pressing pleasure levers until we pass out from exhaustion” that bypasses the brief thinking moment of “Why am I using all this stuff?” while driving to the store. I didn’t realize that Amazon already offers a speech recognition and barcode scanning version of Dash for users of its expensive AmazonFresh grocery delivery service in Seattle, California, and New York metro areas.

Other

USA Today profiles the involvement of patients in the EHR selection of Partners HealthCare (MA), which invited a patient who sits on its advisory board to help choose its $700 million system. I like the approach, although I can’t help but think of the economic strong-arming and brand name-brandishing Partners does to squeeze out competitors and force insurers to pay its exorbitant rates, which isn’t really in the best interests of patients or the healthcare economy in general.

An investigation has been underway in Texas to review the state’s issuance of a no-bid Medicaid anti-fraud system contract to a local bidder with zero experience. The Houston newspaper points out that the state was already using a similar system that had recovered $56 million against its original cost of $16 million, while the new $20 million system (with a pending $90 million extension) has recovered zero dollars. Nearly all of the funds came from all of us who pay federal taxes. State government was asleep at the wheel, with a prime example being that the contractor (21CT) billed it the full price of a $452,000 project the day after the purchase order was signed and the state paid it immediately. A few state employees have been fired and a criminal investigation is underway. The state’s HHS inspector general who arranged the deal lied to CMS by claiming that a competitive bidding process had been conducted and then resigned after local newspapers exposed the scandal.

Sponsor Updates

• Nordic offers a recap of #HIMSS15 through its Twitter feed.
• PatientKeeper offers thoughts on “HIMSS and hEHRs.”
• MBA HealthGroup offers “Skin in the Game: Keys to Success in a Private Dermatology Practice”
• MedData breaks down the 2015 PQRS payment adjustment statistics.
• Wellsoft will exhibit at the EDPMA Solutions Summit April 26-29 in Amelia Island, FL.
• Sandlot Solutions will exhibit at the Big Data in Healthcare Summit April 28-30 in Boston.
• Netsmart’s e-prescribing solution attains certification for controlled substances.
• TeleTracking asks, “Who’s Looking Out For Nurses?”
• PDS offers “Five Tips for a Trend-Setting Healthcare IT Strategy.”
• NTT Data offers “Wearables in the Enterprise – What are Industries Saying?”
• Patientco adds 2.4 million patients to its patient revenue cycle platform.
• PeriGen recaps last fiscal year in “Another 48,611 births powered by PeriGen.”
• PMD offers “Keeping Priorities Straight and Scaling Support.”
• QPID Health CMO Michael Zalis, MD is featured in “Diagnosing Imaging: Maximizing Appropriate Use with Smart Decision Support.”
• Sagacious Consultants offers “ICD-10 Training for Providers, Coders, and CDI Specialists.”
• New York eHealth Collaborative offers “The Healing Power of Your Own Medical Records and SHIN-NY.”
• Stella Technology offers “HIMSS15 Conference Highlights and Takeaways.”
• Summit Healthcare declares that “HIMSS 2015 Did Not Disappoint!”
• T-System will exhibit at the UCAOA National Urgent Care Spring Convention April 27-30 in Chicago.
• Truven Health Analytics offers “Appealing the CMS Risk Adjustment and Reinsurance Calculations: Making Sense of the Discrepancy Regulations.”
• Versus Technology publishes “Reflections on the Oklahoma City Bombing, from a Nurse Who Was There.”
• Huron Consulting Group is named one of America’s best employers by Forbes.
• Winthrop Resources will exhibit at Interop Las Vegas 2015 April 27-May 1.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 4/24/15

U.S. cancer institute, software firm reach deals in Cuba

Two New York-based healthcare companies are among the first to sign commercial agreements in Cuba. The Roswell Park Cancer Institute of Buffalo, New York will work on lung cancer vaccinations with Cuba’s Center for Molecular Immunology, and Infor has found a partner that will resell its integration engine software in Cuba.

Few People Lost Jobs With V.A. in Scandal

A New York Times investigation finds that only three VA employees lost their jobs over the VA wait-time scandal, far less than the 60 people that VA Secretary Robert McDonald reported during a NBC television interview he did in February. Additionally, only eight of the VA’s 280,000 other employees were punished in some way for their involvement in the scandal.

WebMD Deserves Fees In Failed Patent Case, Judge Says

MMRGlobal, which sued both WebMD and Allscripts over frivolous patent infringements claims, has lost both claims and will now have to pay each company’s legal fees.

Oxycodone overdose deaths drop 25 percent after launch of Florida’s Prescription Drug Monitoring Program

Oxycodone-related deaths dropped 25 percent after Florida implemented a controlled prescriptions database. However, the project went live in tandem with state-wide efforts to shut down prescription mills posing as pain clinics, which likely also contributed to the reduced deaths.

EPtalk by Dr. Jayne 4/23/15

It was only a couple of weeks ago that I was lamenting a slow health IT news cycle. Now I’m up to my eyeballs in things I want to write about.

The physician lounge is buzzing about the Medicare Access and CHIP Reauthorization Act of 2015, also called the “SGR bill” or “Doc Fix” bill. Unfortunately, most of them didn’t read beyond the AMA headline — “Medicare payment formula bites the dust” — to see what is really heading their way. Although they won’t be threatened frequently with Medicare payment cuts, the entire Medicare payment game is changing. For those who participate, there will be annual payment increases of 0.5 percent through 2019 and then a variety of other changes.

Although that’s certainly better than a cut, it doesn’t even keep up with inflation. Physicians can’t ask their suppliers to limit their price increases to 0.5 percent. Many hospitals and health systems that only offered employees that level of salary increase would see feet moving towards the door. AMA leadership is lauding it as historic legislation that “finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians.” Based on the discussion around the physician lunch table, anyone who thinks this is going to end uncertainty about physicians and Medicare might be confused.

I have to admit I haven’t read the whole thing, but rather several strategic digests and quite a few chest-thumping press releases. Colleagues who are savvier about the actual contents of the legislation are appropriately skeptical. Those that were considering a departure from Medicare haven’t changed course, and today, additional physicians were jumping into the discussion. Although Medicare’s quality reporting programs should be streamlined, many physicians still are not on board with pay for quality if physicians will continue to be graded on outcomes beyond their control.

Although the new payment models are voluntary, I can see employed physician organizations immediately heading in that direction. Administrative bloat will increase as teams are hired to review and comply with what will undoubtedly be reams of new CMS requirements and regulations. While physicians around the table were initially applauding the end of MU as we know it, the room became quiet when the detail-oriented ones pointed out its replacements. The more unified incentive program will be based on quality metrics, resource and cost utilization, practice improvement, and also Meaningful Use. Physicians in the so-called “Alternative Payment Models” will also have to continue using certified EHR technology, so vendors aren’t off the hook either.

Physicians are particularly leery of metrics that include untested patient satisfaction or engagement metrics. A piece in The Atlantic this week addresses the issue. My favorite quote: “Patients can be very satisfied and be dead an hour later.” It cites research by a professor at the University of California-Davis that concluded the physicians may be reluctant to have difficult conversations with patients due to fears of lower patient satisfaction scores. There’s not a tremendous amount of data looking at patient satisfaction scores compared to morbidity and mortality data. We all know of patients who continue to go to physicians that we know have horrendous disciplinary records and poor clinical skills, yet when a change is suggested, they profess happiness with their care.

I’m encouraged that legislators included some level of protection so that plaintiff’s attorneys can’t use Medicare quality data to support a standard of care, but there are plenty of other organizations collecting and analyzing the data and where no such protections exist. As CMS goes, so go the commercial payers and eventually we’ll all find ourselves dealing with all kinds of different flavors of payment schemes from the large health insurance companies.

Interoperability is also a key feature of the legislation. HHS will have to figure out how to measure whether national priorities are being met and determine how providers will be evaluated. This means additional rulemaking and additional burdens on providers and vendors. As specified in the title, the bill also extends the Children’s Health Insurance Program (CHIP) as well as community health center funding for another two years.

The good news is that the bill didn’t include anything delaying ICD-10, so those of us making plans can get on with it. I had a good laugh reading an AMA fluff piece on prepping for ICD-10. “Spend your time in the month ahead identifying the changes you need to make in your practice for ICD-10. For example, you’ll need to update your systems, forms, and work flow processes.” Just a couple of small things you can do in your spare time, right? The next sentence was even better. “Pull together a group of all staff members involving coding, billing, claims processing, revenue management, and clinical documentation, then figure out each task necessary to bring your practice in line with the new code set.” That’s pretty much everyone in a typical physician practice. If practices are just figuring out what they need to do now, they’re way behind and oversimplification doesn’t help things.

The bill also includes provisions on competitive bidding; Medicare face-to-face documentation requirements; chronic care management services; funding for the National Quality Forum; and requirements that Medicare Administrative Contractors establish “improper payment and outreach education” programs. It also includes a section on what happens to monies recovered by Medicare Recovery Audit Contractors. The Secretary of Health and Human Services is required to use that money for alternative payment model incentives, additional Medicare Administrative Contractor functions, reducing payment errors, prior authorization for repetitive scheduled non-emergency ambulance trips, and improving chiropractic documentation.

You never know what you’re going to find in a piece of legislation this size, which illustrates the old adage about the devil being in the details.

What’s your take on this recent legislation? Email me.

Email Dr. Jayne.

News 4/24/15

Top News

Two New York-based, healthcare-related organizations strike deals that will make them some of the first US firms to conduct business in Cuba now that sanctions have been relaxed. Roswell Park Cancer Institute (cancer research) and Infor (hospital data integration) announced their plans following a trade delegation visit this week led by New York Governor Andrew Cuomo.

HIStalk Announcements and Requests

I decided to follow through on looking at female representation on vendor executive teams as listed on company webpages since it came up on HIStalk last week. Companies have the incentive to hire the most qualified people regardless of demographics, but just in case you’re interested for whatever reason, here’s the percentage of females they’ve chosen.

Percentage of Females on Leadership Team (highest to lowest)
Wolters Kluwer Health 50
Meditech 41
Merge 33
TriZetto 25
Advisory Board 25
Optum 23
Athenahealth 22
Quality Systems 22
InterSystems 22
Cerner 19
Nuance 18
Greenway Health 18
Leidos Health 17
GE Healthcare 15
Premier 15
Surescripts 12
Philips North America 11
MModal 10
Emdeon 8
Allscripts 0
McKesson Technology Solutions 0

Some other percentages:  Facebook (20), Microsoft (19), Google (15), and IBM (27). HIMSS comes in at 17 percent.

I was reading a tweet that referred to pilot turned safety expert (and 2010 HIMSS keynoter) Sully Sullenberger as a “national hero.” The cynic in me (which has a significant presence) cringes at how we’ve devalued the term “hero” to label anyone who experiences adversity (including the randomly applied kind) rather than reserving the term for those who exhibit bravery or noble deeds in intentionally sacrificing themselves on behalf of others. Sully landed his plane safely in the Hudson River, but he was saving himself as well as his passengers. He was cool under pressure, humble, and performed the job he was being paid to do better than most would have done, but “hero” might be a stretch, just as it is when referring to athletes, victims of violence, someone who calls police to report a crime in progress, or groups that may well contain some but not all heroes (firefighters, service members, or even clinicians, for instance).

This week on HIStalk Practice: interoperability melancholia sets in after HIMSS. Matter Chicago CEO previews AMA physician office of the future. Radiology practices select new rev cycle technology. Azalea Health takes on telemedicine. Physicians’ Alliance of America looks for PCP feedback on EHR charting productivity. New study finds that online physician reviews don’t have much to do with clinical expertise. Modernizing Medicine CEO Dan Cane dives into the company’s relationship with IBM Watson. StatDoctor CEO Alan Roga, MD outlines the benefits of video in telemedicine.

This week on HIStalk Connect: Tech-savvy health insurance newcomer Oscar Health raises a $145 million funding round on a $1.5 billion valuation in just its second year in business. Ernst & Young creates a digital maturity index focused on quantifying the sophistication of telehealth programs. Color Genomics unveils a $259 genetic screening test that looks for 19 key mutations, such as BRCA1 and BRCA2, that are known risk factors for developing breast or ovarian cancers. Gravie, a private health insurance exchange startup, raises a $12.5 million Series B to expand its presence into Texas and Illinois.

DonorsChoose Fundraising Project Update

Our total now stands at $10,000 thanks to new participation from ZirMed, TransUnion Healthcare, BlueTree Network, and Orchestrate Healthcare. BlueTree Network was notable in donating $1,000 instead of the requested $500, while TransUnion Healthcare VP Patrick Gilmore missed the chance to meet with Centura SVP/CIO Dana Moore at the HIMSS conference but said he wanted to donate anyway. Dana will provide a summary of his conversations with these companies later. I’ve funded $6,656 in projects and will get the remaining $3,344 out to classrooms by this weekend.

Acquisitions, Funding, Business, and Stock

Navicure announces a 32 increase in year-over-year sales of its billing and payment solutions.

India-based Wipro expects its healthcare business to hit $2 billion in annual revenue by 2018, double its 2015 expectations, mostly due to increased technology spending triggered by US healthcare reform. The company will target acquisitions in the $100-$200 million range, saying it passed on acquiring TriZetto (acquired by Cognizant for $2.7 billion) because of the price.

The Illinois Hospital Association will merge with the Metropolitan Chicago Healthcare Council effective January 1, meaning the state hospital association will be running an HIE (MetroChicago HIE) and insurance company.

A federal judge orders the legally prolific MyMedicalRecords to pay the defense fees of WebMD and Allscripts, which beat some of MMR’s bottomless patent infringement lawsuits after refusing to pay “licensing fees” for ubiquitous technologies.

Jeff Bezos discloses the financial performance of Amazon Web Services for the first time in the unit’s nine-year history, stating that it’s a $5 billion business that’s growing fast.

A Wall Street Journal article finds that universities (Vanderbilt, Emory, and University of Arizona) are cutting ties with their cash cow academic medical centers as their high costs threaten to exclude them from exchange-based insurance networks.

Sales

Swedish Cancer Institute (WA) chooses the Synapse Precision Medicine Platform to provide oncology clinical decision support using patient genomic information.

Mount Sinai Health System (NY) selects the InterSystems HealthShare interoperability platform.

CareWell Urgent Care chooses Athenahealth’s EHR and practice management system for its 49 providers.

LTPAC EHR vendor SigmaCare chooses Liaison EMR-Link hub to connect with lab and imaging vendors.

Augusta Health will use Meditech performance monitoring tools from Goliath Technologies. The company’s press release doesn’t bother to mention where its new client is located (who writes this stuff, anyway?), so I’ll take a Google-inspired guess and say Virginia.

People

Davide Zaccagnini, MD (Nuance) joins SyTrue as CMIO.

Dominick Bizzarro (Value Informatics) joins insurer MVP Health Care as EVP of business development and informatics.

Cerner co-founder and Chief of Innovation Paul Gorup is retiring, insiders tell me. He helped develop PathNet in the 1980s, left Cerner in 1987 to run a radio station monitoring company, then returned to Cerner in 1999 to develop its hosting business. Gorup said in a 2013 interview, when asked why Cerner succeeded in healthcare while IBM and GE fizzled, “That’s easy. What does the head of IBM get up and think about every morning? I guarantee you it’s not healthcare. Same with the head of GE. He might think about energy or finance, but not healthcare. You have to think about it 24 hours a day. It’s not a part-time business. If healthcare becomes a part of something else, you’ve lost your focus.”

Announcements and Implementations

Referral software vendor EHealth Technologies announces a partnership with Box to support PDF viewing, medical image display, and structured document viewing.

Craneware announces enhancements to its Chargemaster Corporate Toolkit that include a single consolidated view, corporate chargemaster change distribution, and advanced workflow integration.

Capsule releases its Early Warning Scoring System for its SmartLinx Chart Express charting solution to alert clinicians of patient deterioration based on real-time vital signs analysis.

Zynx Health enhances the secure text messaging capabilities of its ZynxCarebook mobile coordination platform.

A TransUnion Healthcare analysis finds that increasing healthcare expenses and lower consumer credit lines have left consumers less able to pay their medical bills than last year. A big driver of the increased patient cost involves joint replacement procedures, which are 20 percent more expensive than they were a year ago.

Government and Politics

In Australia, the Victoria medical association calls on the state to spend $39 million to improve connectivity between hospitals and practices, hoping to at least enable delivery of discharge summaries and lab results after several expensive IT projects failed to deliver that capability.

Minnesota’s health commissioner says he’s concerned about pushback on the state’s 2008 requirement that all providers use EHRs by the end of this year. He debunks four privacy myths that are apparently the crux of the unstated opposition’s campaign.

A New York Times investigative report finds that the VA’s wait times scandal cost only three jobs vs. the 60 firings the VA claimed. One VA employee was fired for accepting gifts not directly related to wait times, one retired to avoid being fired, one is awaiting termination, and five employees were reprimanded. The VA often transfers problem employees and those who appeal their terminations can collect their paychecks for up to two years while awaiting a decision. 

 Innovation and Research

HHS will support three projects via its Ventures Fund: a website that allows providers to crowdsource possible new uses for existing drugs, an evaluation system for funding disaster preparedness, and a smart phone based diagnostic tool for malaria.

A Robert Wood Johnson Foundation study of personal health records finds that while consumers believe the most important information contained in PHRs is their own recorded daily observations (diet, exercise, mood, medication response), physicians usually don’t even look at them, instead turfing such review off to nurses and health coaches. The study also found that consumers think their information is valuable enough to outweigh any privacy concerns. It also concludes that demand for PHRs is surprisingly low because nobody is sure what problems they’re supposed to solve. I’ll extend my own musing: technology-powered lusting for discrete data capture and big data analysis cannot overwhelm the essential nature of the encounter, which is to listen to what the patient (and not necessarily their data points) is saying. Not everything that’s health related can be described by passively collected data dropped into convenient little buckets, and not everything that’s important will come up without skilled engagement of the “tell me how things are going” variety. My takeaway is that we need to make sure that technology enhances rather than limits the use of the patient’s own voice in the participatory guiding of their health.

 Technology

Heal releases a house call app for the Apple Watch that allows users to request a doctor visit with a single touch. Doctors equipped with mobile diagnostic apps such as the AliveCor ECG and CellScope otoscope arrive at the desired location within an hour and spend as much time as needed for a fixed fee of $99. One of Heal’s investors is Lionel Richie.

Other

Hospitals are moving inner city hospitals to suburbs where better-paying patients live, a Kaiser Health News article reprinted in Newsweek points out. Hospitals defend the practice by saying it’s cheaper to build a new suburban hospital than to renovate a old, land-locked downtown facility, but city officials say their core areas are being medically abandoned as hospitals chase patients who have better insurance.

Oxycodone-related deaths dropped 25 percent following Introduction of Florida’s doctor-shopping database of controlled substance prescriptions, a University of Florida study finds. However, deaths were already decreasing after the state shut down hundreds of pill mills posing as pain management clinics.

A study finds that 28 percent of Americans did not perform even one physical activity in 2014, increasing the “totally sedentary” number to the highest it’s been since 2007. Experts blame reduced physical education time in school and the competitive nature of school sports that leaves most students on the sidelines.

HealthLoop founder Jordan Shlain, MD says he started the company when he realized as a doctor that his mental model was wrong – inviting a patient to contact him when in need is not the same as proactively checking up on them, which he summarizes as invalidation of the “no news is good news” attitude since that means the same as “no data is good data.” He also says hospitals dehumanize their treatment failures by giving them the blame-free, dumbed-down label of “readmission.” He warns that probability-challenged people often make bad decisions in using data and algorithms as a blunt instrument without paying attention to what it means for individual patients.

An Australian blogger who built a business (including a wellness app) by claiming she cured her terminal brain cancer by diet and lifestyle alone admits that she was lying – she never had cancer. She was caught when she failed to donate $300,000 in app sales to charity as promised.

Weird News Andy titles this article as “A Rocky Experience in the OR.” A professor and facial surgeon in England loses his license after punching an anesthetized patient in the face 10 times to correct a broken cheekbone. The doctor admits that he “manually reduced the fracture” because the patient wasn’t fit for surgery, adding that doctors punch patients all the time while doing CPR. The patient is fine, while the surgeon is now offering his services in Dubai.

Sponsor Updates

• Valence Health is convening its second annual Pediatric Collaborative for Value-Based Care forum in Chicago this week.
• DocuSign is named among Silicon Valley’s “Best Places to Work 2015” for the fourth consecutive year.
• E-MDs will exhibit at the MGMA regional meeting April 29 in Galveston, TX.
• Galen Healthcare recaps the “Top 5 Themes from the Super Bowl of HIT.”
• Hayes Management Consulting offers “Planning for the Unexpected EHR Downtime: 4 Key Steps.”
• HCS will exhibit at the National Association of Long Term Hospitals 2015 Annual Meeting April 30-May 1 in Washington, DC.
• HCI group offers “7 Essential Items Every McKesson Horizon Customer Should be Considering.”
• Healthfinch’s Karen Hitchcock offers “A First-Timer’s First Impressions.”
• Healthwise will exhibit at the Annual NPSF Patient Safety Congress April 29 in Houston.
• Holon Solutions offers “RightFax End of Life Support Dates: Are You Ready?”
• Impact Advisors offers its top 10 takeaways (and HISsies Award coverage and predictions) from HIMSS15.
• The Atlanta Business Chronicle recognizes Ingenious Med as one of the city’s top 100 fastest-growing privately held companies.
• PDR will exhibit at the National Association of Chain Drug Stores Annual meeting April 25-28 in Palm Beach, FL.
• LifeImage celebrates five years in business and 1 billion images exchanged.
• LifePoint Informatics offers a new white paper explaining “Why Access to Lab & Diagnostic Data is Important to Providers, Payers, and Patients.”
• Logicworks explains why it sells managed cloud services rather than consulting services.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 4/23/15

FDA grant to determine drug safety through EHRs

The FDA is offering a grant worth up to $1 million to fund research focused on mining EHRs for data that will support post-market drug safety assessments.

Comparative Effectiveness of Childhood Obesity Interventions in Pediatric Primary Care

A study published in JAMA Pediatrics finds that the use of clinical decision support prompts in the pediatric primary care setting had a positive effect on reducing BMI in obese children. The CDS alerts presented clinicians with obesity screening guidelines and links to relevant weight management programs.

Senate hearing examines telehealth benefits, barriers to expansion

More than a dozen bi-partisan senators attended yesterday’s Senate Commerce Subcommittee meeting on telehealth to lobby for expanded access to telehealth services for Medicare beneficiaries and for infrastructure investments that would expand internet access in rural areas.  Kristi Henderson, chief telehealth and innovation officer at the University of Mississippi Medical Center, explains ‘Right now, the greatest challenges lie in winning the federal level reimbursement parity that will make telehealth attractive in the marketplace and securing the reliable, high quality connectivity that telehealth requires.”