Morning Headlines 1/13/15

FDA puts interoperability guidance on back burner

The FDA has published its list of priorities for 2015, which includes clarifying regulatory guidance on clinical decision support software, but does not include any short-term efforts to improve interoperability.

eLearning as good as traditional training for health professionals

Researchers at Imperial College in London, carrying out a study commissioned by the World Health Organization, review findings from 108 research studies and conclude that online learning is likely to be as effective as traditional education for training health professionals.

Health Poll: Data Privacy, Part 2

In a survey of 3,000 Americans conducted by Truven Health Analytics, only 53 percent of respondents report that they would be willing to anonymously share their medical data to support research.

Curbside Consult with Dr. Jayne 1/12/15

It’s hard to believe that I just started my fifth year as a member of the HIStalk team. Even though I’m more “in the know” than I was before, I still depend on HIStalk as a valuable source of information on all things Health IT. I also enjoy the discussion of technology in general, since it’s hard to separate that from the healthcare part and goodness knows I don’t have time to read Wired magazine or surf tech blogs.

With that in mind, I chuckled when I saw The PACS Designer’s comments about Windows 10 and its new browser.

He mentioned that its code name is “Spartan.” I immediately wondered what attributes of the Spartan culture Microsoft was trying to celebrate. Sternly disciplined? Rigorously simple? Brave? Undaunted?

Certainly those dictionary descriptions seem desirable and noteworthy. For those of us who didn’t sleep through World History, there are some other more colorful Spartan characteristics and I’m wondering if they were considered before the name was chosen.

As a city-state in ancient Greece, Sparta was the dominant military power for several hundred years. That sounds a bit like Microsoft. The Spartans were eventually defeated, but remained independent until the Romans came along. While the overall society focused on excellence in military training, the social classes had rigidly defined roles. Legend has it that the Spartans would take children who were weak or disabled and leave them to die of exposure or alternatively throw them into a chasm.

That certainly sounds like a couple of vendors I’ve worked with, where products with a lot of potential are thrown out if they aren’t thought to be highly profitable. On the flip side, sometimes it feels like products are pushed forward just because they look good, regardless of whether they are truly game-changers or solve an unmet business problem in a compelling way. Marketing teams reign supreme in some organizations and it is increasingly difficult to separate the reality from the hype.

My health system has an enormous development shop since we’re one of the few best-of-breed organizations that haven’t yet succumbed to Epic. Sometimes it feels like they’ve taken the “Innovate or Die” mantra a little too seriously. Clinical end users don’t typically ask for more disruption or sassy new paradigms. They want things to be easy and fast rather than eye-catching and trendy. It’s hard to get developers to understand that when every single physician has a common verbiage for the parts of the patient visit note, we’re not likely to appreciate their capricious use of synonyms to try to make the work we do more fresh, exciting, or new.

I recently dipped my toe into “fresh, exciting, and new” with a foray into the land of the MacBook. Quite a few of my friends and a couple of family members are big advocates. I was a Mac devotee early on, but years in corporate IT have stifled the desire to use anything other than Windows. Although it’s been great for my non-work computing needs, I’ve been relentlessly teased at the office. The jury is still out on whether I’ll be able to make a go of it.

As for the Windows 10 browser, personally I hope they’re calling it Spartan because it’s going to be austere with muscular performance. I don’t need any new shiny objects in my life. I just need things that are easy to use and that work day in and day out. If Windows 10 and Spartan hit those marks, they’ll do well. If not, the user community will abandon them on the windswept edge of oblivion.

What do you think about the future of Microsoft and the debut of Windows 10? Email me.

Email Dr. Jayne.

Startup CEOs and Investors: Brian Weiss

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

Are We On Fire Yet? (Or, Where’s the Data?)
By Brian Weiss

A Star(tup) is Born

Healthcare IT startups can often trace their origins to an “Aha! Moment” when a tech-savvy entrepreneur-to-be experiences the healthcare system in a significant way (often, sadly, due to the illness of a loved one) and decides, “There has to be a better way to …” (avoid allergic reactions, make sure medications are taken properly, keep track of blood sugar readings, avoid filling out the same forms over and over in the waiting room, have this doctor know what that other doctor already did, make sure they amputate the correct limb …)

Eureka! A mobile app / web application is born. It will be “just like …” (Facebook, Instagram, Google, Uber,or any other multi-billion-dollar Internet wonder) – except, “It will  be perfect for …” (patients, doctors, caregiver moms,  hospitals, home care …) Not to mention that it rhymes with “ACO” and runs … (on a smartphone, in a cloud, directly on your retina in the next version …)

A related family of startups, loosely termed “healthcare analytics,” often starts with an entrepreneur who is a bit older and more seasoned, has enough business savvy to “follow the money trail,” and whose neighbor’s daughter is in her last year of grad school for the third year in a row. Said neighbor’s daughter says that given a standard blood test kit, a strand of hair, and the first and third letters of someone’s last name, we can “predictive analytics” (yes, it’s a verb — I say so) anything you want about someone’s future medical conditions with proven accuracy of at least 98.7 percent on all predictions for the time period following their death.

Now Let Me Explain …

These great ideas of my younger and hipper friends are predicated on a surprisingly problematic assumption. Namely, that patients (more broadly, “consumers”) have reasonable access to electronic copies of their own healthcare data. If you’re reading HIStalk, I probably don’t need to explain to you what a silly notion that is. Why do entrepreneurs assume this is the case?

First, some of them saw the hip-HIPAA video (or something similar) from Uncle Sam Productions stating that every person in America has a right to get an electronic copy of their records from anybody that maintains such an electronic record (which I think right now is almost everyone involved in healthcare in some way, with the possible exception of Aunt Emma and her world-famous chicken soup, and it’s just a matter of time before she attests for MU Stage 1.)

Throw into the mix some intuitive modern consumer expectations and you can begin to understand (not condone, of course, just relate to in a non-judgmental way) why some of our misguided youth are jumping to the wrong conclusions.

The result is cool apps that work great, as long as everyone either (a) has the actual same clinical data as in the sample data they used in development, or (b) wants to spend a few hours every weekend updating their clinical data manually from whatever scraps of it they can get their hands on.

But fear not! Fortunately for all of us, I now have this prominent published column that one or two of these lost souls might actually read, so here’s my chance to step up to the pulpit and set everyone straight.

My Friends! Salvation is Just One Committee, Acronym, and Decade Away

So, listen up, my young, big-idea friends.

The umpteenth committee in a series that began running before most of you were born is taking care of this problem even as we speak. Like every committee in the series, it includes multiple leading vendors, multiple leading standards organizations, and multiple very experienced (from previous committees – I wonder how the first one was formed?) leading experts.

This is not your father’s Oldsmo-committee. This one (did I mention it was “leading” and “multiple?” Yes, that’s an adjective for real, so I can use it any way I want) is dedicated to one of the principles our great country was founded on (whenever the public funding well runs dry): “More acceleration without regulation.” The original cry of the Boston Tea Party before a focus group said “taxation” and “representation” worked better.

This latest committee is hipper than most, as evidenced by a name taken from Greek mythology. They’ve published a charter that makes it clear they plan to work very, very quickly, so that by 2016 we’ll have a shiny new accelerated standard and then we can figure out if and how consumer data is actually going to be made ubiquitously available with it sometime in the 2020s (is that going to be a hip decade, with a name like that, or what?) for your cool apps.

You’ve got enough seed funding to carry you until then, right?

The new standard (OK, it was actually new quite a few years ago – but not enough people were paying attention back then) is called HL7. No, ASTM CCR. No, HITSP CCD. No, SMART. No, Blue Button Plus. No, C-CDA. No,C-CDA R2.0. No, no, no — it’s called FHIR (rhymes with “liar,” but that’s the honest truth).

The Lessons of Blue Button Plus

I (virtually) know a few Argonauts and some of the other folks who have been working on FHIR for many years. They are incredible folks who are smarter, more experienced, more capable, and more all kinds of stuff than me.

Then again, so were/are the folks who worked on something called Blue Button Plus (it had a bunch of other names like ABBI — I forget more easily at my age) back in what seems like just a few months ago.

Two years ago at HIMSS, there were some slick PHR startups showing off their Blue Button Plus capabilities for fetching data from Blue Button Plus-enabled sites.

I wasn’t personally involved, but I’m told that Blue Button Plus integration meetings were a bit like dating sites with members of only one gender registered. Lots of folks wanted to be Blue Button Plus clients, but nobody was offering to be a server (you can see why I didn’t want to pin down the gender in the dating site analogy – that could get me in trouble with the whole client-server thing).

One of the poster children for Blue Button was (and still is, I believe) MyMedicare.gov. You know what special next-generation data format they use when you Blue Button (yup, another verb I created) your records for re-use? FHIR? C-CDA? CDA? CCD? JSON? XML? If you guessed “ASCII text files,” you’re our lucky winner.

And you know what? That’s actually a whole lot better than what you (can‘t) get from most sites using Blue Button Plus or SMART or any of the other standards and frameworks that promised to deliver MU2-aligned C-CDA (or similar) data with push delivery, notifications, security and authentication, and an App Store-like ecosystem.

It’s Not (Just) the Data Format, It’s the Data Availability

Now I actually know a little bit about some of these standards. Once upon a time, HL7 even contracted me to help write some of their knowledge base articles on CDA and C-CDA.

I’ll send you my rubber stamp so you can add my signature to any learned commission or task-force reports listing what’s wrong with C-CDA. It’s complicated, ambiguous, overly academic, insufficiently documented, lacking examples, has too low a validation bar in MU2. Did I mention complicated?

There’s lots more work to be done on standards. FHIR sounds great. My FHIR friends assure me that in due time it will replace HL7 v2 and CDA, and might even shorten the coffee lines at HIMSS. And I’m told that if you can figure out how to play Candy Crush, you can write a great healthcare app with FHIR.

Don’t misunderstand my feeble attempts and rancorous wit. We definitely need better standards, better guidelines for MU Stage 3, and a better 5-10-50 year strategic data interoperability roadmap for posterity.

Just sayin’ that is not what I think we need most. That honorary title belongs to…. DATA ACCESSIBILITY.

Despite all its flaws, the M2 C-CDA standard we already have is all my fellow startupers (plural noun, yup) and I need right now to do all kinds of cool stuff. Actually, we would do fine with the MU1 CCD (aka “HITSP C32 CCD”). Or the CCR that came before that. Or even the HL7 v2 messaging before that. Or Blue Button Plus, or SMART, or whatever.

But wait. Don’t developers need simple RESTful APIs for their apps (as FHIR will provide)? Of course, but we don’t need another year or two (and I’m not even getting into the debate if those are human years, dog years, or ICD-10 years) to wait for FHIR, just for that.

The translations between whatever other formats are out there and actually available today and the mobile app-ready formats developers will adopt are not the real barrier or issue. My company and many others will try to kill ourselves outdoing one another to provide those more quickly.

The main issue is what is really out there and actually available today in terms of real patient clinical data. And without belittling the importance of how many steps you took today on your way from your desk to the restroom, I mean the clinical data in the myriad of EHRs and similar that contain your more traditional health records, not the stuff from your neon fitness bracelet or your mood ring.

If application developers could reasonably get the “C-CDA over DIRECT” data promised by MU2 and Blue Button Plus from every hospital, doctor, pharmacy, lab, clinic, we’d be flying.

How can I be so sure? Because we’re almost managing today, with a lot less.

If my friends at HL7 and FHIR were shown the minimalistic JSON being returned by early-stage commercial APIs that provide patient portal data to PHR developers, they’d have a heart attack (though they probably wouldn’t know it without the correct SNOMED codes for that condition , which aren’t provided).

The data available today is a hodgepodge of formats, coding standards, semi-structured text, and whatever else you can think of. It’s not pretty, but it’s a whole lot better than what we (can’t) get (yet) from “future standards.”

It’s Not Either-Or

If you ask me (you don’t really have to, it’s my column, so I get to make up both the questions and the answers), getting ubiquitous access to data now is as important to FHIR itself as whatever else is being worked on in Argonaut projects and similar.

“Build it and they will come” works in the movies. Everyone else has to get real-world feedback and iterate to the right solution. Lessons learned from real-word smartphoning (yes, it’s a verb) by consumers with apps running off of C-CDA document data as mandated for delivery by MU2 is as important to the future of FHIR as API connectathoning (ahem) with like-minded geeks.

Of course, focusing exclusively on data accessibility with existing problematic standards, flawed policies, undefined authentication APIs, incomplete code system alignment, and all the other myriad of gaping holes still open isn’t a good idea, either. We need to be working on these issues from all angles simultaneously: standards developers, established vendors, policy organizations, regulators, providers, industry leaders, payers, consumer groups, government agencies, startups, public opinion influencers, and more.

But the funny thing about the future is that you get there a whole lot quicker if you start now.

I think we need a lot more energy and focus on just getting vendors, portal providers, MU2-attesting providers, and everyone still playing hide-and-seek with consumer clinical data to align with both the letter and the spirit of the law. Let consumers get electronic copies of their data in the app(s) of their choice — today.

With apologies to Dickens, I think I might be speaking for a few of the other orphans in the room when I humbly ask, “Please, sir, I want some more consumer-centric clinical data, now.”

Brian Weiss is founder of Carebox.

Startup CEOs and Investors: Bruce Brandes

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

Why Your Pitch Makes You Sound Like Charlie Brown’s Teacher
By Bruce Brandes

Mr. HIStalk was kind to offer me this opportunity to periodically share anecdotes, observations, and insights from my career at the intersection of healthcare and information technology. My goal in writing for HIStalk is two-fold: to support  life-long healthcare folks charged with transitioning from a fee-for-service to a fee-for-value healthcare proposition, and to encourage young tech entrepreneurs who are building important solutions that accelerate healthcare transformation by giving them the best opportunity to succeed, given an array of unique challenges and historical realities.

My first job out of business school, over 25 years ago, was as a sales rep at IBM, which just so happened to assign me to the healthcare vertical. I thought then, “Healthcare is really screwed up. Certainly technology should be able to fix this mess.” While over the past quarter-century we have made some progress moving around the deck chairs on the Titanic, for the first time ever, it is clear that long-awaited, meaningful disruption is beginning to happen.

Subsequent to IBM, I have held sales, strategy, and leadership positions at early and growth stage companies including ESI, Eclipsys, HealthStream, AirStrip and Valence Health. Recently I joined Charlie Martin, a lifelong hospital operator and the founder and CEO of Vanguard Health Systems (now Tenet) to develop Martin Ventures. The Nashville-based firm invests in ideas and innovations that apply integrative approaches that simultaneously improve care, improve health, and reduce the cost of healthcare. Being a part of Martin Ventures has lifted the curtain for me on the venture capital and provider mindsets, which entrepreneurs must appreciate to build a successful business.

Having delivered thousands of presentations over the years, I am now on the other side of the table. I sit in the audience with my "investor hat" alongside long-time healthcare executives. The first observation I feel compelled to share is about your pitch deck (this also applies to sales presentations from vendors to prospects). 

To you, your message is unique and compelling. To your audience, this is the 20th presentation they have sat through this week with people who look just like you and are saying the same thing. Add to that, they have had a history of being misled by exaggerated claims, so skepticism is in the air even if they manage to stay awake while you read your slides.

At a recent conference with rapid-fire presentations from aspiring and emerging digital health entrepreneurs, Charlie (who has been building bricks-and-mortar hospital systems for 50 years) leaned to me and commented, “I don’t understand why anyone in the US still has diabetes. All these people have already solved the problem.” That is my point — you all sound the same!

My favorite TED Talk is a popular one from Simon Sinek, who reminds us that, “People don’t buy WHAT you do, they buy WHY you do it.” Reflecting on and embracing this idea may help set you apart.

When I was at AirStrip, shortly after our founders presented behind Steve Jobs at the 2009 Apple Worldwide Developers Conference, we had the opportunity to meet leading investors as we searched for our first round of growth capital. Prestigious Silicon Valley venture capital firms had a placeholder for several years for a portfolio company to address mobility in healthcare, having passed on everything before AirStrip.

As we built a relationship with the partners of a prominent Sand Hill Road firm, I later learned that it was not the content of our presentation (which we painstakingly developed for weeks) that attracted them to the company. Our allure was less about how we had built a broad platform for mobility specifically for healthcare or that we had proven the concept in obstetrics with a compelling value proposition.  

The investors were more interested in investing in the technical and clinical credibility, passion, and commitment of the founders to eliminate the geographical and informational boundaries that had historically hindered doctors, nurses, and patients from delivering and receiving the best possible care. People don’t buy what you do, they buy why you do it.

As a call to action, focus on how to set yourself and your organization apart from others – at your core, not just in your presentation – but, good grief, for the sake of your audience, at a minimum step up your game in how you present!  

A little guidance: 

• Understand your audience well enough to meet them at a common baseline so you do not waste time telling them information which they already know.
• Cut the number of slides in your deck in half (if you must use them at all) and ensure their purpose is to support your having a conversation with your audience, not to distract from it.
• Tone down wildly speculative claims about the market, potential ROI, forecasted revenues, etc.
• Be honest and realistic. Sincerity, insight, and integrity make a much stronger impression than telling your audience what you think they want to hear

Most importantly, read your audience to see if they are hearing what you are trying to convey, or if instead you are coming across as Charlie Brown’s teacher: “Wah, wah wah, wah wah wah."

Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.

Startup CEOs and Investors: Marty Felsenthal

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

The JPMorgan Healthcare Conference
By Marty Felsenthal

It’s bigger than the Super Bowl, the World Series, the World Cup, and the Winter and Summer Olympics. It’s more important than the BCS Championship game (particularly if you’re from Florida or Alabama) and maybe even the Famous Idaho Potato Bowl, the Scottish Highland Games, and the Cooper’s Hill Cheese Rolling and Wake Competition combined (unless you are from Idaho, Scotland, or, of course Gloucester, England).   

My name is Marty Felsenthal. I’m a middle-aged, workaholic healthcare venture capitalist with thinning hair and a thickening mid-section. Mr. HIStalk asked me to write a little bit about the JPMorgan Healthcare Conference taking place this week in San Francisco and to describe it for readers who have never attended. 

My life’s greatest joys and accomplishments are increasingly defined by (a) finding great post-holiday sales online; (b) the "sports" achievements of my nine-year-old, boy-girl twins, and occasionally, my seven-year-old daughter; and (c) by the nights my wife actually laughs at a joke I make rather than thinking I’m a workaholic, balding, overweight man who she periodically tries to pull a Chief Bromden on and pillow-suffocate for snoring in my sleep.

Since that is increasingly my life, the JPMorgan Healthcare Conference is actually a big deal for me. But it wasn’t always that way.

The conference has been taking place for decades. In fact, it used to be called the Hambrecht & Quist Healthcare Conference prior to H&Q being acquired by JPMorgan. But for decades, it was really dominated by drug companies, biotechnology companies, and medical device companies. On a relative basis, there was just less growth and innovation in healthcare services and healthcare information technology and, as a result, less investor interest.  

For clarity’s sake, I should point out that I’ve been a healthcare-focused venture capital investor for 18 years and work exclusively with what we hope are innovative healthcare services and healthcare information technology companies. This year, our firm will be hosting a reception during the conference for other venture capital firms who invest in healthcare services and healthcare information technology.  

This will be my twelfth consecutive year of co-hosting this reception. There were years when we had fewer than 30 venture capital investors show up. There was just nothing sexy about investing in venture-stage healthcare services and healthcare information technology. I was like the Kevin James of the JPMorgan Healthcare Conference.  

This year, however, we have over 150 venture capital investors attending and had to turn a number people away at the threat of the fire marshal. This year, I’m like the Kate Upton of the conference — actually, let’s say the David Beckham of the conference (and maybe with a lot of help from Photoshop, that could actually be the case). 

When did it change and why? That’s easy.  2009 and 2010 when the HITECH Act and Affordable Care Act were passed. They were catalysts for innovation in "my" sectors unlike anything I’ve experienced since I first got involved in healthcare in 1992.

The conference itself is held at the Westin St. Francis on Union Square. It’s a forum for hundreds of public healthcare companies and an increasing number of not-for-profit healthcare systems and health plans with public debt to present to mutual fund and hedge fund investors. These companies include drug and biotechnology companies, diagnostic companies, medical device companies, healthcare services companies, and healthcare information technology companies.  

JPMorgan is also increasingly inviting a number of still-private companies to present. My firm is fortunate to have a few of these — Teladoc, Redbrick Health, and Vet’s First Choice. I unfortunately don’t have a chance to actually go into the conference and listen to these companies present any more. I wish I did.  

The presenting companies are among the largest and most influential players in the US healthcare ecosystem. They include UnitedHealthcare, Wellpoint, Aetna, Cigna, Centene, and all the major health plans. They include large health systems such as HCA, Tenet, Geisinger, and Banner; pharmacy chains and PBMs such as Walgreens and CVS Health; and most of the country’s most influential health information technology companies, such as Cerner and Athenahealth.  

These companies are talking about much more than their financial performance. They are talking about their strategies and how they are evolving in the face of the huge changes sweeping across our health care system. They are talking about their efforts to help reduce healthcare costs in our country, to improve quality, to improve the consumer experience, and to help lay (or take advantage of) the healthcare information technology backbone so we can transition to a more value-based environment. They understand that, in the current environment, they have to adapt and innovate to survive and thrive, and this is what some of the largest players in the US healthcare ecosystem are presenting and discussing.

Unfortunately, I don’t have time to go into the conference any more. I won’t even have a chance to see our portfolio companies present. As the customers of our portfolio companies (broadly speaking, health plans, hospital systems, pharmacy chains, HCIT companies, distributors, etc.) have started needing and demanding more innovation, more innovative companies have formed to address these needs. These companies need capital. They need investment bankers. They need management teams. They need executive recruiters.

All of these constituents — many of whom are old friends from my days as "Kevin James" and many new to the industry as we became cool — descend upon San Francisco during the conference to network, to catch up, to search for new jobs, to craft business partnerships, to look for capital. There is as much if not more action taking place outside the Westin St. Francis as there is taking place in the actual conference.

At Mr. HIStalk’s suggestion, I took a look at my calendar. This is my week. I start at 5 p.m. on a Sunday, and from there, I am booked solid every hour on the hour, breakfast through dinner, until Friday at 10 a.m. 

I am meeting with seven investment bankers. These investment bankers know and represent many wonderful entrepreneurs and companies who are in need of capital (capital that we can provide). They are also looking to represent companies we invest in when they need more capital and/or want to sell their businesses or go public.  

I am meeting with six other venture investors/firms. These are organizations that we co-invest with already or that we would like to co-invest with. We talk about opportunities to work together within our existing portfolios, companies we are currently evaluating where there might be an opportunity to invest together, and areas of innovation of mutual interest.  

We have more than 20 meetings with executives from some of the largest health plans, pharmacy chains, distributors, HCIT companies, and hospital systems in the country. We’ll talk about innovation. We’ll discuss our portfolio, trends we’re seeing in the marketplace, and interesting companies we’re seeing. 

I have meetings with three entrepreneurs who just want to network or who are looking for new opportunities. I’m getting together with Pete Hudson, the very talented founder of iTriage/Healthagen, with someone who was formerly a senior executive at McKesson, and with a former senior executive from HCSC. 

We also have an opportunity to meet with more than 10 innovative companies that are seeking capital. For obvious reasons, I can’t name them, but they are providing analytics for health systems and provider groups, and they are developing novel insurance exchange platforms. They are developing tools that deliver better provider quality information to consumers. They are helping health plans manage patients with certain types of high-cost chronic diseases (in one case we’re particularly excited about, a very large problem that no one has previously tried to target), and they are helping hospitals lower labor and equipment costs and are also facilitating better patient collection efforts.  

Unfortunately, the meetings during the conference are always too rushed, but there are two highlights of the week for me. The first is getting to sit down with these great entrepreneurs seeking capital and learning about their businesses. Occasionally this leads to an investment, as was the case with a digital pathology company called Aperio that we met with at the conference in 2007.  

The other highlight is getting together with the large healthcare companies and learning about where they are looking for innovation. One of the most satisfying aspects of our job is when we actually help young companies develop relationships with these large players. It’s a lot of fun to try to marry the young, nimble, aggressive (and sometimes naive) startups with the large, sophisticated, complex, highly influential (and sometimes slower-moving) titans of our industry.  

Unfortunately, there are also lots of people and companies I don’t get to meet with during the conference. People have started reaching out to schedule meetings during the conference as early as November now (for a conference that takes place in January). This leads to a lot of calls the first and third weeks of January with the people I couldn’t meet.  

So in short, it’s a hugely productive week of networking. We learn a lot. We get to help drive revenue to our portfolio companies on occasion. We reacquaint with old friends. We meet new friends who might someday work with our portfolio companies or partner with them. If we’re lucky, we find a new investment.

When the week is over, I go home feeling like the rock star that is David Beckham. I grab a drink. I crack a joke to my wife, I get ready for my Posh Spice, and then I usually fall asleep and start snoring, which often coincides with her trying to suffocate me.

Marty Felsenthal is a long-time venture capital investor who invests in and works with growing healthcare information technology and healthcare services companies and has been attending the JPMorgan Healthcare conference since the 1990s.

Morning Headlines 1/12/15

HLM Venture Partners aiming at $150M for fourth investment fund

Boston, MA-based HLM Venture Partners raises its fourth funding round, a $150 million investment fund. While the new funds will likely be distributed across a wide variety of industries, HLM has a track record of investing in digital health.

Internists Suggest Congressional Actions to Improve American Healthcare

The American College of Physicians calls on Congress to: repeal the Medicare SRG formula, continue the current Medicare 10 percent primary care bonus, restore the Medicaid primary care pay parity program, and provide relief from “unrealistic Medicare meaningful use requirements for Electronic Health Records.” 

The Future of Medicine Is in Your Smartphone

In a Wall Street Journal op-ed, digital health advocate Eric Topol, MD predicts that new smartphone-based medical technologies will improve care delivery and create a “radically altered” doctor-patient relationship.

Monday Morning Update 1/12/15

Top News

HLM Venture Partners, which made several health IT investments in its first three funds, is raising up to $150 million to launch a fourth fund. Its portfolio companies include Nordic Consulting, Aventura, Medicalis, Phreesia, and Teladoc.

The investment challenge, it seems to me, is that in the frenzy to throw money at unproven healthcare IT startups, we’re well past the wheat and deep into the chaff. It’s good that demand for new technologies seems strong, but too many no-name companies confuse the market and many of them will fizzle out quickly. Companies that are thrown together purely to chase money usually don’t find it and there’s only so much proven management talent to go around. Incubators and accelerators are encouraging a lot of shaky startups that will experience the inevitable Darwinism. Still, a few of them will avoid enough minefields to get market traction or sell out to a bigger player.

Reader Comments

From Frustrated Surgeon and Developer: “Re: big health IT. Epic and Cerner are using strong-arm techniques to counter any move to interoperability. Congressman Dave Camp (MI) testified before Congress that he was being pressured by lobbyists paid for by Epic to remove interoperability from MU 2 ( and now 3) to secure their business position. Cerner said they weren’t interested in interoperating with my cloud-based system that several hospitals are using. APIs and licensing fees never came up — they just won’t do it. Cerner’s representative to ONC’s Jason Task Force is pushing hard to stop MU 3 interoperability requirements. We should not look to Epic and Cerner to open the doors. We need a HIE which Epic, Cerner, and all other permitted applications should use. It’s the data, not the application.” Unverified. I searched the Congressional Record for Epic-related comments by Dave Camp (who is now retired) but didn’t see anything relevant, although the search isn’t exactly Google quality.

From Jack Gutenberg: “Re: HIStalk book club. You should invite readers to read along and add their comments to yours.” I like the idea. I’m just starting Eric Topol’s “The Patient Will See You Now” in case anyone wants to start it along with me and then add their comments once I’ve posted mine. I’m not only interested in critiquing the book itself, but also discussing the interesting ideas inside. Books I’ve summarized here previously include “Connected for Health,” “Your Medical Mind,” “Safe Patients, Smart Hospitals,” and “Where Does It Hurt?”

From The PACS Designer: “Re: Windows 10 browser. Rumors have been swirling for months about the next version of Windows 10 and its browser style since Internet Explorer and Bing have such a small market share compared to Firefox. The leaked browser is called Microsoft Spartan.”

HIStalk Announcements and Requests

More than three-fourths of poll respondents agree with a popular stock expert’s characterization of the Athenahealth as a “bubble stock” that won’t be “the backbone of anything” rather than the company’s stated high-flying ambition to be the Salesforce of healthcare. New poll to your right or here since I ask every year: what are your HIMSS15 attendance plans compared to HIMSS14?  

Ready for your input: the HIStalk reader survey and HISsies nominations. Thanks for participating. I’ll also randomly draw three reader survey responses for a $50 Amazon gift certificate.

I was thinking about Uber’s surge pricing model, where the app tells you in real time that local demand is high and you’ll have to pay more. I’m frustrated when I get that message, but it makes perfect sense from a supply and demand point of view. When cars are in short supply, the higher price does two things: (a) it allows price-sensitive consumers to seek alternatives to Uber such as taking a cab or walking, increasing Uber car availability for those willing to pay more; and (b) it encourages more Uber drivers to get out on the road and start picking up fares. (obviously it does a third thing: it raises Uber’s profits, so you have to trust them to proclaim surge pricing only when they really are swamped). An Uber model would work in medicine if it were a pure science instead of an art and if people actually paid cash for their services – you could have doctors willing to provide telemedicine consults at a given time and price via an Uber-type service and let patients decide what it’s worth to them, with an app setting the intersection of supply and demand. That leaves those unable to pay out of the picture, but medicine is already heading toward a two-tier system where cash-paying patients have better options anyway.

Last Week’s Most Interesting News

• IBM and Epic enhance their DoD EHR bid pitch by announcing that they’ve already installed an Epic model instance in a DoD-hardened environment for testing and also formed an advisory committee.
• Walgreens adds health management, real-time health coaching, and wearables connectivity to its website and mobile app, offering users reward card points for using the tools to meet their health goals.
• The AMA says EHRs, ICD-10, prior authorization, and Medicare fraud detection are barriers to care that it will target in 2015.
• Sue Schade of University of Michigan Hospitals and Health Centers wins the Gall CIO of the Year award.
• Analytics vendor Inovalon files for a $500 million IPO.
• Allina Health and Health Catalyst announced an analytics technology and quality improvement partnership, explained by Allina President and CEO Penny Wheeler, MD in my interview.
• Only 24 percent of respondents to my poll said their impression of HIMSS is positive.

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.

Acquisitions, Funding, Business, and Stock

Francisco Partners makes an unspecified investment in Olathe, KS-based revenue cycle solutions vendor eSolutions.

The Columbus paper profiles Lyntek Medical Technologies, whose PatientStorm Tracker software provides a weather radar-like display of an inpatient’s overall condition. It’s being beta tested by OhioHealth Riverside Methodist Hospital. Founder and pulmonologist Lawrence Lynn, DO says the outdated fire alarm model of medical monitoring systems doesn’t provide useful information until vital signs hit specific limits. He adds, “You can be in the hospital dying of sepsis with a smartphone in your pocket that can detect the pattern of a song just by listening to it, but this sophisticated-looking monitor above you can’t detect a single pattern of evolving death.”

Sales

Atlantis Health Group chooses Influence Health’s Navigate population health management solution.

People

UMass Memorial Medical Center (MA) appoints Pam Manor, RN, MSN, DNP (St. Francis Hospital) as chief nursing informatics officer. 

William Hersh, MD (Oregon Health & Science University) is named the winner of the 2014 HIMSS Physician IT Leadership Award.

Streamline Health promotes David Sides, who has been with the company for five months,  to president and CEO. Sides, on the left above, replaces Bob Watson, who will leave the company to become president of NantHealth but will remain on Streamline Health’s board. NantHealth announced in November that it will use Streamline Health’s analytics product in its system.

Government and Politics

The American College of Physicians urges Congress to: (a) repeal Medicare’s SGR formula; (b) continue Medicare’s 10 percent bonus for primary care; (c) restore the Medicaid program that pays primary care physicians no less than Medicare rates; and (d) provide relief from “burdensome and unrealistic” Meaningful Use requirements and “other excessive regulatory burdens.”

Other

An opinion piece slated for publication in Academic Medicine examines whether it’s ethical for medical students to use an organization’s EHR to track their former patients so they can match outcomes to the students’ original diagnosis and treatment. The authors conclude that the benefits outweigh the harms. I couldn’t agree more – it’s hard to believe that an intelligent argument could be made otherwise. The opportunity would only arise in teaching hospitals and I see no potential ethical or HIPAA conflicts since patients understand that their treatment has an educational component. The practice should not only be allowed, it should be mandatory, and perhaps not just for medical students. Medicine (and ancillary fields) are literature-based and that always involves aggregated, de-identified research, but what could be more educational than seeing how your care decisions impacted a particular patient’s life and whether your actions were ultimately right or wrong? The patient has to live with the impact, so  why shouldn’t the professionals who made those decisions? It would also be interesting to look at a patient’s overall perception of health and well-being (perhaps via a self-survey with results trended over time) instead of just a problem list if we’re really interested in improving their lives and not just their medical conditions. We have to leave the “treat ‘em and street ‘em” mindset behind.

The Wall Street Journal runs an essay by Eric Topol, MD titled “The Future of Medicine Is In Your Smartphone” in which he again predicts that technology will alter the patient-physician relationship, reduce costs, and empower patients. He thinks that doctors will still have a role, just not as today’s paternalistic “priestly class.” He has vested interests, however, even going beyond pitching his new book: he lists consulting engagements with Google, AT&T, Walgreens, Quanttus, and Sotera Wireless. A skeptical WSJ commenter weighs in: “I am in atrial fibrillation, now what? That is the rub. All these carnival barkers for the utopian vision of the smartphone/connected world are simply exhausting. For all its many benefits, the Internet is rife with misinformation when it comes to healthcare and the burden is now shifting to the consumer to sort out what is real and what is bogus.”

Ebola vaccine researchers face a surprising challenge: a sharp drop-off in the outbreak could make it hard to find enough victims to test new vaccines.

Sponsor Updates

• HCI Group CMIO William Bria, MD will present at IMN’s HealthIMPACT Southeast on January 23 in Tampa.
• Passport/Experian Health will exhibit and present at the HFMA Region 11 Healthcare Symposium January 11-14 in San Diego.
• nVoq releases a case study on the success Teleradiology Specialists (AZ) experienced with its SayIt cloud-based speech recognition technology.
• SCI Solutions VP of Business Development Bill Reid shares his thoughts on price transparency and how to equip patients with the right tools to understand the financial consequences of care.
• Netsmart will participate in the New York Coalition of Behavioral Health Agencies conference on January 27.
• Patientco outlines three healthcare finance game-changers for 2015 in a new blog.
• MedData will participate in the ACEP Reimbursement Trends and Strategies in Emergency Medicine Conference in Las Vegas from January 13-15.
• RazorInsights will exhibit at the Texas Hospital Association Annual Convention in Austin January 22-23.
• PMD recaps the previous week in healthcare in a new blog post.
• Nordic Consulting offers a new white paper, “Beaker Lab: Planning for Meaningful Use Stage 3.”

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 1/9/15

Insider Selling: McKesson CEO Sells 77,100 Shares of Stock

McKesson stock hit a 52-week high of $215 this week, prompting CEO John Hammergren to sell 77,000 of his personal shares for a profit of $16 million.

NY State Ready to Deploy New Weapon in the Battle Against Prescription Drug Abuse

DrFirst reports that 80 percent of New York providers and 85 percent of New York hospitals are prepared for the states I-STOP deadline, at which point all prescriptions, including controlled substances, must be sent electronically. While 97 percent of the states pharmacies are setup to receive electronic prescriptions, only 58 percent are equipped with the additional security features required to receive controlled substance prescriptions electronically.

The BD Intelliport Medication Management System Receives Clearance from the Food and Drug Administration

BD Medical receives FDA clearance for a medication management system that focuses exclusively on IV bolus injections. The system verifies that the correct type and dose of medication are being administered, and checks for allergy conflicts at the point of administration, then it wirelessly records the medication administration in the EMR.

News 1/9/15

Top News 

 
IBM and Epic start background work on the $11 billion Department of Defense EHR project for which they are bidding even though the award won’t go out until summer, saying they need a head start to meet the DoD’s aggressive timelines. IBM has installed an Epic model system in one of its government-level security data centers so that it can test an integrated in a DoD-like environment. The companies also announce that they have formed a 17-member advisory group that includes former Kaiser Permanente CIO Bruce Turkstra and military patient advocate Major William Lyles.

Reader Comments

From Dan Nigrin: “Re: wayfinding apps. We’ve had Meridian’s technology in place for years at Boston Children’s.” Dan is the CIO at Boston Children’s, whose MyWay app offers a nice package of services for visitors and patients. I think hospitals that offer way-finding apps assume that everybody uses them, I bet the penetration is tiny. It would be nice as a patient to be able to get turn-by-turn instructions from the parking garage to a particular hospital department or physician office. Hospitals have the most consumer-unfriendly access that I’ve seen in any industry, starting with dreary pay parking garages and inadequate spaces for their huge numbers of employees. Tip: if you’re a vendor trying to get a meeting with a mid-level hospital IT executive whose non-CIO status doesn’t come with a reserved parking spot, offer to pick them up and drop them off curbside at their location – they’ll accept since they otherwise rarely leave campus for lunch because of the trek to get their car followed by endless cruising for an open space upon returning.

From Fracker: “Re: Meditech. Terminated its distribution agreement with Riyadh, Saudi Arabia-based National Technology Group.” Unverified.

From Vegas Baby: “Re: conferences CMIOs attend. Which ones are popular other than AMDIS?” The HIMSS conference probably has more CMIOs attending than any other conference, although obviously they make up a small percentage of attendees overall. AMIA would have a higher percentage but lower number, I’m guessing. Anyone have insight?

From Malice Cooper: “Re: HIStalkapalooza. Are you taking requests? I am sure demand is high, but I would love to be part of the event.” I haven’t yet put up the “I want to come” page. I need to finalize who’s sponsoring the event to figure out how many people I can afford to invite. That will tell me when I’ll have to cut off requests, assuming that demand exceeds supply, which has happened every year since the first (tiny) event in 2008. I’ll also have a great HIStalk sponsor networking event the Sunday of HIMSS week and will send details about that shortly for those looking to swap war stories or strike deals.

HIStalk Announcements and Requests

It’s time for my once-yearly HIStalk Reader Survey, which helps me picture who’s reading and to get your advice. I would really appreciate your participation since, as usual, I’ll plan everything I do this year based on the results. I’ll also randomly choose three respondents to win a $50 Amazon gift certificate. Thanks for taking a handful of minutes to help me out.

Early January also means its time for your HISsies nominations. Tell me the worst vendor, the smartest vendor action taken in 2014, the industry figure of the year, and the all-important “Industry figure in whose face you’d most like to throw a pie.” The final ballot will contain the most-nominated entries, so think of this as the primary election that precedes the general one by a couple of weeks.

This week on HIStalk Practice: New Hampshire pediatricians sound off on the state’s non-existent vaccine registry. HealthTap CEO brings telemedicine back down to Earth. HHS looks for vendors to run its National Data Warehouse. Healthcare gets New Jersey physicians down in the dumps. EHRs create threats to confidentiality. 23andMe sees investment revival. Thanks for reading.

This week on HIStalk Connect: The year’s biggest digital health stories are recapped, including: unprecedented VC funding levels for digital health startups; Apple, Samsung, and Google all expanding their presence in the digital health sector; 3D printing finding more uses in healthcare, DNA sequencing breaking through the long-awaited $1,000 price barrier, and IBM doubling-down on its Watson supercomputer despite a slower than expected road to profitability. During this week’s CES conference in Las Vegas, Withings unveils its newest fitness tracker, Alterica introduces a smartphone-connected EpiPen case, and Cambridge Consultants shows of breakthrough technology in sensor-laden sportswear.

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.

Acquisitions, Funding, Business, and Stock

Par8o, which grandly styles itself as “Healthcare’s Operating System,” raises $10.5 million in Series A funding. The referral management software company, whose name is a play on the word “Pareto,” was co-founded by Sermo co-founders Daniel Palestrant, MD and Adam Sharp, MD. Customers include hospitals that are part of the Harvard and Mount Sinai health systems.

Entrepreneur and author Sramana Mitra profiles for her upcoming book those “Unicorn” companies that generate their initial funding from sales rather than from financing, listing among them eClinicalWorks, which she says has $300 million in annual sales and, “If it were valued, it would easily be a multi-billion dollar company.” ECW’s Girish Kumar is among the most astute, genuine, and interesting people I’ve ever talked to.

HCS announces record sales in 2014 with 19 percent revenue growth and the addition of 30 employees.

McKesson shares hit a 52-week high Thursday, valuing the company at $50 billion. Above is the one-year share price of MCK (blue, up 24 percent) vs. the Dow (up 9 percent).

A venture capital firm increases its stake in Etransmedia with an unspecified investment that will support the company’s merger with physician practice services vendor DoctorsXL.

Chicago-based health analytics and algorithm sharing marketplace vendor Apervita, known until last week as Pervasive Health, completes an $18 million Series A funding round. It’s an interesting concept – allowing people to buy and sell health-related databases, algorithms, and measures.

Sales

Rush University Medical Center (IL) chooses Merge Cardiology PACS. MRGE shares have jumped 71 percent in the past 90 days vs. the Nasdaq’s gain of 8 percent.

Health Information Network of Arizona selects Quality Systems subsidiary Mirth to provide patient information exchange.

People

GetWellNetwork hires John George (StayWell) as chief growth officer.

Tom Stampiglia (Origin Healthcare Solutions) joins Surgical Information Systems as president and CEO.

Announcements and Implementations

Walgreens adds Your Digital Health Advisor, a virtual coaching program developed by WebMD, to its website and mobile app. The app includes programs for smoking cessation, weight management, nutrition, exercise, and emotional health and also offers real-time 24×7 coaching via Walgreens Pharmacy Chat. It will connect to WebMD’s iPhone app Health Target, which lets users upload their data from connected devices to receive physician-reviewed advice and tips. Users who meet their health goals earn Walgreens Balance Reward points.

Walgreens also announces that it will use Qualcomm’s medical device connectivity for remote patient monitoring and chronic care management, initially offering integration with Walgreens blood pressure cuffs and glucose meters. A new line of Qualcomm-branded devices will be announced in the next few months. This, too, will reward members with Walgreens Balance Rewards points for their participation. Walgreens is unbelievably ahead of just about everybody in healthcare in terms of technology use, consumer connection, and industry partnerships. Their technology creates revenue instead of just expense. I tried to connect with the company to interview its CIO, but they didn’t respond to my inquiry.

Capsule announces GA of its SmartLinx medical device information system that includes patient surveillance, clinical decision support, alarm interpretation and alerting, and asset tracking.

InterSystems HealthShare is certified as an eHealth Exchange Validated Product.

BD Medical gets FDA clearance for its Intelliport Medication Management System, which provides real-time drug identification, dose checking, and allergy detection at the point of IV bolus injection and then wirelessly documents the drug’s administration in the EHR. The system, which includes an IV access site sensor, wireless base, and table software, will reach the market in spring 2015. It will be marketed for use in perioperative areas to reduce syringe swap, dosing errors, and manual documentation requirements. This looks like a very cool product, even smarter in some ways than IV infusion pumps, and bolus dose errors cause patient problems much faster than an IV.

O’Reilly releases a freely downloadable e-book, “Data Driven: Creating a Data Culture,” that contains interesting business examples including a cool one that studied why people who had tried Twitter stopped using it. It’s a straightforward, hype-free overview of the possibilities of using data to do good work. I ran across it by accident – I like it a lot.

A DrFirst market share analysis of EHRs used in New York finds that 80 percent of the ambulatory EHRs and 85 percent of the hospital EHRs are ready for the state’s I-STOP law that takes effect March 27, 2015. The law requires that all prescriptions be sent electronically from prescribers to pharmacies. New York pharmacies aren’t as well prepared as prescribers, however, with only 58 percent of them ready to accept electronic prescriptions for controlled drugs.

NantHealth announces a new version of its HBox medical device that collects and transmits real-time information from blood pressure cuffs, scales, and other personal devices using technology from BlackBerry.

Skylight Healthcare announces a secure videoconferencing solution that connects hospitalized patients with up to four other people simultaneously via the company’s interactive patient engagement technology.

Erlanger Health System (TN) becomes the first US hospital to roll out AlarmNavigator from Excel Medical Electronics, which helps users analyze alarms from GE patient monitoring systems to support customizing settings to reduce alarm fatigue.

The Michigan Department of Community Health launches a mobile app and portal so that Medicaid patients can access their medical information remotely.

Government and Politics

The FCC proposes updating its 2010 definition that said “broadband” has a minimum speed of 4 Mbps down/1 Mbps up to instead require 25/3 Mbps. The agency says rural and Tribal lands are underserved, with the proposed definition change upping the requirements for broadband providers that requesting federal grant money to add services. Both AT&T and Verizon had already objected to a previously proposed 10/1 Mbps minimum speed requirement, saying 4 Mbps is plenty for consumers.

Innovation and Research

The Economist corrects yet another example of attention-seeking publications that create inaccurate headlines and stories hoping for salacious clicks. It turns out that despite the recent hype, getting cancer isn’t only due to bad luck. The original research paper said that two-thirds of the variation in cancer risk is caused by chance mutations, which is not the same thing as saying that two-thirds of the chance of getting cancer is due to luck (since not every mutation causes cancer in the given tissue). The authors explain that cancer is “a combination of bad luck, bad environment, and bad inherited genes” and people control 40 percent of the risk via their lifestyle decisions about smoking, diet, sunlight exposure, exposure to papilloma virus, obesity, exercise, and alcohol intake.

Technology

A survey finds that while fitness tracker companies desperately try to outdo each other with added features and higher prices, 85 percent of consumers have no plans to buy one.

Other

Athenahealth says its network and previous years’ data suggest that the flu season has peaked, although CDC’s just-updated report says 29 states have high flu intensity. February is usually the worst flu month.

A new survey finds that nearly two-thirds of Americans couldn’t afford to write a $1,000 check for an unplanned ED visit. More than one-third of them would dip into savings, 26 percent would have to cut back elsewhere, 16 percent would borrow the money from family or friends, and 12 percent would charge the amount to their credit card.

Sponsor Updates

• Allscripts will integrate Perceptive Software’s enterprise content management into its EHRs, giving customers a common infrastructure for storing and sharing patient content. 
• Medicity publishes case studies on Trinity Health’s use of Medicity HISP to transmit information and Intermountain Healthcare’s lab results notification and public health reporting via Medicity Exchange. Brian Ahier, Medicity’s director of standards and government affairs, publishes an article with Wisconsin Statewide Health Information Network COO Jean Doeringsfeld titled “FHIR and the Future of Interoperability.”
• Teramedica-sponsored Vendor-Neutral Archive Institute of Technology offers free online courses that include CPHIMS and CPHIMA credit.
• Direct Consulting Associates will sponsor “Becoming a Game Changer in the World of Healthcare Technology” on January 29, 2015 in Scottsdale, AZ. Texas Health Resources SVP/CIO Ed Marx will deliver the keynote address.
• Logicworks publishes a blog on healthcare security, highlighting three reasons why hackers target healthcare clouds.
• Liaison Technologies publishes a new blog on next-gen data integration and management by Chief Marketing Officer Manish Gupta.
• Local papers profile Ingenious Med President and CEO S. Hart Williford’s work with startups; and COO Mike Pickering’s work with the Atlanta All Stars Talent Show Network, a non-profit community outreach program he founded in 2004.
• Impact Advisors offers a snapshot of its latest white paper, on population health management, in a new blog.
• Huntzinger Management Group Client Executive Rob Tashiro will speak during a CHIME webinar on January 28 covering lessons learned from big bang implementations.
• Optum’s latest blog looks at how providers use analytics to better manage their populations and reduce costs.
• Healthfinch sets intentions for the new year in a new blog post.
• Healthcare Data Solutions shares insight into the Walgreens-Qualcomm partnership in a new blog post.
• HCI Group’s SVP of Delivery Operations Robert “Bob” Steele receives his HIMSS senior member certification.
• Hayes Management Consulting posts a new blog on the advantageous countdown to ICD-10.
• DocuSign will host the Tech Founders Forum in San Francisco on January 13.

EPtalk by Dr. Jayne

While I share many of Mr. H’s pet peeves with regards to grammar, my top peeve at the moment is misleading headlines. It was bad enough when it was just Yahoo and MSN, but now the sensationalism is rampant in various physician publications. Medical Economics screams “Meaningful use penalties sear more than half of EPs in 2015.” Personally, “sear” wouldn’t be the verb I would choose for a 1 percent Medicare penalty. Tintoretto’s “The Martyrdom of St. Lawrence” illustrates what it would really look like to be seared.

Massachusetts physicians will need to update their own pet peeve lists with this one. The Massachusetts Board of Registration in Medicine recently adopted a regulation that requires demonstration of Meaningful Use as a condition of licensure. It went into effect last week. Fortunately, they’ve built some flexibility into the final requirement. Beyond successful attestation as an Eligible Provider, other options include:

• Completing continuing medical education that discusses EHRs and the MU programs objectives and quality measures.
• Employment, contracting, or credentialing by a hospital that is participating in MU.
• Participating in the Massachusetts Health Information Highway.

Physicians renewing their licenses prior to March 31 can receive a single-use “get out of jail free” exemption. If you’re due for renewal within 60 days of the end of March, you can take advantage of it as well by applying early, so get those checkbooks ready.

For those of us who wear many different hats (CMIO, practicing physician, anonymous blogger) time management is a constant challenge. If you’re as compulsive as me about it, you’ll want to consider blocking time on your schedule to peruse the proposed rule for Meaningful Use Stage 3. I highly recommend slotting a weekend evening with a roaring fire and a nice bottle of wine, as that worked well for me when Stage 2 was released. Given the state of my average work week, there’s no way it’s going to happen during normal business hours.

If you’re new to the game, the proposed rule currently sits at the Office of Management and Budget. It will be published in the Federal Register once the OMB review is complete. Stage 3 is supposed to focus on using the work done in previous stages to actually drive improvements in patient outcomes. According to statements from HHS, there will also be changes in the reporting period and program structure.

They also hope to clarify the definition of Meaningful Use (given confusion about requirements from multiple stages and multiple revisions) and to make sure the program is sustainable. I don’t have a crystal ball, but I hope there’s a 90-day reporting period involved and that they give vendors at least a year after finalization of the Rule to write code and physicians a year to install and upgrade.

Earlier this year, the Health IT Policy Committee recommended that HHS incorporate fewer objectives and reduce the burden on providers. Various other constituencies have pushed for further narrowing of the requirements. I’d bet we have the NPRM in the Federal Register within the next few weeks, so get your wine selections ready.

HIMSS is releasing more information about the conference and several new offerings including a Cybersecurity Command Center, Disaster Preparedness Knowledge Center, and the HIMSS Health IT Value Suite. Another new offering is HX360 , a joint effort of HIMSS and AVIA to look at non-EHR technology that can benefit health systems and provider organizations. I was initially drawn to it, but seeing that they’re charging an additional fee to attend the “Venture+ Forum pitch competition for early stage companies” dampened my enthusiasm. I don’t think what they’re offering is worth an additional $225 (or $795 as a standalone) of my hospital’s money.

I’m a little more enthusiastic about the “HIMSS Speakeasy” theme for the opening reception, which is usually pretty vanilla. Who’s ready to bob their hair and pack their flapper dresses and dancing shoes? Email me.

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 1/8/15

Stage 3 proposals go to OMB, hint at changes

ONC submits a notice regarding Stage 3 MU to the Office of Management and Budget that contains the following description of the yet-to-be-published rule: “Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements.” 

IBM, Epic already prepping for military EHR work

In pursuit of the DoD EHR contract, IBM and Epic announce the formation of an advisory group comprised of 17 medical informatics specialists, physicians, hospital administrators, and a former US Army Special Forces Major who lost his leg in combat and who will represent the patient perspective, detailing his experience transitioning from the Army’s care to the VA health system.

Avoiding Unintended Incentives In ACO Payment Models

An analysis of ACO shared savings reimbursement levels published in Health Affairs finds that the calculation used to establish benchmark spending level focuses too heavily on spending data from the year immediately preceding the transition to an ACO. Researchers suggest that this could encourage ACOs to ramp up their spending before transitioning to an ACO model so that benchmark costs are falsely inflated, resulting more substantial year-one savings.

Qualcomm announces new connected health collaboration with Walgreens

Walgreens partners with Qualcomm to bring medical device integration to its growing ecosystem of health applications.

Open Enrollment Week 7: December 27, 2014 – January 2, 2015

HHS reports that 6.6 million consumers have used the federal insurance marketplace to enroll in an insurance plan thus far, though many were automatically re-enrolled into their existing plans. The number does not include state-run marketplace enrollments. Open Enrollment ends on February 15.

Startup CEOs and Investors: Brian Weiss, Carebox

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

Delivering Opening Lines
By Brian Weiss

My name is Brian Weiss and I’m the founder of a healthcare IT startup.

I’ve got these really great ideas about how to make everyone healthier, solve healthcare data interoperability, enable payment reform, advance clinical research, leverage big data to fix the US healthcare systems, make the world a better place, and create a billion-dollar company. Oh, and did I mention it all runs in the cloud?

You’re not really buying that, are you? I don’t blame you. It’s not a very good opening line.

Opening Lines

I’ve spent much of the last few months delivering opening lines – to (potential) investors, team members, strategic partners, pilot customers, editors of healthcare IT publications with proper-capitalization fetishes …

It’s not like I’ve never delivered an opening line before I became a startup founder. In everything we all do, there’s always a first line, a first slide, an opening paragraph, a first impression, a useless abstract class at the top of the object model hierarchy (what, I’m the only former software engineer in the room?)

I’ve had to pitch ideas, sell things, present solutions, and introduce myself many hundreds of times. No, I haven’t ever written a column in a publication like HIStalk (is there even such a thing?) But I’ve delivered really bad opening lines countless times! I’m even experienced enough to know it’s not the end of the world. At various times in my past, I’ve somehow managed to get hired, promoted, selected in an RFP, invited back to a conference, and even married, despite being opening-line-challenged.

So why am I having such a hard time writing this column’s opening?

Matchmaker, Matchmaker, Make Me A Match …

Today, I’m attending a “Matchmaking Session” in New York as part of the ONC Market R&D Pilot Challenge. To help encourage innovation around some of its strategic priorities, ONC is sponsoring a contest that will select six winning pilot projects. Each pilot proposal has to be presented jointly by an innovator (an early-stage healthcare technology company) and a host (an established healthcare organization operating in a clinical environment). To help match up hosts and innovators, there are three of these matchmaking events taking place over the next few weeks.

If “matchmaking session” sounds like something from “Fiddler on the Roof,” you’re on the right track. The format here is speed dating for startups, commonly used at events that bring together startups and investors. I will have 13 minutes to woo my date(s).

They also sent me a colorful one-page tip sheet to help me prepare. It seems they think I will do a better job if I make an effort to have a clue in advance about the company I will be meeting with, make my presentation engaging, explain what I do, and say something about my team and business model. And, they suggested that I practice in advance.

I’m being a tad cynical about their tip sheet. I suppose it’s pretty good advice… for presentation beginners.

My Kindergarten Artwork

My memory from when I was five years old is probably flawed, but I think this is close to being a direct quote from my kindergarten teacher to my parents about my artwork: “Brian is trying hard and we don’t want to discourage him. The important thing is to keep at it.”

A couple of weeks ago, I was in a meeting with a senior executive at an important partner of ours. It was a preparation meeting in advance of a larger meeting she had coordinated in which I would be presenting my startup to other leaders at her company.

I showed her what I had prepared. In a very polite and cheerful way (curiously reminiscent of the disposition of my aforementioned kindergarten teacher), she told me (in not so many words) that what I had prepared for the meeting clearly showed I was trying hard and she didn’t want to discourage me, but the important thing was …

… to just say very concisely what the problem was we were trying to solve, what our solution was, why it was good for her company, why we could do a good job, and “then just show them the demo.”

I dusted off my ego, did my best to do exactly what she suggested, and I thought it went pretty well.

I’ve coached others with similar advice countless times. Why did I need to be told that now?

Introductory Presentations

Last week I had a call with the CMO of a very large healthcare organization, which I can barely allow myself to dream might one day be a partner of ours. The call lasted less than 15 minutes.

Just as I was concluding my build up to Slide 1, he said he was already on Slide 8 and asked me a couple of short questions. Then he told me it all looked pretty clear, sounded interesting, he would do some checking internally, and get back if they were interested in hearing more. He got back to me the next day about setting up a follow-up meeting to go into more detail. We’ll see where it goes.

I’ve done 10s of similar calls before that one. They run 30-60 minutes and my results generally weren’t as good. I now have a much better presentation than I had before and the obvious advice I got a few weeks ago was clearly something I needed to hear.

What’s Different/Special About That?

My column will only be worth reading if I have unique and valuable perspectives to share with you that emanate from the fact that I’m a healthcare IT startup CEO, not just some guy who has to get better at introductory presentations and opening lines.

Can I do that? I’m not really sure – and this might be a very short-lived column.

For now, I just want to share with you why (I think I’ve figures it out) I am now having experiences like the ones above that sound like something out of “my first days a junior salesman” – when I am quite certain I knew how to do an effective introductory presentation many, many years ago.

Starting Up Means Starting Over

Each step in our career generally lets us build on the previous ones. When I was EVP/SVP/pick-your-favorite-letterVP of products, my title, the company and organization I represented, the many people working for me, a ton of support infrastructure — all came through the front door with me.

But it’s even more than that.

Once you get your degree, you don’t have to pass your mid-term exams anymore. But could you if you had to? On the way to the where you are today in your career, you probably paid your dues on many rungs of the ladder. But could you go back and do a good job at each level again, now?

When you are given a new challenge today, is it really all that new? Or is it a natural evolution of what you do today that lets you relatively easily carry over your skills, expertise, experience, and credentials?

I’m no longer the exec who gives good advice to others about how to structure their presentations. I am the junior salesman getting better at making a pitch. I’m the guy at the ONC matchmaking event who needs the tip sheet. I’m the guy working on the template, the web site, the demo, the story. Everything I do starts with a blank piece of paper. I’m the guy who now needs the feedback that people who do that kind of stuff get.

The fact that I could do a good job presenting as a corporate exec doesn’t mean I can do a good job presenting in this context. The fact that I could give advice to others about the kinds of presentations I am now making doesn’t mean I don’t need to hear that advice myself from others, now.

Whatever I think I’ve learned or accomplished in my career to this point only matters if I can translate it into something concrete that helps me better do the stuff I need to do now. That’s always a true statement for all of us, but it takes on a whole new meaning when you have to do something that isn’t a natural evolution of what you did yesterday.

What Is This?

Two weeks ago, Mr. H put out a call for a "startup CEO or a venture capitalist who wants to share their keen insight and sharp writing skills with the world."His intent, I believe, is that this column provide interesting and different insights and perspectives for the many HIStalk readers who are employees in established companies and interested in getting an insider view of the world of healthcare startups.

I told him I qualified as, “A startup CEO who wants to share” and we could see about the rest.

The column I’m planning to write (exact frequency to be determined) will draw from both agendas – the healthcare IT topics we’re focusing on and the ups and downs of the stages in the growth (I hope) of a startup – with a special emphasis on where the two meet.

I’m a beginner column writer. I hope to not completely disappoint relative to Mr. H’s objectives. If you’re able to suggest topics, approaches, improvements, etc. that can help me do that – I’d be most grateful. You can write to me directly.

Brian Weiss is founder of Carebox.

Morning Headlines 1/7/15

Top 10 issues for physicians to watch in 2015

The American Medical Association says that it will spend 2015 fighting to remove “barriers to providing high-quality care” by lobbying for relaxed Meaningful Use rules, improved EHR usability, and improved interoperability.

Epic Systems draws on literature greats for its next expansion

Epic unveils the designs for five new buildings it will construct on its increasingly cramped Verona, WI campus, adding 500,000 square feet and 1,600 offices. The new building designs were inspired by children’s literature classics, like “Charlie and the Chocolate Factory” and “The Wizard of Oz..”

Allina Health and Health Catalyst Sign $100 Million Agreement Creating Model for System-wide Outcomes Improvement

Allina Health (MN) signs a 10-year,  $100 million deal with Health Catalyst to accelerate outcomes improvement across the organizations 12 hospitals and 90 clinics.

A Restraining Order Can Be Just A Videoconference Away

Domestic abuse patients being treated in the ED at St. Joseph’s Regional Medical Center (NJ) will have a new videoconferencing platform that will connect them with a local judge who will hear their case and issue a restraining order while they are still in the hospital.

News 1/7/15

Top News

The American Medical Association says EHRs, ICD-10, prior authorization, and Medicare fraud detection programs are “barriers to providing high-quality care” that it will oppose in 2015. AMA will continue its push to make the Meaningful Use program more flexible, improve EHR usability, and expand EHR interoperability. It will also “urge regulators to ease this physician burden” of the October 1 implementation of ICD-10, study the physician workload impact of prior authorization, and push CMS to overhaul its RAC-centered “bounty hunter” fraud and abuse programs.

Reader Comments

From Hallway: “Re: smartphone wayfinding apps. I passed along information on Jibestream that you mentioned in June 2014. I agree that this type of application will offer competitive advantage, not only with patients and visitors, but for new hires, for patient transportation, and for ancillary staff that need to deliver services at the bedside, maybe even eventually to route robots delivering supplies (I can just picture R2D2s roaming the halls).”

From Title Contender: “Re: smartphone wayfinding apps. Check out Logic Junction, whose solution works on both web and mobile with a single database that can be updated in real time.” The company lists Cleveland Clinic, LA County, Sarasota Memorial, and the VA as clients. The online demo is pretty cool and doesn’t require registration to run. If I were the company, I would white label the product and let hospitals sell ads or promote their own services to make it cost neutral.

HIStalk Announcements and Requests

I’ve ordered Eric Topol’s “The Patient Will See You Now” and Steven Brill’s “America’s Bitter Pill,” so I’ll have book reports soon.

The latest in my long line of pet grammar peeves: starting sentences with “there.” The next-to-latest: sites that post articles with a question as the headline, indicating that the author isn’t confident enough to actually answer the question (meaning: the article is a complete waste of time). I’m curmudgeonly even in restaurants whose menus gets overly cute by offering “veggies” and “mashers.”

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.

Acquisitions, Funding, Business, and Stock

Allina Health (MN) will take an equity position in Health Catalyst as part of a 10-year agreement in which the Allina will outsource its 60-employee analytics and quality improvement teams to Health Catalyst and will contribute its clinical expertise, while Health Catalyst earns a portion of its payment when Allina hits specific quality improvement targets as overseen by a governing committee. The organizations value the agreement at $100 million. I interviewed newly promoted Allina President and CEO Penny Wheeler, MD this week about the agreement and other topics.

Lexmark acquires Toronto-based medical imaging technology vendor Claron Technology for $37 million in cash. Lexmark will position the company’s medical imaging viewing platform and zero-footprint viewer within its Perceptive Software business, which offers a vendor-neutral archive and medical content management.

Staffing services company General Employment Enterprises acquires Jacksonville, FL-based medical scribe contractor Scribe Solutions.

Baltimore-based hospital hiring software vendor Pegged Software, which claims to have reduced employee turnover in its customers by an average of 45 percent, raises $9.2 million to increase its sales and marketing efforts.

Guided episode management software vendor Wellbe raises $2.42 million.

Honeywell renames its HomMed remote patient monitoring business to Honeywell Life Care Solutions.

The non-profit MedicAlert Foundation will reduce headcount and cut its budget “to better focus on its core mission of protecting and saving lives by serving as the global information link between members and emergency responders during medical emergencies and other times of need.” Beyond a variety of bracelet-type medical IDs, the organization offers an online health record linked to the medical ID number for an annual membership fee that starts at $19.99.

Sales 

Saint Luke’s Health System (MO) chooses Phynd to create a single provider profile of its 15,000 referring and credentialed physicians.

Children’s Hospital of San Antonio (TX) selects Ingenious Med’s patient encounter platform.

People

   

HIMSS adds four new board members who will serve three-year terms: Michael Nusbaum (MH Nusbaum & Associates); James Peake, MD (SVP, CGI Federal); Christopher Ross (CIO, Mayo Clinic); and Ferdinand Velasco, MD (CHIO, Texas Health Resources).  

CHIME names University of Michigan Hospitals and Health Centers CIO Sue Schade as its 2014 John E. Gall, Jr. CIO of the Year.

Rick Adam is named president and COO of analytics vendor Stanson Health. He has work for a variety of health IT vendors over the years, including Baxter, NEON, and Recondo Technology. The company’s board chair is Scott Weingarten, MD now with Cedars-Sinai after co-founding Zynx Health.

Halfpenny Technologies hires Carl Smith (Airclic) as CFO.

David Silberstein (Teradata) joins Leidos Health as service line director for analytics.

The former HHS acting director of cybersecurity is sentenced to 25 years in federal prison for distribution of child pornography, including participating in discussions with another member of a private website that the two get together to fulfill their mutual fantasies of raping and murdering children. The FBI says Timothy DeFoggi used the technology expertise he gained in working for HHS to evade detection, ultimately unsuccessfully.

Announcements and Implementations

Epic announces plans for Campus Five, a five-building expansion that will add 500,000 square feet of space, 1,600 offices, and 1,500 parking spaces, all with a children’s literature theme. The company says it needs the space because 45 percent of its employees are sharing offices. Epic’s Wizards Academy campus is already under construction and will open in about a year.

Connance adds a Claims Optimization platform to its predictive analytics solution.

The HCI Group creates a freely viewable e-book, “The Definitive EHR Go-Live Guide.”

Sure, I think there’s more focus, for example, on hospital readmission for Medicare patients, which is costly, but in the sum total of things, it’s kind of a drop in the bucket. There are little things like that, but there aren’t any big things, there’s nothing to control the price of drugs, there’s no tort reform, there’s nothing to control the profits of allegedly nonprofit hospitals. There’s nothing to deal with the profits and the secret contracts that device-makers negotiate with hospitals that buy their products.

It’s not just the lobbying influence. You combine that money with the emotional pull and fear that people have when they think about healthcare. People care more about their health than they do about healthcare policy. And then you add to that the multi-channel political power of the healthcare industry in every congressional district, because in about every congressional district, the largest employer is the local hospital. And the local hospital is again seen as a charity. You combine that kind of local power with the lobbying power, with the fear and emotion that’s attached to healthcare, and that makes for a toxic political stew.

How is that going to change? I think the only way it’s going to change relates to what the thinking was in Massachusetts when Romneycare passed. They’re very candid about this — we’ll give everybody coverage and then when people see how much it costs, there’ll be this huge political wave to say we have to reform this or we’re going bankrupt.

Technology

NPR’s “All Things Considered” covers the consumer medical devices being displayed this week at the International Consumer Electronics Show in a piece titled “Self-Tracking Gadgets That Play Doctor Abound at CES.” It mentions CellScope (a phone-powered ear camera that sends images to doctors for diagnosis) and Neurotrack (quiz-based Alzheimer’s diagnosis). The article wanders confusingly into thinking that phone apps have something to do with cyberattacks and telemedicine, so the only interesting aspect is that NPR wrote up the article in the first place.

An interesting use of telemedicine: St. Joseph’s Regional Medical Center (NJ) connects ED victims of domestic violence with county court officers, allowing them to take out restraining orders within 45 minutes directly from the hospital. The program is being expanded to make an iPad-equipped judge available around the clock to handle night and weekend cases, which are the majority.

Other

Physicians responding to a Sermo poll name wearables-based remote patient monitoring and telemedicine as the top two expected trends of 2015.

Surgeon and writer Atul Gawande, MD, MPH weighs in on technology in an interview with Bob Wachter, MD:

Information is our most valuable resource, yet we treat it like a byproduct. The systems we have – Epic and our other systems – are not particularly useful right now in helping us execute on these objectives. We’re having to build systems around those systems … the issues have less to do with systems than with governance … the residents feel they’re caught up in this world where everything they need to know is on the computer screen. That’s creating angst in their day-to-day life. You go up to the floor of the medical service in my hospital, and there are no doctors there. They come, they see the patients, and then they escape to this tribal room where all 15 residents hang out together, each doing his or her computer work. That means that many of the informal interactions that used to occur between the docs and the nurses, or the docs and the patients and their families, have withered away.

A veteran sues the Atlanta VA hospital that was treating him for PTSD, claiming that the single dose of antidepressant he was prescribed created a weeks-long erection that made him the laughingstock of doctors and nurses and resulted in improper treatment that left him disfigured. “One had mentioned that I should line up all the women. I haven’t had that many people who had seen it in my whole life until I went to that hospital.” His attorney (Mr. Johnson, strangely enough) cites another patient who took the same drug with the same result, to whom a jury awarded $10 million.

Weird News Andy drives us into the new year with a story he titles, “Making a turn for the better.” Surgeons remove a turn signal lever from a 1963 Thunderbird from the arm of a man who had been in a car accident 51 years ago, unaware until now that he had a seven-inch piece of metal embedded there.

Sponsor Updates

• Phynd publishes a blog post titled “Direct Addresses Are Yet Another Reasons Hospitals Need to Move to a Single Provider Profile (SPP) Model.”
• ADP AdvancedMD will integrate its EHR with physician practice reporting from Iron Bridge Integration, giving customers access to pre-built connections to 57 registries in 48 states to help meet Meaningful use Stage 2 requirements.
• Chadron Community Hospital (NE) successfully attests to Meaningful Use Stage 2 using NTT DATA’s Optimum product suite. I interviewed CIO/COO Anna Turman several months ago and it’s still among my favorites.
• Netsmart publishes several new white papers: “In Transition: How Electronic Data Sharing Enables Improved Outcomes and Reduced Costs,” “5 Things to Consider When Selecting Your New (Next) EHR,” and “Transforming the EHR into a Knowledge Platform to Ensure Improved Health and Healthcare.”
• Medhost describes the use by Larkin Community Hospital (FL) of its YourCareLink integration service to automate public health reporting for Meaningful Use Stage 2.
• Amerinet will offer the interoperability and population health management solutions of Sandlot Solutions to its members.
• A market research survey finds that VMware’s AirWatch enterprise mobility management solution is the #1 choice of decision-makers, handily beating out MobileIron.
• Four Army National Guard locations will use AtHoc’s network-centric crisis communications system, which allows base officials to quickly send deployment orders and emergency notifications via text, phone, and desktop.
• Besler Consulting offers a review of the FY2015 Hospital Outpatient Prospective Payment System.
• A CareSync blog post reviews CMS’s chronic care management reimbursement program and how doctors can use the company’s CareSync CCM product.
• Clinovations posts an article titled “Patient Access: What Does Failure Cost?”
• CommVault announces the schedule of its “Hockey Helping Kids” fundraiser.
• DataMotion publishes an article, “Want to ensure secure and compliant data exchange? Integrate security!”
• Divurgent will participate in the HIMSS East Tennessee Summit on January 22, 2015 in Knoxville and the HFMA Florida Mid-Winter Conference January 26 in Miami.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

HIStalk Interviews Penny Wheeler, MD, President and CEO, Allina Health

Penny Wheeler, MD is president and CEO of Allina Health of  Minneapolis, MN.

You’re a brand new health system CEO, unusual in that you’re female, you’re a practicing physician, and you’re not afraid to get your hands dirty digging into IT and data issues. What are the challenges Allina is facing and how does IT fit into those?

The challenges aren’t atypical to other healthcare organizations. Our biggest challenge is that what we want to accomplish for our mission isn’t necessarily the way that our incentives are lined up right now. Our financial success doesn’t always equal the success for our patients.

For example, right now we’re having, unfortunately for the community, a bad flu season. A lot of people are getting sick. That’s meaning good things for us financially. That’s not the way it should be. We want to help drive an incentive system that rewards us for good health for the community. That’s our biggest challenge. 

The challenge to get to that is the second biggest challenge … to transform into a whole different business model. What we have to do to reduce costs and have the right information to do that.

The third thing would be to have the infrastructure set up to be able to do that successfully, which is why this information and turning data and information and consolidating that and organizing that in a way that actually can move towards better better outcomes is so important.

Regarding the announcement that just came out (Allina Health and Health Catalyst Sign $100 Million Agreement Creating Model for System-wide Outcomes Improvement), most people would see Health Catalyst as an IT tools and services vendor. What gave you the confidence to let them get so involved in quality projects going beyond the technology?

We have a history with Health Catalyst. We were their first customer out of the chute when they were a two-man shop, then known as Health Quality Catalyst. At that point, I was leading the quality agenda for the organization. I saw that we had insufficient information to know what outcomes we were getting at what price for the patients we served. 

We had to integrate dozens of databases to be able to show what that looked like, to show our outcomes. The electronic medical record was not enough. It was one source input, but it wasn’t nearly enough for us to do what we needed to do to get all the — you can call it big data, you can call it whatever you want — integrated in a way that it allowed us to focus our resources correctly for patients.

We engaged the two founders of the Health Quality Catalyst, now Health Catalyst, Steve Barlow and Tom Burton. We were their first customer because we realized we wanted a way to set up a data in an integrated way akin to what Intermountain Health had done, and they came from Intermountain Health.

There’s the question of whether organizations don’t have enough data or whether they don’t have the willingness to act on the data that may already have available to them. How do you quantify an organization as to whether they’re ready to be data driven?

I’d say it’s neither of those two things. We have tons of data, but our previous data was just dumped, like a dumping ground, into what was a data warehouse. There was no way to get it out in any meaningful ways nor have it be actionable on the back side.

I would say that it’s actually the integration of the data in a way that’s usable and meaningful for the people who know the work the best. That is the biggest challenge for folks. Everybody and their mother might say they have a data warehouse and they do. We had one before, too. It was a big dumping ground and we couldn’t get anything meaningful out of it.

Now we have a data warehouse that actually integrates over 27 different databases and shows us an outcome of what our variation is in the way that we’re caring for people. What outcomes at what cost. It puts an overlay on it that gives us a dashboard so that people can make some use out of the numbers.

For example, through all these databases, we were able to develop using hundreds of factors a predictive model that told us who was at greatest risk for readmission. Now we have a predictive model that predicts with about 80 percent effectiveness who’s likely to be at greatest risk. They’re flagged right when they’re in the hospital. We know we can put care management resources right to those people because they’re flagged as being high risk for readmission.

It’s those kinds of things that we can do. Our caregivers can use that information directly.

Other than readmissions, what impactful results have you seen from the use of data analytics?

A lot of its success has been cultural. We’ve been able to engage physicians much better in better care improvement activities because they know that we have measures of performance that are meaningful and accurate. A huge part of this has been cultural and engagement of physicians and caregivers because they’re the ones who really can improve care process, which is where most of the wasted cost is now is … on care processes. A lot of it’s been on the engagement because they know it.

I’ll give you an example that shows you about an initiative and shows you about that engagement. We had an early initiative about reducing, like many organizations have, early inductions of labor. We had integrated all the data that shows us where they were happening, by what physicians, at what gestation, for what reasons. We could get it in moments where other health care organizations were taking months and months to get that information. We could get it in moments.

Then I was at a conference table where somebody said to another doctor, "Well, that can’t be right. That can’t be what my induction of labor is." The other person looked at them and says, "Nope, I’ve looked at the data. I trust the data and it is right." We were able to, in that case, reduce our elective inductions of labors from 14 percent — which it should be next to zero — to about 1 percent. We have maintained that for the last two and a half years. That results in about 250 fewer women having Cesarean sections per year and many fewer babies being in the intensive care unit.

That’s an example of where we’ve been able to engage the physicians. They believe the data. We’ve been able to drive towards an outcome that has meaning in terms of better health for the individuals at a lower cost.

For a health system that doesn’t have a physician CEO, what would you recommend as a structure to take that information and convince physicians to act on it?

We try not to invent what has already worked well other places. The structure we’ve used is looking at our clinical service lines across the organization for specialty care and also our primary care base. Then having content expert groups around a particular care conditions of the patients focus on what they wanted to measure and what data and information they needed to make sure that the care was the best.

For example, in the oncology clinical service line, we have a breast program committee. That breast program committee decided the 31 things that they wanted to measure around quality. That breast program committee includes doctors, but it also includes administrators and nurses and radiation folks and all kinds of multidisciplinary physicians from oncologists to surgeons to radiation oncology people and general medicine. I think focusing around a condition of the patients was important and getting the multidisciplinary team together to do that and to find what was important.

One other thing I’ll add is in the best of our groups, adding some patients to it also has helped. The patients — I’m just thinking about that breast program committee — said, "You’re measuring how long it takes me to get a diagnostic mammogram done. That doesn’t matter to me. What matters to me is when you find a problem, how long it takes me to get in for the next test, because that’s when I don’t sleep at night."

That’s where we’ve been able to connect that dot with the patients in our best forms. We don’t have that everywhere, but that’s been best. That changes the conversation and makes it assured that it’s patient focused because, as I said when you were talking to me about challenges right now, right now one of our biggest challenges in healthcare is that the waste that we’re trying to reduce in healthcare is somebody’s revenue these days. That’s where it gets very difficult.

The agreement with Health Catalyst must have been complicated to negotiate since Health Catalyst is taking financial risk along with Allina, but then Allina gets partial ownership of Health Catalyst. Is the agreement that you’ve signed going to be difficult to manage and measure?

We spent a lot of time on that part. I think it’s a great partnership because Health Catalyst has incredible tools, but most people like them just hand you the software tools and they say, "OK, now here do." Through this partnership, we can have these incredible tools, but then we have the arm that shows us how to implement those and how to engage caregivers around implementing them in the right way for the right reasons for the right patient. We think it’s a good marriage that marries the knowing and the doing in a big, important way, so that’s huge.

We spent a lot of time, to your point, about what do we each look at as measures of success. We spent just painstaking time saying, “What looks like success in this? What key process indicators do we have? What do we have to make sure is maintained in this agreement to make sure it’s successful?” I think we’ve done that enough up front so that it won’t be very difficult to administer now that we’ve defined it on the front end of these negotiations. We’ve aligned our interests in a very profound way.

There’s a lot of discussion about the need for patient empowerment, getting patients involved in their care and having some control over their care episodes. Are there any projects that you’re working on that address that?

That’s a really great question. That’s where we’ll have to evolve to. Right now we’re evolving in ways that we can have trusted outcomes information and an implementation arm in terms of management to move those outcomes in a better way.

But you’re absolutely right. The holy grail is, how can we make patients the principle agents in their own health so that we move even further upstream instead of just reacting to how we can better care for those who are ill? How can we better support them to be well? I don’t think we’re all the way there yet, but we’re talking about tools and ways in which to do that better.

How do you draw the line between the healthcare system and social services delivery, where the health system has responsibility for managing populations but can only go so far into the community? What are the challenges or opportunities?

That’s another really great insight and question. There will surely be partnerships and walls broken down in ways that we never envisioned them to be broken down. I certainly don’t think that we as a healthcare organization can do things like fixing the cracks in the sidewalk. We need partnerships with social services agencies. But a lot of what we do will become more an more analogous to social work services and partnerships with those social service organizations than we do today.

I’ll give you an example. We did actually merge with a organization called the Courage Center for people with disabilities. We had all the acute care services for those people who had had a recent stroke and needed physical rehabilitation. We had some sports and PT clinics. But we didn’t have the in-betweens of having post-acute care for those patients, transitional care. What the Courage Center brought us was vocational training, activity-based training, and sports and activity programs where they were able to see how they could drive, where they could do some of those community-based programs. That’s the full continuum.

In this case, we did it through a merger. In other cases, we’ll have to do it through partnerships. But you’re absolutely right to ask that question because the continuum is becoming much broader than we ever thought of in the past.

Morning Headlines 1/6/15

Lexmark International to Buy Medical Imaging Company Claron

Lexmark acquires Claron Technology, a web-based medical image sharing platform, for $37 million. The company will be integrated into Lexmark’s content management software division.

U-M Hospitals’ Sue Schade named CIO of the Year

Sue Schade, CIO of University of Michigan Hospitals and Health Centers in Ann Arbor, is named CIO of the year by CHIME and HIMSS.

A Look Back at 2014

John Halamka, MD and CIO of Beth Israel Deaconess Medical Center, blogs about the major events that shaped 2014, both in health IT and on his small farm outside Boston, of which he quips “ I shovel manure because it is so different from my varied day jobs, although some debate that point.”

The remaining uninsured: Closing ACA gaps

While the Affordable Care Act has significantly reduced the uninsured rate in the US, 14 to 18 percent of the general public are still uninsured, despite the fact that most of the remaining uninsured qualify for one or more assistance programs.

Curbside Consult with Dr. Jayne 1/5/15

For many, the end of the year means time off and relaxation. The end of 2014 brought extra stress for our medical group as our Meaningful Use coordinator took an unexpected medical leave three days before the end of our reporting period. 

After having previous employees leave us in the lurch, we’ve learned to assume that someone could win the lottery and not come into work the next day. We’ve tried hard to make sure that all of our key roles have a backup person designated to step in. We also have strong policies and procedures regarding documentation to ensure that if we have to replace someone, the potential negatives are minimized. This was a good test of our system. So far, things seem to be working well with just some minor glitches. 

Our leadership group had already approved the plans for creating the attestation documentation for Eligible Providers. Those parts of it that could be done in advance were already largely complete. Fortunately, our vendor provided extremely detailed Meaningful Use training with almost ridiculously specific instructions for how to prepare documentation in case of an audit. Although we made fun of it at the time, we’re very grateful for it now because it has allowed us to quickly determine what documentation we have and what we still need for each physician.

Although some people instinctively react to the billions of dollars spent on Meaningful Use and even more specifically to the $44K per Eligible Provider figure as some kind of a windfall for physicians, it doesn’t even begin to cover the amount of money needed to actually install, maintain, and optimize the software needed to qualify. It doesn’t pay for the lost productivity while we check boxes that don’t assist us clinically, either. For our group of several hundred providers, it also requires multiple full-time staff members to train, report, retrain, track, analyze, and educate so that we don’t miss our goals. 

We’ve definitely been hurt by the fact that Meaningful Use is all or none. Last year, we had a couple of providers who were really close, but failed on one or two measures, which results in an unsuccessful attestation. We redoubled our efforts around those providers and it looks like they’re going to be successful this year.

Still, my office is now full of hundreds of individual physician binders, ready to receive the rest of the attestation documentation as it becomes available. I wound up as the lucky repository for it since my office is a converted conference room and I’m in it only rarely. I didn’t think much of it initially, but now that I sit here looking at all the work in progress, I think about how many hundreds of hours of staff and physician time have been taken up trying to chase the MU money and avoid future penalties. I can’t help but think that it hasn’t been worth it.

As employed physicians, most of my colleagues don’t have a choice whether to participate or not. As we continue to acquire practices, it has become more complicated. Some may have attested previously under another employment agreement or as individuals and may not have the data we need. Others are unsure whether they’ve attested or not. 

For those who have been employed at the same place since 2011 when this all started, though, it has been a little less complex. Still, those "complicated" binders take up an entire folding table in my office. At least as independent physicians they received the MU payments directly. However, as employees, the payments are shared between the physicians and the organization.

Our group is one of the only employed groups in the area that actually shares the incentive payments between the employer and the physician. Our competitors absorb the payments as a cost of doing business. It’s all part of the complexity of physician compensation and reimbursement. 

Some health systems "charge" employed physicians for EHR costs and maintenance, while others don’t. Some distribute payments based on overall group performance (so providers might get compensated for MU payments although they would be filtered into the general fund first). Still others have arcane and specific accounting systems that charge or reward physicians on a line item basis. As employees, they could determine whether MU payments were a boost or a bust, but they still wouldn’t be able to do much about it.

The one entity for which MU was definitely not a boost (at least not at my organization) was the environment. We’re printing reams of paper for our attestation documentation binders (aka audit defense). Although we have soft copies as well, providers will be required to maintain the documentation at their primary practice locations and we will also keep a copy at the home office. The amount of paper moving into my office on a daily basis as more reports are delivered and more screenshots are prepared is truly staggering. At least someone had the foresight to buy printer paper that was already binder drilled so we don’t wind up with repetitive motion injuries from the three-hole punch.

I don’t think any of us expected to be in this position a decade ago, where we would be using twice the paper we eliminated with EHR just to keep up with government mandates. Although we’ve streamlined care through interoperability and data sharing (at least in my surrounding community), we’ve created more bureaucracy than we’ve eliminated.

Still, it’s a new year and I remain hopeful. Hopeful that MU Stage 3 will not bring more onerous requirements and that our vendors will have some breathing room to return to coding features we actually want and need rather than what government entities think we want and need. I’m hopeful that patients will continue to take advantage of all the patient engagement opportunities and that those who are not yet doing so begin to manage their health and have preventive services performed as appropriate. I’m less hopeful that physician and staff burnout will decrease, but I’m trying to remain optimistic and instead just hope that it won’t increase.

What are your hopes for the New Year?  Email me.

Email Dr. Jayne.

Readers Write: Death to the Dinosaurs! DRGs and the Legacy of What it Means Under the Affordable Healthcare Act

Death to the Dinosaurs! DRGs and the Legacy of What it Means Under the Affordable Healthcare Act
By Matthew B. Smith

You could really also call this piece “History Repeats Itself.”

For those of you who recall the reimbursement transformation of the healthcare industry from a cost-plus formula (no institution in the field lost money under this approach) to the DRG Era (October 1983), life is about to repeat itself.

Payment caps were placed on 466 diagnostic and therapeutic procedures based upon the type and place where a procedure was performed. The Old Guard of Dinosaur Hospital Administrators couldn’t adapt and the nearly 6,000 U.S. hospitals at the time underwent a financial operation that affected their health.

Prior to the enactment of the federal regulations, less than 1 percent of all inpatient facilities (which funneled about 80 percent of all healthcare dollars) were in financial straits. Within seven years, well more than half were suffering asset declines and nearly 20 percent were facing cash flow dilemmas that threatened their very existence as going concerns. New York State had more than half its hospitals in financial difficulty.

A new breed of administrator — drawn from outside the industry, by and large, and with MBAs, not the soon-to-be outdated MHA — had to find their way into the industry (along with substantially larger salaries and performance structures) to reformulate how these institutions play the game.

Now the Affordable Healthcare Act (AHCA) portends yet another drastic (read: draconian) change to our beloved industry. The current crop of dinosaurs will need to be replaced yet again.

The AHCA will drive reimbursement towards direct links with patient outcomes and be a distinct report card on the deliverers of care. Penalties for not achieving population catchment healthcare levels (too many readmissions; too many specific conditions with below average status; higher costs per unit of service relative to the patient’s achievement level; mistakes in medication administration; higher than normal nosocomial infection rates) will cause the bottom 3 –5 percent of providers to lose payments and have it redirected to the top 3-5 percent. This is a “taking from Peter to pay Paul”* concept so that net/net healthcare payments are flat.

The ability to achieve this and measure it so that it can be implemented (along with the other AHCA factors that are mandated) will give rise to a new healthcare administrator extremely well versed in IT and data accumulation and farming the data. The accent on secured and incontrovertible healthcare information adhering to the concepts of confidentiality, integrity and authenticity (CIA) to make an institution’s case will demand new management with a decided proficiency in not only amassing, but organizing and clinically and financially proving that the provider organization has successfully delivered care.

Failure to be a top performer or even a middling-level participant will have excruciating financial impact as it did when DRGs came into effect. These new breed leaders will look at industry and non-industry solutions to accumulate and manage the massive amount of data that the HITECH Act is encouraging. The New Breed will master it as other industries have shown they can, but the healthcare field will, once again, be strewn with the fossils of dinosaurs among providers and vendors who didn’t listen to the changing reimbursement and care outcome winds that are blowing.

*For those of you not familiar with the origins of this phrase, it arose when the Church of England separated from the Roman Catholic Church and the English King (Henry) levied taxes on the Cathedral of St. Peter (Catholic) in London to pay for the construction of the Church of St. Paul (which Henry headed as the Church of England) also in London.

Matthew B. Smith is president and CEO of SecLingua of Shelton, CT.