Morning Headlines 11/7/14

Changes in Medical Errors after Implementation of a Handoff Program

A New England Journal of Medicine study finds that implementing a structured process for resident handoff procedures at nine hospitals led to a 23 percent medical error-rate decrease, and a 30 percent decrease in preventable adverse events.

Epic replies to comments made by Cerner CEO Neal Patterson at health conference

Typically media shy,  Epic’s media spokesman responds to charges from Cerner that her company shrugs off its interoperability responsibilities, claiming that, according to KLAS, it is an industry leader in this segment as well.

Allscripts Healthcare: Blue Harbour Group Won’t Go Lightly

Activist investor Blue Harbour Group has increased its stake in Allscripts from five to seven percent.

News 11/7/14

Top News

The 2015 work plan of HHS’s Office of Inspector General includes several EHR-related items beyond the usual Meaningful Use payment audits. OIG will audit the security of cloud-based service providers (including EHR vendors) and will review the downtime policies of hospitals. OIG’s future efforts “may consider the significant challenges that exist with respect to overseeing expenditures for health IT, the interoperability and effective sharing and use of health care data for medical care, and emergency preparedness and response.”

Reader Comments

From Zippy: “Re: Alameda Health System. The outgoing CEO removes the blame for its financial problems from Siemens Soarian.” The five-hospital system’s CFO told its board last month that its financial meltdown was caused by its $77 million Siemens/NextGen implementation, but the outgoing CEO says the system’s own managers — not Siemens — caused its problems. He specifically blamed two unnamed former health system executives.

From Sauerkraut: “Re: Siemens. The hearing aid business sold for more than twice the HIT business with lower revenues and the usual higher multiples of software businesses. Perhaps Ben Rooks can explain.” Singapore-based Siemens Audiology Solutions posted $860 million in 2014 revenue and just sold for $2.68 billion, or three times revenue. The healthcare IT business had about $1.2 billion in annual revenue and sold for $1.3 billion. I would guess the revenue multiples are based on profitability, market position, and future prospects rather than revenue. My impression is that Audiology is a turnkey business while Health Solutions is a slightly shabby fixer-upper with a reputation problem. There’s also the issue of having few qualified buyers, which would have kept the price down and given Cerner a clear shot at picking it up for a bargain basement price.

HIStalk Announcements and Requests

This week on HIStalk Connect: Microsoft and Jawbone unveil new fitness trackers, Microsoft in an attempt to capitalize on the digital health trend and Jawbone trying to differentiate itself in the emerging smartwatch market. Rock Health raises its next investment round and announces that it will fund accepted startups with a $250,000 seed round. Google revamps its Flu Trends platform to include CDC data in an effort to boost accuracy.

This week on HIStalk Practice: Healthcare buzzwords reach a "tipping point." DuPage Medical Group begins offering e-visits. The Eye Institute of Utah implements a new patient portal. Portland’s healthcare IT accelerator scene doubles. 5 O’clock Records rebrands. ONC launches a new innovation challenge. Thanks for reading.

I was clearing out space on my phone for an iOS upgrade, which forced me to decide which apps to delete since some are data hogs. My “can’t live without” survivors are below. What are yours?

• Yelp. Probably my most-used app.
• Motion-X GPS Drive. The best GPS I’ve used and the only paid app on my list, although it barely qualifies at 99 cents.
• Slydial. lets you call someone’s cell phone voicemail directly in case you just want to leave a message without talking to them.
• Airline apps. American is my most-used one.
• GateGuru. Helps me find decent airport food and check an airport’s flight board.
• OpenTable. I will sometimes make a restaurant reservation an hour before eating just to make sure there’s a table waiting, plus I trust the reviews and lists (I often also look at TripAdvisor).
• Uber. I use it occasionally, although I’ve been burned expensively a couple of times by the surge upcharge.
• Kindle. I don’t mind reading books on my phone’s small screen.
• Spotify. I subscribe to Premium so I can play music offline.
• Speedtest. I check Internet speed the moment I set foot in a hotel or house where I need to work, although usually I can’t do much more than swear and fret at Stone Age speeds (less than 3 Mbps down and 1 Mbps up).

Listening: new indie folk from Portland, OR-based The Decemberists, which sound a bit like R.E.M. Peter Buck has played on some tracks, although not on their pretty good cover of my favorite R.E.M. track, “Cuyahoga”.

Webinars

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

November 18 (Tuesday) 1:00 ET. Cerner Takeover of Siemens, Are You Ready? Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The Cerner acquisition of Siemens impacts 1,000 hospitals that could be forced into a “take it or leave it” situation based on lessons learned from similar takeovers. This webinar will review the possible fate of each Siemens HIS product, the impact of the acquisition on ongoing R&D, available market alternatives, and steps Siemens clients should take to prepare.

November 19 (Wednesday) 1:00 ET. Improving Trial Accrual by Engaging the Digital Healthcare Consumer: How to Increase Enrollment with Online Consents and Social Marketing. Sponsored by DocuSign. Presenters: B. J. Rimel, MD, gynecologic oncologist, Cedars-Sinai Medial Center; Jennifer Royer, product marketing, DocuSign. The Women’s Cancer Program increased trial accrual five-fold by implementing an online registry that links participants to research studies, digitizing and simplifying a cumbersome, paper-based process. This webinar will describe the use of e-consents and social marketing to engage a broader population and advance research while saving time and reducing costs.

Acquisitions, Funding, Business, and Stock

Aspen Advisors will be acquired by healthcare management consulting firm Chartis Group, with Aspen’s Managing Principal Dan Herman joining the board of Chartis.

Allscripts announces Q3 results: revenue up 4 percent, adjusted EPS $0.06 vs. $0.05, missing analyst expectations for both. Shares dropped sharply in after-hours trading following Thursday afternoon’s announcement, down around 15 percent to levels not seen since early 2013.

Meanwhile, activist hedge fund Blue Harbour Group increases its ownership in Allscripts to 7 percent of the outstanding company shares, up from 5 percent. Blue Harbour Group says it avoids public shareholder fights by investing only in companies that welcome its ideas for unlocking value, happy to make money from share price appreciation rather than selling off parts piecemeal. Its Allscripts ownership stake looks like around $170 million worth, right in line with its stated sweet spot of $100-$200 million. Allscripts shares have dropped 7 percent in the past year and 38 percent in the past five years.

Healthgrades acquires digital marketing form COCG to enhance its strategic marketing services for hospitals.

Siemens reorganizes its remaining healthcare lines into a separate business as it suggested it might do several months ago, which won’t do much to squelch the rumors that it wants to sell of the whole package and get out of healthcare completely. Siemens just announced that it will sell its hearing aid business for $2.7 billion. It previously sold the HIT business to Cerner and its microbiology line to Beckman Coulter. Like GE, Siemens is putting big money into energy-related product lines.

Francisco Partners invests an unspecified amount in medication benefits network provider CoverMyMeds.

Shares in Merge Healthcare hit a 52-week high Wednesday, having jumped 33 percent in the past two weeks. Above is the one-year MRGE share price (blue, up 23 percent) vs. the Nasdaq (red, up 18 percent).

The Department of Defense awards Fulcrum a five-year, $13.9 million contract to update the systems used by DoD’s year-old Richmond, VA EHR testing facility and to open a second health IT testing center in West Virginia. Both will support DoD’s DHMSM EHR replacement project.

Global Healthcare Exchange will acquire Atlanta-based procurement software vendor Vendormate.

Etransmedia wins a multi-million award in its deceptive trade practices lawsuit against Allscripts. An arbitration panel ruled that Allscripts convinced Etransmedia to buy MyWay EHR licenses in advance to improve its own financial performance, but then “deliberately sabotaged” MyWay sales by retiring the product in October 2012, leaving Etransmedia holding millions of dollars in unsold licenses. Etransmedia has since developed its own Connect2Care product.

Sales

Beaumont Health System (MI) chooses PHYND’s Provider Population Management Platform for 20,000 physicians.

Rhode Island awards 3M the analytics contract for its All-Payer Claims Database that will aggregate claims and provider data to publish consumer-facing quality and cost information.

The VA will add two service networks to its Philips eICU program, expanding its ICU remote monitoring service to 1,800 beds.

People

Prison health provider Corizon Health names Andy Flatt (HealthSpring) as CIO.

Fogo Data Centers hires William Esslinger, Jr. (Esslinger Tech Law) as CEO and board member.

Peter Dolphin (PatientKeeper) joins Advanced Practice Strategies as EVP of sales.

National Library of Medicine Director Don Lindberg, MD will retire in March 2015 after more than 30 years on the job. He was also the first president of AMIA.

Announcements and Implementations

Cerner CEO Neal Patterson says in a blog post that the company will provide CommonWell services to its clients at no charge (after a “nominal setup fee”) through January 1, 2018. He adds that CommonWell will make its interoperability services available at a low cost, passed through from participating vendors to their clients. He emphasizes that CommonWell will never sell data.

A new startup, MD Revolution, launches RevUp, which allows providers to collect Medicare’s new $40 per month chronic care management payment through team-based monitoring of a user’s fitness device data. The HealthKit-enabled RevUp supports provider-user messaging, personal health coaching, and an unspecified level of integration with EHRs. It appears that the company provides all of the coaching services. Founder Samir Damani, MD, PharmD is a Scripps cardiologist. Also on the executive team is CIO Jean Balgrosky (former Scripps SVP/CIO) and SVP of Business Development Parker Hinshaw (founder of maxIT). The company’s page also neatly summarizes the requirements to collect the monthly payment that starts in January 2015 — 20 minutes of non face-to-face care of Medicare patients with two or more chronic conditions. .

Blood Bank of Alaska implements Mediware’s blood center management and donor recruitment systems.

Government and Politics

An ONC survey finds that most consumers (75 percent) are concerned about the privacy of their medical records whether paper or electronic, but few (less than 10 percent) are worried enough to withhold information. Three-quarters of respondents want their providers to use EHRs and share their information with their other providers. Survey pluses:  it was a random-dial telephone survey that removes online-only and self-selected participant bias and it had a good number of responses, but the folks willing to take a cold-call survey may not be representative. Survey minus: it was conducted last year.

CMS postpones its eHealth Summit, scheduled for December 5, until further notice.

Innovation and Research

The Wall Street Journal highlights companies that are working on diagnostics that can detect Ebola quickly, including BioFire Defense (which I wrote about quite a bit last week), CorGenix Medical (a $15 non-instrument system that works like a home pregnancy test), Chemnio Diagnostics Systems (a $10 finger-stick test),  and OraSure Technologies (which is considering development of a mouth swab-based test like the one it offers for HIV).

A nine-hospital study finds that use of a structured patient handoff procedure among medical residents was associated with a 23 percent reduction in medical errors and a 30 percent drop in preventable adverse events. Residents used a mnemonic-driven checklist for both oral and written handoffs.

Technology

Microsoft announces free versions of Office for the iPhone and updated versions for the iPad, with Office for Android coming soon.

Qualcomm Life Director of Business Development Kabir Kasargod urges wearables developers to move from activity trackers to the real healthcare industry:

Go from the children’s table to the grown-up table. If you’re serious about this, embrace the FDA. Learn how HIPAA works. Make sure it’s connected to the [electronic medical record] and that all the health laws are observed. There’s a tremendous dearth of innovation here. I would move away from fitness and go hardcore into health. That’s where the money is.

Other

A Pennsylvania business paper profiles Pittsburgh-based Health Monitoring Systems, whose service monitors hospital EHR information to provide real-time outbreak information to public health departments.

PayPal co-founder and early Facebook investor Peter Thiel says he is skeptical about healthcare IT, big data, and cloud computing.

Epic responds to Cerner CEO Neal Patterson’s calling the company “immoral” for being an interoperability “black hole” among EHR vendors at Cerner’s user group meeting. Epic’s statement:

Epic is No. 1 for interoperability performance as ranked by actual users surveyed by the highly respected firm KLAS. Epic can interoperate with any other electronic health record that meets government standards, regardless of vendor. We support open standards rather than private platforms such as CommonWell that further privatize and monetize exchange of health information.

A Health Affairs blog post by MedStar Health’s influential informatics expert Peter Basch, MD says the Meaningful Use program is impeding interoperability by its rigid, metric-driven approach that fails to meet the needs of providers and patients. He adds that EHRs don’t work well for advanced primary care models that emphasize chronic disease management and care coordination and observes that today’s version of interoperability makes matters worse by more widely spreading clutter-filled summary of care and visit summary documents.

S&P downgrades the bonds of Wake Forest Baptist Medical Center (NC) because of large receivables write-offs and the high ongoing expense of its Epic system.

PeaceHealth (WA) ends affiliation talks with Ocean Beach Hospital (WA), with PeaceHealth’s CEO saying his organization is too busy and too far over budget on its Epic implementation to take on a new hospital.

The tweets of Scripps cardiologist Eric Topol, MD have the highest signal-to-noise ratio of just about anybody even though he gets a bit app-happy at times, so I enjoyed this interview, in which he made some interesting points. He’ll be delivering a keynote presentation at the Digital Health Conference 2014 November 17-18 in New York City.

• Patients will help diagnose and monitor themselves using algorithms, leaving doctors to focus on treatments.
• Continuous monitoring will allow patients to stay at home, reducing hospital usage.
• Virtual visits can help with the difficulty involved in getting a PCP appointment, which he says requires a six-week lead time in Boston.
• A major shift to virtual visits will reduce trips to the doctor’s office.
• Patients will bear much of the responsibility and cost of their health.

Weird News Andy expects this story to fill a void. A bus driver in Egypt attempts to dodge a mandatory urine drug screen by submitting a sample from his wife and is surprised to hear from officials, “Congratulations, you’re pregnant.”

Sponsor Updates

• RazorInsights publishes a company video, a brilliantly done history that includes founder interviews.
• Surgical Information Systems names Indiana Orthopaedic Hospital (IN) as a Center of Excellence.
• HCI group posts “Meaningful Use to Meaningful Care” by William Bria, MD and Robert Steele, RN.

EPtalk by Dr. Jayne

The November 30 deadline for eligible hospitals to report for the 2014 Medicare EHR Incentive Program is fast approaching. I haven’t been on the attestation site lately, but I am told that the 2014 Flexibility Rule options are available. If that doesn’t work, you can still apply for a hardship exception, but if you’re just now figuring out that you need one, I feel for you.

Speaking of Meaningful Use, several providers at my hospital forwarded links to articles about the dismal attestation statistics, demanding that we consider “stopping this nonsense” and “get back to practicing real medicine.” They’re not alone, although most national groups are focusing on shortening the reporting period for 2015 and adding additional flexibility. CHIME, the AMA, MGMA, and of course HIMSS are among the loudest voices.

With the Flexibility Rule slowing some organizations’ upgrade schedules, CMS also made some updates to the final 2015 Medicare fee schedule. Primary care practices can report Chronic Care Management codes on whatever certified EHR they were on as of December 31 of the previous calendar year, rather than being required to use 2014 CEHRT. Additionally those services can be billed using a CPT code instead of a G code. I’m not sure why that’s an advantage, but provider groups seem happy about it.

If you have nothing else to do this weekend, it’s 1,185 pages of glory and includes summaries of comments received while it was under consideration. Comments are being accepted through December 30 and it goes into effect January 1, so read up. Any document that includes five and a half pages of acronym explanations is bound to be a hit.

I’ve been recovering this week from a Continuing Medical Education conference. I’m not a huge fan of Las Vegas, but it seems like a lot of conferences are held there. After learning about dermatological diseases in a drab hotel ballroom for two days, a conversation in the row ahead jogged my memory that the NextGen One user group meeting was starting at the tail end of my trip. A quick call to Bianca Biller confirmed that she was also in town, which improved my spirits. In addition to being one of the smartest revenue cycle experts I know, she is also the most fun.

She warned me that tight security was keeping non-registered people out of the conference center, but was able to score me a pass to the Navicure client event on Monday at the Hard Rock Live. I was feeling a little giddy when I got carded at the door until I realized they were carding everyone. We arrived fairly early, but the party was already in full swing. The Atlanta-based band was fantastic and it was fun to watch medical practice folks kick back to Journey and James Brown covers. Since MGMA had wrapped up a few days earlier, she said there were a lot of vendors staying over, so we headed out to hit a couple more get-togethers. We ended up with the obligatory wild and crazy taxi ride, during which Bianca received a marriage proposal from the cabbie.

We dialed it down a notch and stopped by the Intelligent Medical Objects suite at Mandalay Bay for a glass of wine and some much-needed time off our feet. There we ran into one of Bianca’s nurse informaticists, who lured us to the casino with the promise of riches to come. I was content to watch others gamble and to do some people watching – the number of folks still in Halloween costumes several days after the fact was pretty entertaining. Although I missed MGMA this year, I felt like I at least got my party fix and that will hold me until HIMSS.

My new nurse friend was the big winner of the night, where I was lucky to walk away with the same $20 I started with. The Cerner conference was also this week, but I haven’t heard anything about it.

Do you have conference pictures or a crazy taxi story? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 11/6/14

More Problems Expected on Federal Health-Insurance Site in New Year

The Wall Street Journal reports that known bugs and unfinished development efforts on Healthcare.gov will likely cause a fresh set of problems for consumers this enrollment period, including erroneous renewals of cancelled policies and duplicate enrollments for those that try to switch insurers.

AHIMA/eHealth Initiative 2014 ICD-10 Readiness Survey Results

A recent survey conducted by AHIMA finds that 63 percent of health systems will be ready for end-to-end ICD-10 testing by the end of 2014, while 10 percent report that they plan to forgo testing altogether.

Office of Inspector General: Work Plan 2015

HHS’s OIG will increase its focus on EHRs in 2015, according to its recently published work plan. Audits will focus on validating downtime contingency plans, securing medical devices that interface with EHR systems, and verifying entitlement to Meaningful Use incentive payments.

Readers Write: A Practical Response for Ebola Relief

A Practical Response for Ebola Relief
By Paul Molingowski

The noise surrounding the current Ebola outbreak is tremendous, with a Google search producing 385 million results. Hospitals, clinicians, NGOs, and governments around the world are scrambling to develop effective responses and put preventive measures in places.

Despite all of the attention – or perhaps because of it — there have only been four confirmed Ebola cases in the United States. Compare that to Sierra Leone, which has 3,778 confirmed cases (5,338 suspected) in a population of only 6 million people.

My point in writing this article is to help shed light on an overlooked problem that is a terrible side effect of Ebola: starvation.

I was blessed to be able to travel to Sierra Leone early this year. It is a wonderful country. We know many men, women, and children who have been impacted by Ebola. Our group’s scheduled departure was just as the first Ebola cases were being diagnosed. Our friends in Sierra Leone with literal boots on the ground have done a tremendous job with limited resources to provide education, medical supplies, basic healthcare, and village support.

There is still a huge need for food for the suspected Ebola victims and their families who are quarantined. Normally in Sierra Leone, hospital food is supplied by the families of patients. Since the patients are isolated and often treated with fear, this sometimes means they are not fed.

When families are quarantined in their homes for 21 days, they are surrounded by armed guards and left with little food or water. Some escape to avoid starvation, spreading the disease to other villages. Also, the already fragile economy of Sierra Leone has been hurt by the epidemic, causing food prices to rise dramatically. Simply put, providing food to starving victims will help stop the spread of Ebola.

Other big needs are for medical supplies and effective transportation. Hospitals and treatment centers do not always have the resources to provide gowns and do laundry, so patients who are sick are often left dirty and naked to fend for themselves.

I can personally attest to the poor condition of the roads in Sierra Leone. Most are dirt, which means they are severely rutted and can become almost impassable in the rainy season, making it very difficult to deliver aid. Motorcycles are a great way to get around and we are providing more.

The practical response is to donate to Ebola relief efforts.

Paul Molingowski is sales director of Skylight Healthcare Systems of San Diego, CA. He is on the board of EduNations, which builds and operates schools and digs wells in Sierra Leone.  One hundred percent of donations go directly to food, medical supplies, and motorcycles.

Morning Headlines 11/5/14

HIT Policy Committee

At Tuesday’s HIT Policy Committee meeting, ONC released updated Stage 2 MU attestation numbers. 93 hospitals and 2,282 providers have attested for Stage 2, compared to the 4,000 hospitals and 266,067 providers that attested for Stage 1.

CPSI Announces Third Quarter 2014 Results

CPSI reports Q3 earnings: revenue was up 14 percent to $53 million, while net income jumped 29 percent, EPS $0.83 v $0.66.

Novant Health to cut pay for medical secretaries

Novant Health will demote and reduce the wages of 150 medical secretaries after its EHR implementation eliminates one of their core job functions, order entry.

Cerner will break ground Nov. 12 for $4.45B Three Trails Campus

Cerner will break ground on its $4.45 billion Three Trails Campus construction next week. The project will add 3.7 million square feet of offices and eventually house 16,000 employees.

News 11/5/14

Top News

The HIT Policy Committee reports that 93 hospitals have been paid Meaningful Use Stage 2 payments through September vs. nearly 4,000 that earned Stage 1 money. EPs had 2,282 MUS2 attesters vs. 266,067 who earned Stage money. None of that matters much since attestation runs all the way through 2015 and there’s not a lot of reason for providers to jump on early, but critics will miss that point in calling MUS2 a failure early in the game. The total of the Meaningful Use money handed out so far exceeds $25 billion.

Reader Comments

From Popinjay: “Re: Remedy Informatics. Has apparently shut down, according to customer QOPI.” Oncology quality assessment organization QOPI cancels its fall reporting round, saying it has no choice after technology provider Remedy Informatics “unexpectedly ceased all business operations on October 21.” The Salt Lake City-based company, which provide registry and research informatics products, hasn’t responded to my inquiry. I interviewed CEO Gary Kennedy several years ago and was impressed with the technology, but the company’s business model changed a couple of times since then.

From Remy C: “Re: [company name omitted]. The company, one of the larger former-Epic consulting firms, is losing faith from its partners after ‘spreading itself too thin.’ Two of its staffing partners are withdrawing from offering subcontracts after the company’s problematic attempt at adding go-live support.” I’ve removed the company names since the rumor is so vague that there’s no easy way to confirm it, but I’m more interested in the overall trajectory of Epic consulting firms anyway. Epic go-live support would seem to be a good business line as long as there’s enough of them to keep people working.

From Walkin’ Dude: “Re: Neal Patterson’s keynote speech at Cerner Health Conference Tuesday. He skewered Epic (without naming them) by saying that it’s immoral that they use their closed system for competitive advantage. He sais CommonWell will cover 50 percent (of patients? data? visits?) and that he’s reasonable sure Meditech will join and add another 25 percent of market share. He said that Epic, with 30 percent of the market share, is a data sharing black hole.” That’s Neal above on the right, sharing the CHC podium with John Glaser from Siemens Health Solutions, which will become part of Cerner early next year. Neal said GPS devices are an example of what can happen when proprietary standards are opened up.

HIStalk Announcements and Requests

Listening: reader-recommended indy folkers The Accidentals, two newly-graduated female high school students from Traverse City, MI who have written 45 songs, played 500 shows, scored two movies, and play 13 instruments between them. 

Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

November 18 (Tuesday) 1:00 ET. Cerner Takeover of Siemens, Are You Ready? Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The Cerner acquisition of Siemens impacts 1,000 hospitals that could be forced into a “take it or leave it” situation based on lessons learned from similar takeovers. This webinar will review the possible fate of each Siemens HIS product, the impact of the acquisition on ongoing R&D, available market alternatives, and steps Siemens clients should take to prepare.

November 19 (Wednesday) 1:00 ET. Improving Trial Accrual by Engaging the Digital Healthcare Consumer: How to Increase Enrollment with Online Consents and Social Marketing. Sponsored by DocuSign. Presenters: B. J. Rimel, MD, gynecologic oncologist, Cedars-Sinai Medial Center; Jennifer Royer, product marketing, DocuSign. The Women’s Cancer Program increased trial accrual five-fold by implementing an online registry that links participants to research studies, digitizing and simplifying a cumbersome, paper-based process. This webinar will describe the use of e-consents and social marketing to engage a broader population and advance research while saving time and reducing costs.

Acquisitions, Funding, Business, and Stock

Drug information provider PDR Network merges with LDM Group, which improves medication adherence by connecting patients, prescribers, and pharmacists via personalize messaging. PDR says its network will now include 250,000 prescribers and 16,000 retail pharmacies. Former LDM Group President and CEO Mark Heinold is named CEO of PDR, while former PDR President and CEO Richard Altus will join majority shareholder Lee Equity as operating advisor.

Aetna will acquire Chicago-based retail health insurance platform vendor Bswift for $400 million to extend Aetna’s proprietary insurance exchange strategy.

CPSI announces Q3 results: revenue up 14 percent, EPS $0.83 vs. $0.66, beating revenue estimates but missing on earnings. Above is the one-year share price chart of CPSI (blue, up 3.8 percent) vs. the Nasdaq (red, up 17.8 percent). President and CEO Boyd Douglas (above) said in the earnings call that 38 of the 200 hospitals that have attested for Meaningful Use Stage 2 are CPSI users, placing it behind only Epic. CFO David Dye, responding to an analyst’s question about CPSI’s KLAS scores, said, “Our KLAS scores have been hit or miss now for 25 years. We don’t have particularly good relationship there. But I’ll put our performance up against anybody else who’s been ahead of us over that time frame” and says the company’s churn rate is at an all-time low. Dye said in answering a question about CPSI’s CommonWell participation that it’s not opening up sales opportunities, but adds, “It’s probably a bit cheesy to say that we all did this out of the goodness of our hearts, but I think it’s closer to that. I think it’s going to help us with new business. I will say that we’ve got some competitors in our space that haven’t joined yet, and that we certainly aren’t afraid to mention that when we’re talking to the potential hospital clients. But to say that we expected and/or now expect that to benefit us competitively, I think would be a stretch … we didn’t think the government was ever going to do it.” 

Imprivata announces Q3 results: revenue up 41 percent, adjusted EPS –$0.16 vs. –$0.34, beating earnings expectations and meeting on earnings.

Physical therapy EHR vendor WebPT acquires WebOutcomes, which offers an online outcomes tracking tool for PT/OT.

Release of information vendor Healthport, which entered into an agreement last week to be acquired by a New Mountain Capital investment found, announces its merger with competitor Supna Healthcare Solutions.

Truven Health Analytics acquires JWA Consulting, which offers Lean consulting that Truven will pair with its data analytics and consulting capabilities.

CVS Health reports Q3 results: revenue up 9.7 percent, adjusted EPS $1.15 vs. $1.06, beating expectations for both in a quarter in which it changed its name from CVS Caremark halted tobacco sales.

In Canada, Clearwater Clinical raises $2 million in funding. The company, founded by an ENT surgeon, offers Clearscope (smartphone video recording for endoscopy) and Shoebox (an iPad-powered hearing tester). Mayo, Hopkins, Mass General, and CHOP are among its listed clients.

Sales

St. Mary’s Hospital (CT) chooses Imprivata Cortext for clinical communications.

Campbell County Health (WY) chooses Cornerstone Advisors to lead its Meditech Pathway Implementation project.

People

Don Reed, VP/CIO of Crozer-Keystone Health System (PA), receives a lifetime achievement award from the Philadelphia business newspaper.

UPMC’s Children’s Hospital of Pittsburgh names Srinivasan Suresh, MD, MBA (Children’s Hospital of Michigan) as CMIO.

Jim Gibson (Jimenez Consulting Solutions) joins Hayes Management Consulting as VP of strategic services. 

GetWellNetwork CIO David Muntz is awarded CHIME’s Board of Trustees Legacy Award.

Announcements and Implementations

Cerner will integrate data from the smart glucose monitor of Livongo Health, launched by former former Allscripts CEO Glen Tullman in September 2014.

EHR vendor Amazing Charts announces GA of its new practice management system.

NextGen announces at its UGM a mobile version of its patient portal, native iPad EHR support, a population health management solution, a HISP Direct Secure Messaging connectivity offering, and a cloud-based version of its EHR/PM systems that will be released in 2015.

Government and Politics

CHIME uses CMS’s new (and very early, like election returns an hour after the polls close) Meaningful Use Stage 2 numbers (17 percent of hospitals, 2 percent of EPs) to again urge the agency to reduce the 2015 reporting period from 365 days to 90 days. Parent organization HIMSS jumps with a melodramatic stretch in suggesting that raising the bar on taxpayer EHR handouts “hinders our nation’s ability to improve the quality, safety, cost-effectiveness, and access to care.”

An ONC-commissioned report finds that providers participating in accountable care models are hindered by lack of EHR interoperability, with more work also required on analytics and clinical decision support systems.

HHS names Anjum Khursid, MBBS, MPAff, PhD (Louisiana Public Health Institute) as the public health representative to the HIT Policy Committee.

Innovation and Research 

Microsoft opens the preview release of Skype Translator, which performs real-time speech translation between users. Translation is a big and expensive problem for hospitals, so it could be interesting.

Microsoft again – the company opens up unlimited OneDrive storage for Office 365 customers (Home, Personal, and University users – coming soon for Business).

Cerner will break ground on its $4.45 billion Three Trails campus in south Kansas City on November 12.

Technology

Nudge launches Nudge Coach, which combines information from a person’s wearable devices into a single “Nudge Factor” number that doctors can quickly review. The company was formed by two 2010 Wofford College graduates who played semi-pro soccer together. 

Butterfly Network raises $100 million to create an iPhone-sized ultrasound scanner that it says will be as cheap as a stethoscope.

A three-subject study finds that Google Glass creates blind spots in the eyes of users.

Other

University of Colorado Health CMIO CT Lin, MD performs a non-model version of “House of the Rising Sun” for hospitals going live on Epic, recorded at UGM. He didn’t mention his ukulele when I interviewed him in April.

In Australia, the opposing political party says the April 2016 opening of New Royal Adelaide Hospital at risk unless the government fixes its Allscripts Sunrise patient management system, rollout of which was put on hold in July following billing and medication errors, physician complaints, and lack of funds due to higher than expected legacy system maintenance costs. South Australia Health hinted originally that it might sue Allscripts because of rollout delays, but now says it expects to resolve its issues with the company privately

The Wall Street Journal covers EHR vendors that are adding Ebola-specific functionality. It profiles Mass General, which is using a new application from its own EHR-searching spinoff QPID Health that matches patient symptoms and travel history to alert users of potential infection.

In Canada, William Osler Health System holds its second competition for students to develop Android patient experience apps next week, offering a $10,000 first prize. Last year’s winner created HosNav, which gives diagnostic testing patients parking directions, way-finding, and test preparation instructions.

A Boston news service highlights big Massachusetts campaign donors, with InterSystems billionaire founder Terry Ragon topping the list with $3.3 million in contributions to Democratic super PACS and candidates.

Novant Health (NC) will demote 150 medical secretaries to medical unit receptionists and cut their pay up to 10 percent following its EHR implementation that eliminated the position’s most complex task — order entry. The local paper notes that the timing could have been better given that executive retirement plan changes caused recent eye-opening lump sum payouts, such as the $8.2 million paid to CEO Carl Amato in 2013, of which $6.1 million was pension related.

A poorly written article in The Michigan Daily covers the student health service implementation by University of Michigan Health Systems of what it calls a “filing system” and then “MiChart,” not only misspelling MyChart but confusing the Epic patient portal with the provider-facing inpatient and ambulatory modules. The article says 50 percent of patients are using MyChart, but only 5 percent are using it to schedule appointments.

Odd: a six-foot, iPhone-shaped monument honoring Steve Jobs at a St. Petersburg, Russia university is taken down, with an executive explaining that the announcement by Apple CEO Tim Cook that he is gay violates Russian law as “a public call to sodomy.”

Sponsor Updates

• Strata Decision Technology is named a winner of the Chicago Innovation Awards.
• ZirMed will host its user group meeting November 10-12 in Louisville, KY.
• EClinicalWorks, Greenway Health, PerfectServe, RazorInsights, Sandlot Solutions, and Shareable Ink are named to CIO Review’s “20 Most Promising Healthcare Tech Solutions Providers 2014.” The publication’s “20 Most Promising Healthcare Consulting Providers” includes DataMotion, Leidos Health, and TrainingWheel. 
• ESD wins a CHIME CIO Fall Forum award for best video.
• KLAS ranks Premier’s ACO advisory services as #1 in best overall performance.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/4/14

Bids are in for $11B DOD health records system

The deadline to submit a bid on the DoD’s EHR search passed Friday, with submissions from teams proposing Epic, Cerner, Allscripts, and VistA making up the competition.

Oregon’s transition to federal exchange on track

After scrapping its health insurance exchange website after a failed launch in 2013, Oregon reports that it is on track to merge with Healthcare.gov by the November 15 enrollment period.

Onward and upward: Big news at Rock Health

Health IT startup accelerator Rock Health announces that it has raised a new $250 million investment fund and that it will begin offering $250,000 in seed capital to startups accepted to its program, up from $100,000.

CDC National Health Report

The CDC releases its National Health Report which shows a one year jump in life expectancy over the past ten years, topping off at 78.7 years. The increase is attributed to lower heart disease and cancer-related deaths.

Curbside Consult with Dr. Jayne 11/3/14

I’ve taken a few clinical informaticists under my wing over the last couple of years. I shouldn’t be surprised, but I am still baffled that organizations expect someone to take a lead role with clinical software but don’t give them any training or support. I’m not talking about software training (although that may be a factor) but rather assistance with the skill set needed to manage the things that are about to come their way.

Clinical informaticists come in all shapes and sizes and with all kinds of titles and varying levels of experience. That’s the first thing I tell them – to forget about what their title might be and figure out what their duties actually are. The second thing to do is to figure out whether they have the skills to tackle their given areas of responsibility and to put together a plan to prepare for them.

Organizations tend to be penny-wise and pound foolish in this regard. They expect physicians to learn many of these things on the job, but sometimes forget to tell teams they’re responsible for helping to build that provider. That can create fiction among the teams and is often a challenge when providers are not comfortable with exposing a lack of knowledge and need for assistance.

In my first CMIO-type job, I was responsible for managing clinical content for a good-sized outpatient medical group. There was a team of young-ish (well, at least younger than me after umpteen years of training and medical practice) analysts that held the keys to the system as far as modifications were concerned. I was overwhelmed in my role (trying to do the job in four hours a week) and trusted that they were being straight with me.

They weren’t too keen on trying to help me learn the back side of the EHR. The IT team didn’t budget any time for me to go to training other than what I had as an end user. I decided to dig in with the system’s user manual and, believe it or not, read it cover to cover.

That experience was a serious eye-opener. First, I learned that the system had many more capabilities than I knew of. Second, I learned that my team had been snowing me as far as how challenging various configurations and customizations really would be if we wanted to perform them.

The trick was figuring out how to leverage my new knowledge without letting the team know I had discovered the mismatch between their work capacity and the product delivered. In hindsight, the portable putting green and disc golf equipment in their part of the office should have been a clue.

Although I tell them to try to forget about the title, it can be important especially if the title indicates the level of respect or support a clinical informaticist will have in the broader organization. My first stab at this was as a medical director. The CMIO title wasn’t even an option, as there had never been one and the CIO stated he didn’t feel it was necessary to have a CMIO. In itself, that gave me significant insight as to what I was signing up for. However, the only other titled physician leader was also a medical director and that was reassuring.

Regardless of the title, the ambulatory arm of the organization positioned me well and publicly explained my role and responsibilities as far as approving clinical content and working with providers to optimize the EHR implementation and ongoing use. This was important when physicians pushed back in areas that were clearly in my realm because I knew I could count on leadership to back me.

Unfortunately, some of my new colleagues are facing less than optimal situations. One is already chief of service in his procedural subspecialty at the hospital (with all the committee meetings and responsibilities that go with that) and yet is charged with leading a rollout for a largely ambulatory medical group. Although he’s very interested in clinical informatics and has done some coursework, the deck is already somewhat stacked against him.

The odds are also not in his favor regarding how the leadership positions him. Although they’re publicly telling physicians he is going to “run” the application team and “lead” implementations, the staff actually reports in a different vertical whose top leader is openly hostile to the idea of physician leadership. He’s gone on record as saying that CMIOs are “useless” and it does not appear anything has been done to modify the behavior or to ensure public support of the new physician leader.

I’ve seen that before firsthand, when IT and operational teams had difficulty working together. In one organization where I worked, the project’s executive sponsor forced the IT director and the operations director to have regular breakfast meetings with a report out of the issues they were working on to build their relationship and ability to collaborate. No one likes being “forced” to play nice, but sometimes that type of structured intervention is helpful (and often necessary).

In addition to title and responsibilities, the other thing newly minted clinical informaticists need to address up front is compensation. There are still organizations out there that think the job can be done under the “other duties as assigned” clause of the job description. Unless a clinician is only expected to manage a narrow window of content or functionality, it’s just not realistic.

I’m a full-time CMIO (my clinical practice is all on the side, outside of my primary employer’s control) and trying to manage user needs, application limitations, regulatory requirements, accountable and value-based care, and everything else requires coordination with multiple teams and resources. Compensation needs to be appropriate for the level of work being done as well as the responsibility involved and the overall impact to the organization.

Compensation should also include a budget for continuing education in informatics as well as the calendar protection needed to attend sessions and spend time gathering new skills. In my first medical director position, I actually lost my continuing education budget because our bylaws decreed that only full-time clinical physicians received CME funding. It took me 18 months to get training courses approved through our IT staff development budget, which specifically excluded CME courses. Talk about a Catch-22.

Being a CMIO, medical director, director of medical informatics, or clinical champion — or in my case, Jayne of All Trades — can be a rewarding experience. It’s even more so when organizations are committed to setting us up for success, although that’s not always the case.

Have a CMIO horror story? Email me.

Email Dr. Jayne.

HIStalk Interviews Sam Rangaswamy, CEO, ZeOmega

Sam Rangaswamy, MS is founder and CEO of ZeOmega of Plano, TX.

Tell me about yourself and the company.

I started ZeOmega in 2001. I came from a technical background in the airline industry and realized that the healthcare industry is really far behind in terms of adoption of IT tools.

We started the company to service the needs of payers who wanted to do disease management and care coordination. Fourteen years later, we have 24 or so million American lives on our platform. We are making a difference in the way healthcare is being managed in the country today.

How far along is the industry in the journey toward population health management and the technologies that are required to support it?

It’s an interesting perspective from where we started. What we realized was that getting provider engagement was always a challenge. Providers were never really required to do population health management or focus on value.

We quickly realized what was happening was that the kind of interventions or the care that the provider should  own was pretty much outsourced to the plans, in a sense, since there were no billing codes. There were no real mandates for providers to do this. They were more focused on volume. The payers had to take on this burden, obviously, because of the full risk that they take.

We quickly realized that ultimately providers will need the same kind of capabilities. Today we are starting out with maybe a Medicare shared service program. A lot of tools out there are focusing on the population segmentation and focusing on getting them up to par with measures that are published by CMS.

But really, that’s just the tip of the iceberg. Over the last 14 years, the kind of problems we’ve solved with entities taking full risk … there will be a day of reckoning for a lot of the provider systems that that’s where they ultimately need to be.

The tools that are out there right now are just focused on population segmentation and providing gaps in care alerts. They’re just the tip of the iceberg. Ultimately, we have to get to a point where these providers can take on full risk, maybe service employers directly. That’s where we would like to see the industry mature.

Insurance companies have had those capabilities for years and now they’re turning the responsibility over to folks who don’t have them. What are the biggest pitfalls for those providers who are just starting to understand the new expectations?

What you saw at HIMSS the last couple of years is a focus on technology and analytics and very nice dashboards for providers and decision-makers to look at. But ultimately it needs to go to the next level, where there’s provider engagement, where providers are really looking at this and have a way to act upon that information without having to build entire care teams that are a very expensive resource.

Also, to a point that when they go on to take on full risk and maybe service local employers, the ability to slice and dice administrative information, not just clinical information, so that you can target people for the right set of programs. That’s where ultimately they will realize the gaps in the current tools that are available in the industry. A lot of the players that have been doing this in the disease management arena or care coordination arena for a long period of time understand these challenges and have those kinds of solutions.

Are patients, especially the most expensive ones, interested in being engaged?

You’re talking of consumer engagement. In our experience, it is probably the 1 percent of the population that are really, really obsessed with their health or taking care of themselves that will engage with all the fancy tools that are out there. The 20 percent that are the sickest that really need access to the physician, that would love to have their personal phone number because access is a big issue for them and they have complex issues, ultimately it is focusing on those individuals in terms of patient engagement that will yield the results.

Amazon uses its databases to communicate with its customers on a massive scale, yet it makes the relationship feel personal. Can that be done in healthcare?

Yes, absolutely, to the extent that you have that patient-centric view. We like to call them members because everybody starts off as a member in a community or in any system until they become a patient. To the extent that you have information about them, you can make it a very personal experience, especially with the advent of sophisticated tools on the mobile devices. You can target interventions and get engagement at that level. It’s definitely the ones that have complex conditions will be more than willing to engage.

Is patient engagement a technology problem or is it just hard for providers who never had to make an effort to keep in touch with patients to change the way they think?

Technology is an enabler, as in any human situation. Ultimately you need a whole set of staff that are trained to address this problem on the provider side. Just simple issues around health literacy or care coordination. I’ve talked to executives of hospital systems who basically think that most of the nurses should be retrained as case managers because that’s the level of intervention you need with some of these members.

As long as a human element is involved, the technology only enables and helps. Clearly the automation for the 80 percent of the population is where the technology will help. The 20 percent need that human touch in order to make that patient feel secure and trusted and participate in the process.

Going back to your early history in the market, not many companies have had both providers and insurance companies as customers. Is it hard to reach and target both sets of audiences to talk about your product?

It’s a traditional sales challenge because there are different markets and how you position the product to address their specific pain points. It’s a different set of vocabulary, if you will, at least at the current time because providers really don’t know what they need.

It is a challenge in telling the story and helping them understand where they will need to be in the future. They’re starting off ground zero with whatever platforms they can purchase today to meet their MU requirements, for example. But eventually they will need to scale up and they will need those kinds of platform capabilities. Obviously it’s the messaging and helping them understand what they don’t know is always a challenge in the new market and that’s what we are also seeing.

Do you think Meaningful Use is driving bad decisions or encouraging providers to make decisions too quickly just to check the box?

Yes, absolutely. Whenever there’s a mandate and when the requirements are a checklist item and how you meet them is up to you, you can cobble together a set of platforms that are really not integrated, becoming more inefficient than what you were without them. Certainly I think there is that aspect as well.

How do you distinguish he company from competitors and get your message out among all the noise in the market?

We have to continue to tell the story like we have. Obviously there’s a education piece. We have to get the ear of the decision-makers and paint the picture of what they will need in the future.

While they may start off with just a little widget on our platform, eventually the benefits of scaling up and going from purely analytics to complete analytics-enabled workflow, where we reach out across the care continuum, especially when you have bundled payments and all the complexities associated with full risk. That’s the message that we are putting out there and we continue to do that.

I think we are probably an year or two away from serious providers who want to take on risk and really understand that. In a year or two, I think the market will finally come around for enterprise platforms like us.

Cerner just said in their earnings call that the population health management systems market will be bigger than the electronic health records market. How do you see that market evolving and what factors will determine which vendors emerge as the leaders?

From my standpoint, it all goes back to the reform that the Federal government is mandating. It goes back to payment reform and the focus on value, which means now the providers will have to get really efficient in their care management processes, redesigning workflows.

In terms of the EMR vendors, they were glorified data collection tools and a lot of static information for humans to process. But when we are talking about large populations to the extent of a million or two million, the kind of sophistication you need to slice and dice the population and target them to the interventions that are specific to the population, that’s where ultimately the providers will have to head. 

Ultimately the EMR vendors, as much as they’re installed in a group practice or in a single delivery system, will quickly realize that healthcare information is fragmented. It’s all over the place. It’s not just about data integration, but then delivering that actionable intelligence back to the stakeholders that may not necessarily be on one EMR platform.

That’s where technologies that can take that actionable information and communicate with multiple systems in the healthcare delivery system and bring all of these payers, especially in the bundled payments scenario, being able to do effective care transitions between all the players involved in that bundled payment … that’s where eventually everybody will have to end up. It’s rules-driven workflows. It’s not just clinical data, but administrative information, information around multiple domains of health, which will ultimately drive how these processes are enabled.

Unless you can handle information across multiple domains and use that in a meaningful fashion, just collecting data and presenting a report is not going to help. I think that’s where you’ll see the industry mature to eventually.

Do you if you have any final thoughts?

Ultimately while the dashboard vendors and the analytics vendors today are getting their foot in the door, it will be interesting to see how much more the federal legislation or the laws that are unplanned or planned will impact how providers take to this. We are focused on major players, dominant players in our market like maybe a hospital system or a payer system, who have the leverage to make change in a certain region or a geography. That’s where we are focused on right now because they are the ones who have the real challenge.

We see that as the foundation. Lessons learned from these players will eventually impact how the legislation and how the laws are designed to truly affect change across the healthcare system in the country.

Morning Headlines 11/3/14

Revisions to Payment Policies under the Physician Fee Schedule

CMS updates its 2015 Medicare Physician Fee Schedule, adding a requirement that providers use certified EHRs to support Chronic Care Management, a newly created reimbursable service.

Which electronic health record is better: A or B? Realities of comparing the effectiveness of electronic health records

A Future Medicine article discusses the feasibility of comparing EHR systems through comparative effectiveness research, concluding that there are too many variables that would need to be controlled for in the healthcare setting to be able to make an accurate comparison. The authors suggest that the best route would be comparing specific EHR features, rather than entire EHR platforms.

Epic Systems Corporation v. Tata Consultancy Services

Epic files a lawsuit against India-based Tata Consultancy Services alleging that a Tata employee logged into the Epic’s UserWeb and stole documents containing sensitive intellectual property. Epic says the company intends to use the information to improve its own medication management application.

Castlight Health Announces Third Quarter 2014 Results

Castlight Health reports Q3 earnings: revenue jumped 238 percent to $12.2 million, but despite the increase the company recorded a net loss of $20.3 million for the quarter, EPS -$0.23 vs -$1.58.

Monday Morning Update 11/3/14

Top News

CMS adds a scope of service element to the final version of the Medicare Physician Fee Schedule for Calendar Year 2015 that would require providers who bill for Chronic Care Management services (a new reimbursement item) to use certified EHRs and patient-centered electronic care plans for demographics, problem list, meds, allergies, and a structured clinical summary record, using that technology to manage care transitions. The schedule also provides payment for several types of telehealth visits, including annual wellness and psychotherapy.

Reader Comments

From BigDeal: “Re: Epic lawsuit against Tata. Filed quietly Friday evening.” Epic sues India-based Tata Consultancy Services, seeking an injunction and damages for what it alleges is misuse of Epic’s confidential information. The lawsuit claims that Tata’s people downloaded information from Epic’s UserWeb in an “elaborate campaign” that could give that company an advantage in its project to develop a competing product. Epic’s lawsuit says that a Tata employee based in Portland, OR downloaded at least 6,477 documents from an India-based IP address after claiming to be a Kaiser employee and using a KP.org email address. Epic says that it questioned the employee and he first claimed that he didn’t download anything, but when presented with the audit log, admitted that he shared his UserWeb credentials with two other Tata employees. The lawsuit says Epic won’t identify the material it claims Tata stole unless the court grants a protective order to keep it out of the public record.

HIStalk Announcements and Requests

Ebola diagnosis is made harder by reliance on a patient’s self-reported history and a lack of hospital preparedness, poll respondents said, with only a small percentage blaming the EHR. New poll to your right or here: CommonWell Health Alliance is 20 months old – what will be its impact on interoperability? Add a thoughtful comment to impress others that you’re not just a reactionary poll-clicker.

Yes, it’s November already. The clocks have been turned back all over the US, excluding non-observers Arizona, Hawaii, and a few counties in Indiana. Stalwart hospital IT people gained an hour Sunday to make up for the sleep they lost in babysitting their systems just in case something went wrong. Thanksgiving (and thus RSNA shortly afterward) is three weeks from Thursday.

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

Listening: new goosebump-inducing blood harmonies from Indianapolis-based Lily & Madeleine, who sing together as only sisters can. They sound eerily similar to First Aid Kit, which is a good thing.

Last Week’s Most Interesting News

• McKesson announces that its RelayHealth unit has signed a multi-year agreement as the technology provider for CommonWell Health Alliance.
• Google X Life Sciences says it hopes to bring a swallowed sensor to market within five years that can detect molecular-level health problems.
• California’s attorney general issues her 2014 breach report that says healthcare lags only retail in exposing the information of individuals, largely because many provider organizations don’t encrypt mobile devices.
• HHS, responding to negative industry reaction to a nearly complete loss of ONC leadership over the past few months, announces that Karen DeSalvo will continue to oversee ONC’s work even while reassigned as Acting Assistant Secretary for Health.
• CCHIT announces that it has shut down effective immediately after losing its primary revenue source by exiting the certification business in January 2014.
• The first UK hospitals go live on Epic.
• Reuters suggests that Salesforce is about to make a major push into healthcare.

Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

November 18 (Tuesday) 1:00 ET. Cerner Takeover of Siemens, Are You Ready? Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The Cerner acquisition of Siemens impacts 1,000 hospitals that could be forced into a “take it or leave it” situation based on lessons learned from similar takeovers. This webinar will review the possible fate of each Siemens HIS product, the impact of the acquisition on ongoing R&D, available market alternatives, and steps Siemens clients should take to prepare.

November 19 (Wednesday) 1:00 ET. Improving Trial Accrual by Engaging the Digital Healthcare Consumer: How to Increase Enrollment with Online Consents and Social Marketing. Sponsored by DocuSign. Presenters: B. J. Rimel, MD, gynecologic oncologist, Cedars-Sinai Medial Center; Jennifer Royer, product marketing, DocuSign. The Women’s Cancer Program increased trial accrual five-fold by implementing an online registry that links participants to research studies, digitizing and simplifying a cumbersome, paper-based process. This webinar will describe the use of e-consents and social marketing to engage a broader population and advance research while saving time and reducing costs.

Recordings of recent webinars are available on YouTube:

Electronic Prescribing of Controlled Substances Is Here. What Should You Do?
Data Governance – Why You Can’t Put It Off
Using BI Maturity Models to Tap the Power of Analytics
Electronic Health Record Divorce Rates on the Rise- The Four Factors that Predict Long-term Success
Meaningful Use Stage 2 Veterans Speak Out: Implementing Direct Secure Messaging for Success 

Acquisitions, Funding, Business, and Stock

A New Mountain Capital fund acquires release of information vendor HealthPort. CompuGroup bought the company’s IT solutions business for $24 million in late 2010 as HealthPort had been rumored to have been exploring both an outright sale of the company and an IPO.

Castlight Health reports Q3 results: revenue up 238 percent, adjusted EPS –$0.18 vs –$1.58, beating analyst estimates of both. Shares dropped nearly 4 percent Friday after Thursday’s announcement. Above is the one-year CSLT share price (blue, down 69 percent) vs. the Dow (red, up 8 percent).

People

Oncology decision support vendor COTA names Eric Schultz (Quantia) as CEO.

Announcements and Implementations

Philips extends its Lifeline medical alert service to Lifeline GoSafe, a mobile service that uses multiple GPS location technologies to locate users who need help while away from home. A press of the button initiates two-way communication with the monitoring station via AT&T’s network. The system also automatically detects falls and places a call for help. Monthly services starts at $55. I’m a lot more interested in technology like this than wearables that monitor questionably useful body data.

Cleveland Clinic’s annual “Top 10 Medical Innovations” list includes only one healthcare IT-related item, but it came in at #1: mobile stroke units in which ambulances connect with hospital-based stroke neurologists via broadband-connected video. The list’s track record from prior years is pretty good: it previously included private sector HIEs (2009), telehealth-based CHF monitoring (2011), mobile device apps (2012), and big data analysis (2012).

Government and Politics

A report from the HHS OIG finds that Medicare keeps paying for expensive prescription drugs after the patient has died, following a CMS policy that allows prescriptions to be filled at its expense for up to 32 days after death. The report urged an immediate policy change, saying that post-death prescriptions “clearly are not medically indicated.” Some of the drugs are expensive and are feared to have been diverted to the black market. CMS says it’s fixing the problem. Perhaps there’s an ICD-10 code for normal respiration — not holding your breath.  

Technology

Google fine tunes its Flu Trends tool to include CDC data, acknowledging research from earlier this year that showed that the accuracy of Google’s own “big data” approach was improved when combined with even bigger data.   

Nintendo creates a health division and is working with sleep disorders product vendor ResMed to develop a “quality of life” sleep and fatigue tracker that it will sell as a subscription service. The hand-sized device will use microwave-based sensors to collect information from the bedside. It won’t be available for several months. ResMed announced its S+ product a month ago that offers “the world’s first contactless sleep sensor.” Its bedside monitor measures breathing, body movements, and room conditions, sending the information to apps that track sleep scores and recommend changes. Nintendo says the health division, which appears to include the Wii Fit and Brain Age, will be profitable in the 2015/2016 financial year.

Other

Dean Sittig and Hardeep Singh observe in a Future Medicine editorial that too many factors exist to make comparison of one EHR vs. another possible in comparative effectiveness research, proposing instead that they be evaluated by how they’re used in the field. They provide some examples, although I found them to be insufficient to picture the possibilities the authors envision. I would also see more value in using that kind of framework to assess how a given user implements their EHR of choice since in hospitals at least, the new/replacement market has consolidated into just A and B – Cerner and Epic, with some Meditech in the mix for smaller, non-academic health systems, reducing the need to compare the short list of products. My bottom line: treat EHRs as the ubiquitous medical tool or device they have become by letting providers make their own choices, but then hold them accountable for the patient outcomes that result, no different than for a patient monitor or IV pump that can’t be evaluated in a vacuum other than for safety and usability. All the certifications, rankings, and independent evaluations don’t mean a thing if a hospital implements a highly regarded system without seeing improvements in outcomes measures – otherwise, why bother? (other than to rake in more revenue) I never cease to be amazed that hospitals rarely publish their pre- and post-EHR quality metrics after spending dozens or hundreds of millions of dollars to implement systems they assured would do exactly that. The article’s examples:

• Convert free-text entries using natural language processing instead of forcing users to choose from drop-downs.
• Perform drug-lab interaction checks at the point of care and not just during order entry.
• Assess the usefulness of on-screen clinical warnings by measuring how often the provider cancels the order that triggered the alert.
• Evaluate whether implementing Meaningful Use data entry requirements improves outcomes.

Epic will pay $5.4 million to settle a class action lawsuit brought by 45 quality assurance employees who claimed they should have been paid overtime wages. Each employee will be paid for their clocked hours plus 3.7 hours per week in assumed off-the-clock time. Money left over in the fund after the employees and attorneys have been paid, if any, will be donated to Access Community Health Centers.

Awards given at CHIME’s Fall CIO Forum:

• Neal Patterson, chairman and CEO, Cerner — Industry Leader Award
• Truman Medical Centers, Kansas City, MO — CHIME/AHA Transformational Leadership Award
• Frank Fear, VP/CIO, Memorial Healthcare, Owosso, MI and Iatric Systems – Collaboration Award
• Intermountain Healthcare and VMware – Collaboration Award

Researchers find that less than half of the dermatologists listed in the Medicare Advantage provider rosters of insurance companies are actually available. Forty-six percent of doctors were listed twice, 18 percent weren’t reachable, 9 percent were dead or retired, and 9 percent weren’t accepting new patients. The average wait for a new patient appointment was 46 days.

More on Epic’s newly built hosting data center: it was started a couple of years ago, but wasn’t announced until the recent UGM. It’s online now and being used to host client build copies. Live client hosting will start next fall. A hosted Epic option is not good news for Cerner since that’s a big differentiator for them.

A former patient registration specialist at Parkland Memorial Hospital (TX) will plead guilty to Medicare and Medicaid fraud, accused of using insurance information from the hospital’s computer system to bill the government for services he claimed to have performed for 3,000 patients in his home health business. He also bribed patients with cash, food, and gift cards to perpetuate his scam . His wife and business partner, a Baylor nurse, was accused of looking up patient information from the hospital and falsifying clinical documentation.

Interesting: the cash-strapped, currency-controlling socialist government of Venezuela implements food rationing, requiring grocery store customers to verify their ID via fingerprint biometrics to limit black market resale in neighboring countries. The government does the same at gas stations, scanning windshield bar code stickers to prevent people from filling up on $0.01 per gallon, government-subsidized gasoline and driving next door to Colombia to resell it for $4.50 per gallon. The country finished worse than the US in WHO’s ranking of healthcare systems, coming in at #54 vs. our #37 (even Cuba finished #39).

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 10/31/14

Epic Systems makes strategic next moves for expansion

Epic confirms that it has constructed a data center on its Verona, WI campus that it will use to begin offering hosted Epic systems to new customers. A backup data center is currently being constructed in Western Wisconsin.

PwC pitches open-source electronic health records

FWC analyzes the VistA EHR bid that PricewaterhouseCoopers and General Dynamics are proposing for the $11 billion DoD deal.

McKesson’s CEO John Hammergren on Q2 2015 Results – Earnings Call Transcript

In its Q2 earnings call, McKesson CEO John Hammergren highlights its $45 billion quarterly revenue, but notes that revenue from its health IT business dipped six percent.  He also mentions plans to monetize its involvement in the CommonWell health data exchange through the expanded use of RelayHealth, the McKesson-owned exchange suite powering the network.

Lockheed Martin to buy health technology firm Systems Made Simple

Lockheed Martin acquires health IT vendor Systems Made Simple for an undisclosed sum. Systems Made Simple targets government contracts, providing data analytics and systems integration support to federal health IT projects, generating $278 million in revenue in 2013.

News 10/31/14

Top News

Booz Allen Hamilton acquires Boston-based Epidemico, stating its intention to delve deeper into population health analytics and following the recent trend of consulting companies getting into the software business. The company – a 2007 spinoff of Boston Children’s Hospital, Harvard Medical School, and MIT – analyzes large population health datasets to look for problems such as disease outbreaks, drug safety problems, and supply chain vulnerabilities. The company’s HealthMap shows disease outbreaks and alerts, which surely caught the Ebola interest of suitors. One of the founders, Clark Freifeld, is a PhD candidate and was a software developer at Boston Children’s, now apparently working for MIT Media Lab.

Reader Comments

From Capezio: “Re: CMS MU request website. Any idea why they took it down? We used it to get MU clarification until a week or two ago. A message says to use CMS’s main site instead, which has been improved but is infrequently updated and doesn’t cover emerging issues. Can you find out if this is a temporary hold or whether it’s gone for good?”

From The PACS Designer: “Re: end of Windows Server 2003 support. Just eight months away — migration planning should already be in the works.”

From Blue Hawaiian: “Re: service management best practice. Would love to see more. Healthcare seems slow to move in that direction, just as it was for quality management best practice (aka patient safety) for so many years.” It would be fun if a CIO with expertise on this topic would write something up about what they’re doing.

From See Sh*t: “Re: CCHIT. Funny that they’re leaving their minimal assets to the HIMSS Foundation.” My macro view is that HITECH money is losing impact and the hangers-on created to tap into it (certification bodies, HIEs, RECs, even ONC itself) are finding it tough to pay the bills as the taxpayer trough dries up. As I said in reacting to CCHIT’s bizarre January 2014 announcement that it would exit the certification business and turn into a thought-leader non-profit with unstated revenue streams, “The most recent Form 990 I could find was from 2011, at which time it was paying Chairman Karen Bell $409K, Executive Director Alisa Ray $250K,  and five other employees over $100K. It would seem to me that given CCHIT’s genesis, mission, and name, it should just go away rather than trying to morph itself into the already overcrowded thought leadership business. It probably would if HIMSS wasn’t riding in on a white horse to save it, not surprising given that HIMSS formed CCHIT (along with partners AHIMA and NAHIT) in 2004.” Consulting firms and software vendors have already moved on from MU to the next government-incented shiny object: analytics and population health management, emboldened by the continued willingness of providers to focus their entire agenda on whatever Uncle Sam is writing checks for at the moment.

From Sponsor President: “Re: your site. You mentioned our company in a post that just went out a few minutes ago at 10 at night Eastern time. I’ve received 12 emails in the past 15 minutes. You are the best marketing value in all of HIT.” I appreciate that, although all I’m doing is putting out concise, factual information that I think is relevant and readers are free to use it however they like. Their response means the company has interesting offerings. 

From Tipper: “Re: Epic. This week, Judy Faulkner said, ‘We do not like to participate with organizations that are going to sell the data because we’ve always felt the data is confidential. That’s another thing that has always bothered us about CommonWell.’ This seems to be CommonWell’s response.” A CommonWell blog post says the notion that it would sell data is “absurd” and “especially inaccurate,” adding that it will never sell personal health data and in fact as a broker doesn’t even have access to clinical data. The post adds that CommonWell will charge fees of 0.1 percent of each member’s annual revenue above and beyond membership dues.

HIStalk Announcements and Requests

This week on HIStalk Practice: Day 1, 2, and 3 show updates from MGMA. Dr. Gregg takes healthcare IT to the land of Oz. MGMA members show no love for Medicare’s quality reporting programs. Spring Creek Family Medicine goes live on its eCW patient portal. HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers Chicago’s newest digital health accelerator, Matter, and its first class of startups. Google unveils its newest X Labs project: a nanoparticle-filled smart pill programmed to enter the blood stream and search for early-stage cancer tumors. Fitbit releases two new activity trackers and a full blown smartwatch with a focus on health metrics. Salesforce is rumored to be optimizing its customer relationship management platform as an outreach and population health tool.

Welcome to new HIStalk Gold Sponsor Clockwise.MD, which is also sponsoring HIStalk Practice. The Atlanta-based company’s online reservation system lets patients skip the wait – they make an appointment (online or mobile), show up on time knowing their place is reserved, and then watch the wait times and queue order in real time on an iPad (I really like that idea – nothing is worse that fuming in a crowded waiting room wondering if you’ve been forgotten). Providers users gain interesting benefits: they can fill in their less-busy schedule times, keep patients informed about wait times via automatic text messages, and target delayed patients via a real-time dashboard so that appropriate customer service actions can be taken (like furtively slipping a slowly fuming Mr. H a current-issue Popular Science magazine that will otherwise age for months in the practice’s climate-controlled magazine cellar until it’s ripened enough for the waiting room coffee table). Here’s a fun idea: when a patient cancels their appointment, the open slot is broadcast by text message and whoever jumps on it first can take that appointment. The company’s founder and CEO is Mike Burke, who founded informed consent system Dialog Medical and sold it to Standard Register in 2011. Thanks to Clockwise.MD for supporting HIStalk and HIStalk Practice.

A quick YouTube search turned up this brand new Clockwise.MD explainer video.

My task following Dim-Sum’s amazing HIStalk webinar “DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project” (over 1,000 people have watched the YouTube recording) was to see if there’s interest in the sub-topic of military theater medicine, and if so, to enlist experts from Epic, Cerner, and Allscripts to join Dim-Sum in a follow-up webinar panel discussion. He doesn’t have a horse in the DoD’s EHR race, but is passionate about the topic as a military health advocate and veteran. Your thoughts are welcome.

Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

Acquisitions, Funding, Business, and Stock

Lockheed Martin will acquire privately held government health IT provider Systems Made Simple for an undisclosed sum. The company does a lot of work for the VA and had $278 million of revenue in 2013.

From the McKesson earnings call:

• The company’s quarterly revenue was $45 billion.
• John Hammergren says he’s pleased with improved margins in Technology Solutions business, although revenue was down 6 percent in the quarter.
• Hammergren says CommonWell Health Alliance is demonstrating real-world interoperability progress in adding new members, and running four successful pilots.
• Hammergren said of the Technology Solutions business that “We’ve had the biggest challenge with in the EMR kind of space,” repeated that growth won’t return to previous levels until the transition from Horizon to Paragon is complete, and says that McKesson’s imaging business has been hurt as customers focused on buying products to meet Meaningful Use requirements.

In an apparent admission that CommonWell’s work will be commercialized as he hinted in the last earnings call, Hammergren said in the McKesson earnings call that CommonWell has signed “a multiyear agreement for nationwide commercialization of the services, with the core services being provided by RelayHealth.” I don’t know if CommonWell is the altruistic, non-profit, vendor-driven interoperability project it claims to be or a way for McKesson to sell RelayHealth services through Epic-scared EHR competitors anxious to launch a pay service for interoperability. The fact that it came up in McKesson’s earnings call suggests that the company is looking forward to new RelayHealth revenue.

BIP Capital sells its original fund’s stake in Ingenious Med to another private equity firm for a nine-fold gross return, but will continue to hold company equity in a second Fund.

Merge Healthcare posts Q3 results: revenue down 6 percent, adjusted EPS $0.05 vs. $0.02, beating expectations for both.  

MedAssets turns in Q3 results: revenue up 5.6 percent, adjusted EPS $0.34 vs. $0.31.

IBM and Twitter, both desperately seeking new revenue sources, announce a partnership in which IBM will analyze tweet data for “business decision-making.” I don’t have access to big data that would support my theory that this project will go nowhere – tweets are such a uncategorized, free-text mess that surely no sane business would pay IBM to sell it Twitter-powered business advice.

MedStar Health (MD) expands its Cerner relationship with a seven-year agreement.

Sales

North Shore-LIJ Health System (NY) chooses Explorys for Hadoop-based analytics and risk models.

St. Luke’s University Health Network (PA) picks Nuvon for medical device integration.

People

Member engagement software vendor Healthx names Michael Gordon (iTriage) as chief product and strategy officer.

Voalte hires Suzanne Shifflet (ONR, Inc.) as CFO.

Randy K. Hawkins, MD (Glytec) joins Connance as chief medical officer.

Eric Johnson (Informatica) joins DocuSign as SVP/CIO.

Announcements and Implementations

Allscripts introduces Sunrise Mobile Care, an iPhone/iPad app that lets nurses review and input patient information (allergies, vitals, I&O) with alerts and bi-directional updates from Sunrise. It’s curious that the vendor claiming to be the most “open” (whatever that means) supports only Apple devices.

Kaiser Permanente adds what it calls “medical selfie” capability to its patient portal, which allows patients to securely send digital pictures to their doctor for review. A copy also goes into their patient record. Patients can also send PDF files, such as scans of work-related forms that require the doctor’s signature.

RazorInsights will offer its laboratory information system customers instrument interfaces and workflow tools from Data Innovations.  

In India, the renovated Sir HN Reliance Foundation Hospital will deploy Google Glass to its ED doctors, who will be able to review the patient’s history (including images) without looking away. SAP connected Glass to the hospital information system for two-way information exchange. According to SAP, “With the help of the Google Glass, doctors can attend to multiple patients, engage with them and see almost twice as many patients during the rounds. Doctors can take accurate notes on the Google Glass itself. The data is stored automatically and can be accessed when required.” Another hospital in India is creating a Glass-powered telemedicine application.

EClinicalWorks chooses Exostar’s ProviderPass SaaS-based identity proofing and second-factor credential authentication to meet the DEA’s e-prescribing requirements for controlled drugs. The company uses Experian-provided identity challenge questions or live webcam video.

In Canada, Nova Scotia’s Meditech hospital information system will go down next Tuesday and Wednesday for a software upgrade, with hospitals and clinics shutting down all non-emergency services, including surgeries, lab work, and diagnostic imaging.

Audacious Inquiry and Johns Hopkins Community Physicians sign a collaboration agreement to enhance the company’s encounter notification service.

Government and Politics

Former Massachusetts “Obamacare czar” Sarah Iselin, who in February was drafted to try to save the failed Massachusetts Health Connector health insurance exchange, quits to become executive-in-residence at Optum, which was awarded a no-bid contract to fix the exchange. She says there’s no conflict of interest since she hasn’t been involved in the project for the past six months, she was hired before Optum got the business, and technically she worked for the governor rather than Health Connector.

FCW covers the odd open source pitch of PricewaterhouseCoopers and General Dynamics in bidding on the $11 billion DoD EHR contract by offering up VistA, the very mention of which probably causes Pentagon brass to make mock retching sounds given that the VA developed it. They wouldn’t even interface to it, so the odds they’ll implement it surely are near zero, especially when they want a commercial system whose single vendor is committed to supporting and enhancing it. PwC and GD obviously were late to the taxpayer-funded party and found all the available EHR dance cards filled (those bidders that chose Meditech and Siemens later pulled out of the running). If the bid were being handicapped as a Presidential election, it would be Epic (Democrat), Cerner (Republican), Allscripts (Libertarian) and VistA (Green Party).

The AMA should probably just call up Sylvia Burwell instead of issuing a daily statement about ONC, but for what it’s worth (not much), AMA says it’s happy (or at least as happy as AMA can get) that Karen DeSalvo will still lead ONC in whatever fashion HHS decides is necessary to prevent pundits from predicting ONC’s impending irrelevance. It feels like HHS panicked at the ONC-negative response to her transfer and came up with a lame “she’ll do both jobs” excuse.

The House Science Committee on Science, Space, and Technology subpoenas former US CTO Todd Park to describe the security capabilities of Healthcare.gov.

The United States sues New York City and CSC for Medicaid billing fraud, claiming that the city used the default settings of CSC’s billing system to bypass Medicaid’s secondary payor requirement and used generic ICD-9 codes that they knew Medicaid would pay more quickly. 

Technology

The 100-researcher team of Google X Life Sciences is developing a Tricorder-like early warning disease detection system in which patient-swallowed sensors send notice of tracked nanoparticles to a wristband. The project is being run by a renowned molecular biologist who used to work for LabCorp, in partnership with MIT, Stanford, and Duke. He says that healthcare is reactive and transactional, with diagnosis – especially for cancer – coming too late once symptoms are apparent (he calls this the “wait until you feel a big lump in your chest before you go to the doctor” approach). He also suggests that the big data possibilities could be enormous as therapies can be targeted to molecular profiles. This is tied into the company’s Baseline Study, in which it is attempting to quantify the measurements that signify good health. The technology is nearly ready for human testing, a flurry of new patents will come out in the next month, and the company expects widespread usage in 5-10 years. Google will license the technology as they did for their smart contact lens. Another Google group, Calico, is attempting to extend longevity, which he explains as, “We’re helping you live long enough so Calico can make you live longer.”

A Canada-based startup receives approval to sell its on-demand DNA testing device in that country, where frontline providers in any care setting (including pharmacies) can instantly determine whether a patient should receive the anticoagulant drug Plavix based on a known genetic problem that renders it less effective. More test types will follow. The company has earned FDA approval to sell its product in the US, but only to hospitals. The device costs $9,000 and each test is $225, but the company says it will tweak the price to make it affordable.

Microsoft announces Microsoft Health, a platform and app for collecting information from fitness wearables, planning to eventually add connectivity to share the information with providers via HealthVault. It claims its Intelligence Engine will provide insights such as fitness performance by time of day and after meals. In other words, it’s Microsoft’s answer to Apple’s Health and HealthKit with equally limited capabilities given that the information it can collect isn’t worth a whole lot except to quantified self fitness fanatics –your doctor doesn’t really have the time to monitor your step count or sleep patterns that have minimal immediate effect on the current problem list.

I’m not excited about Microsoft Health, but Microsoft also announces its $199 Microsoft Band, which is immediately available (kudos for not pre-announcing stuff that won’t be out for months – looking at you, Apple Watch). Kudos, too, that Band works with Android and iOS devices in addition to Windows-based mobiles and includes a GPS, heart rate monitor, and a two-day battery life vs. the imaginary Apple Watch’s one-day charge. It also uses a Bluetooth phone connection to display text messages, emails, and social media updates. It looks like a winner to me, with the only real competition being Apple (its fanboys are both loyal and patient) and Android Wear. I haven’t been tempted by any fitness tracker since my Fitbit Force was recalled, but Microsoft Band seems worth a look for those willing to pay for extra capabilities beyond the usual tarted-up pedometer.

Other

A piece in Madison’s hippie weekly (as I always call those left-leaning papers that feature mostly music reviews, sex-related ads, and pathetically predictable anti-establishment rants) covers Epic without saying anything new or insightful except one thing: the company confirms that it has built a data center in Verona for client hosting. That’s a pretty big deal: Cerner has gained many small or remotely located customers (and made a lot of money) from its remote hosting services, while Epic, like Meditech that inspired it early on, has stubbornly avoided the obviously smart move of making its systems available as a service to let hospitals avoid the capital costs and personnel requirements of running it from their own data centers. That policy made sense when Epic sold only to academic medical centers with big IT budgets and big IT egos, but now that it’s moving down-market, hosted systems are likely to be a hit. I’ll follow up for more information.

The iMDsoft Metavision software bug that was characterized in a risk assessment as being potentially lethal to ICU patients in Australia turns into a political issue. Opposing political parties in Queensland debate the extent to which patients have been warned and invoke unpleasant memories of Queensland Health’s 2010 payroll system implementation, in which IBM turned a $5 million fixed-price bid into a billion-dollar project with a little help from company-friendly bureaucrats (which got the company banned from future Queensland work). It’s one of three health-related examples that come to mind when enumerating the biggest IT debacles in government IT history, along with England’s NPfIT and Healthcare.gov. Meanwhile, iMDsoft says Queensland Health is testing a fix it provided, explaining somewhat mysteriously that the problem came up during testing, perhaps tactfully declining to throw its client under the bus for their role in going live with a known problem.

Cerner expects 11,000 participants from 26 countries at its annual conference in Kansas City, MO next week, with attendance up 20 percent over last year.

Columbiana Family Care Center (OH) closes temporarily after the computer system of its owner, Salem Regional Medical Center, goes down after an unspecified software problem.

The Chinese engineer charged with stealing proprietary MRI programming information from his former employer GE Healthcare and sending it back to China will plead guilty to stealing trade secrets, facing 10 years in prison, a $250,000 fine, and deportation.

It’s not completely health IT related, but Genentech angers hospitals by changing the way it distributes three cancer drugs – Avastin, Herceptin, and Rituxan – to six regional distribution centers rather than the usual drug wholesaler, citing the need to increase drug supply chain security. Hospitals say they won’t be able to get those meds daily as they always have so they’ll have to stockpile the expensive drugs, they’ll have to rely on overnight shipping companies in emergencies, they will lose traditional discounts, and on the data side won’t get wholesaler-provided benchmarking information and convenient 340B accounting. Similar events have happened on the consumer side, where drug companies declare an expensive item a specialty drug, meaning patients have to get their supply from mail-order pharmacies that focus on expensive drugs for chronic conditions.

Louisiana state health officials tell doctors planning to attend a New Orleans tropical medicine conference this weekend to stay home if they have visited Liberia, Guinea, or Sierra Leone within the past 21 days. The conference, ironically, was to feature presenters talking about their work in fighting Ebola in Africa, but now those experts won’t be allowed to attend. The letter admits that even infected people don’t spread the disease if they aren’t showing symptoms, but adds that, “We see no utility in you traveling to New Orleans to simply be confined to your room.” Science and politics just don’t mix.

California’s attorney general issues her 2014 data breach report, which finds that the number of records exposed in healthcare breaches was higher than in all other sectors except retail. The AG points out nicely that healthcare is an outlier because most of its breaches involved stolen hardware that wouldn’t have been a breach at all had their owners simply encrypted the devices. Here is my advice to healthcare CIOs: if you aren’t encrypting all laptops because you haven’t asked for the money, you should be fired. If you aren’t encrypting all laptops because administration won’t give you the money, you should quit. Either way your name is going to be up in quite embarrassing lights when someone loses a laptop (probably after violating a hospital policy in taking it home after storing PHI on the local drive) and your boss has to sheepishly admit to the local community that it wasn’t encrypted. On the bright side, that one exposure usually results in the board coming up with encryption project money, albeit after the fact.

Sponsor Updates

• Forward Health Group will participate in the IHI National Forum on Quality Improvement in Healthcare December 7-10 in Orlando.
• Clinovations shares Dennis Glidewell’s thoughts on areas of opportunity in the revenue cycle in Ask the Expert.
• IHT2 announces the speakers and topics for Health IT Summit Houston December 10-11.
• EClinicalWorks signs an additional 37 CHCs and FQHCs.
• Washington Business Journal names GetWellNetwork to its “50 Fastest Growing Companies of 2014.”
• CareTech Solutions will discuss hospital website security threats at the 18th Annual Greystone.Net Healthcare Internet Conference November 3-5 in Scottsdale, AZ.

EPtalk by Dr. Jayne

Cleveland Clinic announces its list of top medical innovations of 2015. Since the list was compiled by people in the patient care trenches, it’s not surprising that it was heavy on drug and treatment technologies and light on health IT.

We hear a lot about alarm fatigue, so I was interested to see this article on “decision fatigue” as showing that physicians prescribe more antibiotics later in their workdays, even when the drugs may not be appropriate. It’s a research letter that doesn’t have the same weight as some other studies, but it is interesting nevertheless. I know I get tired at the end of a full day of seeing patients and definitely don’t feel as sharp as when I start. I’d be interested to see an analysis of allergy and interaction alerts stratified by time of day and how our physicians reacted to them.

I had the privilege of moderating a hospital community forum last Saturday morning. I posted some of the questions/comments in Twitter, but I can’t say I’m a fan of live tweeting. I was impressed by the level of patient engagement (and the knowledge) around Ebola. To be fair, there were plenty of questions about other key community health priorities, including diabetes and a couple of questions about childhood vaccinations.

Discussing a disease for which there is no vaccine in the same session as diseases for which there are vaccines that people refuse was a bit surreal. A couple of the attendees mentioned the polio scares of the 1950s and hearing the perspective of people who watched their schoolmates become ill and disabled was moving. I found this NPR piece the other day that talked about the polio vaccine trials and why they could never be done today. If nothing else, we live in interesting times.

I finally registered for HIMSS this week. I waited too long last year and am happy to report that there are still plenty of good hotels left. Although I’m not crazy about Chicago as a site for conferences, it’s a fun town. I’m already scheming with a good friend for some potential pre-conference fun and am keeping my eye out for just the right HIStalkapalooza shoes (although this charming Louboutin handbag is a little out of my price range).

In the Breach of the Week, hundreds of medical records were lost when they blew out of the back of a truck in Omaha, NE. Apparently the medical waste disposal company didn’t secure them properly. I was impressed by volunteers that were helping pick them up, even reaching into a storm sewer to gather documents. The news report indicates they were on their way to be “stored” in Lincoln, NE which makes the fact that a waste disposal company was transporting them a bit curious.

I’m off to CME this weekend and have blown my conference budget for the year. I wish I had saved up some cash to attend the mHealthSummit in December and particularly the Gala Reception for Disruptive Women in Healthcare. If nothing else, it would be a great opportunity to pick up swag and take pictures for my desk that would drive my boss crazy. Maybe someday I’ll make the list of Disruptive Women to Watch.

Who are your favorite disruptive women? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 10/30/14

Big health records firm Epic raises DC profile

Epic CEO Judy Faulkner gives a rare interview to Politico to discuss the company’s interoperability performance, explaining “If we don’t speak up, people will believe what others say about us, and an unanswered accusation becomes seen as the truth if you don’t respond.”

Google is developing cancer and heart attack detector

Google unveils its latest X labs project, a pill that delivers millions of antibody-coated nanoparticles into the blood stream where they will live indefinitely, hunting for signs of early-stage cancers, monitoring for concerning blood chemistry changes, and pushing alerts to a wrist-worn health tracker.

Booz Allen buys Boston health analytics start-up Epidemico

Booz Allen Hamilton will buy Boston-based analytics startup Epidemico for an undisclosed sum. Epidemico is the Harvard and MIT spinoff behind HealthMap, a data analytics project that tracks the spread of infectious diseases on a map by analyzing public health data from a variety of sources. HealthMap was recently credited with picking up on the Ebola virus first, weeks before the World Health Organization noticed it.

Top 10 Medical Innovations for 2015

The Cleveland Clinic publishes its list of the top 10 medical innovations set to disrupt healthcare in 2015, with telemedicine-enabled, ambulance-based stroke units coming in at number one.

Readers Write: Answering Your Questions about Electronic Prescribing of Controlled Substances

Answering Your Questions about Electronic Prescribing of Controlled Substances
By David Ting

Last week, Imprivata sponsored a webinar with HIStalk about electronic prescribing of controlled substances (EPCS) during which we reviewed the DEA requirements, the benefits, and the scope of work involved in implementing an EPCS solution. I was joined by Sean Kelly, MD, an emergency physician at Beth Israel Deaconess Medical Center in Boston and chief medical officer at Imprivata, and William Winsley, MS, RPh, the former executive director of the Ohio State Board of Pharmacy.

The webinar was very well attended. We received a number of excellent questions. Here are a few of them.

Q: Which two-factor authentication method is most often used for EPCS?

A: This depends on the clinical workflow requirements, but we are finding that many customers want to use a combination of solutions. For example, in high-traffic, high-use areas of the acute care hospital, many customers are opting for fingerprint biometric identification combined with passwords for ease of use. However, many prescribers also want the ability to e-prescribe outside the hospital walls, so customers are also enabling the use of one-time password (OTP) tokens for EPCS.

Q: Is there a process one must follow to register as the person who will credential and enroll prescribers for EPCS?

A: The DEA allows hospitals that are DEA registrants to do this on their own through their credentialing office. This is referred to as institutional identity proofing. Private practices must undergo individual identifying proofing. In this case, the designated physician works with a third-party Credential Service Provider (CSP) to obtain the necessary approvals to receive the proper credentials for EPCS two-factor authentication.

Q: Does the DEA allow EPCS signing in batches?

A: Yes, by patient. A provider can sign multiple prescriptions for a single patient simultaneously whether they are controlled or non-controlled substances. Many EMRs and prescribing systems will separate controlled and non-controlled substances, so if a provider is prescribing controlled substances, it will automatically prompt them to enter the necessary two-factor authentication credentials.

Q: The DEA ruling is “interim.”Is it likely to change?

A: Although the DEA ruling allowing EPCS is “interim,” it is unlikely to change. The DEA and other agencies have a number of rules that have been in interim status for quite some time, and in this case, the DEA has not given any indication that it will change anytime soon if at all. This is especially true for the two-factor authentication requirements.

David Ting is founder and chief technology officer at Imprivata. The webinar recording can be viewed here.

Readers Write: Stuff Doctors Leave on Workstations in the Doctor’s Lounge Late at Night (And Other Times)

Stuff Doctors Leave on Workstations in the Doctor’s Lounge Late at Night (And Other Times)
By anotherdoctorgregg

The image above caught my eye when I sat down at a workstation in the doctor’s lounge. I bet whoever left it there thought he or she was making a completely anonymous search, though I could see everything, including visited hyperlinks. We do try to teach our medical staff about using shared workstations, but there is a strong feeling of anonymity even as we are told there is no privacy at work.

One of our gastroenterologists is unhappy with his current employment, at least as judged by the number of versions of his CV on various workstations, complete with cover letters to other institutions. I don’t know whether he is unaware his CV and job hunt letters are on not only one, but multiple workstations, or if he is making a not-so-subtle statement about his job satisfaction to his current employers. I have also seen bankruptcy documents, child custody agreements, wrong-headed letters of complaint to Audi dealerships, and adorable pictures of kids dressed up for prom.

If you think you can’t be tracked and you are not leaving a trail of the most personal information on semi-public workstations, you are probably wrong. In 1997, a graduate student was able to identify Massachusetts Governor William Weld’s health information — even though the state medical database was supposedly de-identified — by correlating the elements of the medical database with voter registration rolls in Cambridge. Although this was probably a fluke, re-identification in a doctor’s lounge might be easier.

We do try to clean up the desktop screens of hospital workstations, mostly so it is easy to find the icons that we want to be found. In a parallel effort to raise awareness about not leaving personal (sometimes very personal) information on workstations through saved files and browser histories, I collected a little data.

The doctor’s lounges require keycard access, so the workstations in there are used almost exclusively by physicians. The information I gathered came from the histories of Internet Explorer (purged every couple of days) and other browsers (Chrome and Firefox) installed by users as non-administrators. With those disclosures, here is a sampling of what doctors look at, at work.

There were 1,052 entries over three days. The first thing to notice is the complete absence of porn. Overall, searches were at worst only mildly embarrassing, with nothing to trigger HR’s attention.

Forty-eight percent of visits were to a practice portal or billing system, 21 percent were to sports sites (cricket scores beating football scores, which either speaks to our physician demographics or penetration of the ESPN mobile app), and 13 percent were visits to medical sites (UpToDate and Medscape being the most common.) The remainder were visits to Google and foreign language and news sites that reflected our demographics.

There were a few visits to the county probate court, checking on malpractice and divorce cases (the search terms are displayed if you reopen the window from the history). One person Googled, “I have water coming into my basement right now.” I know it was a she since she discussed night call plumber’s fees at lunch the following day.

I could also identify my plumber-needing friend by her search history. Users leave sequences in their histories like <foreign language site><another site><same foreign language site>, narrowing the presumptive visitors to just the doctors who speak that language. Also, site visits bracketed by practice EMR portal visits linked the sites in between to specific individuals if you look at the call schedule. The call schedule will generally narrow down the potential users to just one.

Overall, I estimate about 40 percent of the browser history in doctor’s lounges can be associated with a specific person. This is an estimate since I only asked a few directly. The message is that even an otherwise anonymous Google search can probably be linked directly back to a hospital user, even by non-administrators, so surf accordingly.

CIO Unplugged 10/29/14

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

The Art of Saying Goodbye

How you say goodbye is more important than the first hello.

We only get a chance to make a first impression once. It is hard to recover a blown opportunity at saying hello. When I start at a new organization, one of my top priorities is meeting with as many individuals as I can as quickly as I can. I call this “hit the ground listening.” It is amazing how you can accelerate your adoption in a new company by asking questions and showing genuine interest in others and how things work.

I don’t recall all of my interactions. But I do recall every interaction where the first impression was blown by either party. In fact, those relationships rarely recovered despite reconciliation attempts.

Based on that, how can I assert that saying goodbye is more critical than that first impression?

While the first impression is typically a moment between two people, the last goodbye is often public. People watch, observe, and take note. They make impressions that, like first hellos, leave an indelible mark whose impact is irreversible.

How we treat an associate as they leave says more about the culture of an organization than anything else. We need to perfect the goodbye. There is an art.

There are a variety of valid ways to say goodbye. First, I do not believe that title dictates the extravagance of a goodbye. Why do we reserve champagne just for executives? Often the departing analyst may have had equal or greater impact! A rock star is a rock star.

I recall one farewell reception where a fellow executive who was walking by our festivities was wondering which of our peers was retiring. He seemed aghast that is was just a farewell for an analyst who had been with us for five years. I told him that the impact that analyst had in five years was greater than the impact of some execs who had been there twice as long. It is not about title or length of service, it is about material impact. The greater the impact, the greater the celebration.

Second, make sure you understand how the departing person wants to say goodbye. While I am all about big celebrations, others prefer a sedate getaway. Always do what that person prefers — it is their party! I recall lavishing praise on someone for the amazing work they had done. Afterwards, they texted me that they dislike that kind of recognition. My attempt to bless backfired. When someone prefers an understated affair, I think it is important that this is shared with those observing.

The next time this situation presented itself, I simply let the team know that we really appreciated the person who was leaving, but they specifically asked for a quiet exit and we would honor that. A card or small luncheon may be perfectly appropriate.

There are many ways to say goodbye and this is by no means an exhaustive list. My favorite thing to do is to verbally affirm others. We bless them with a reception full of friends and family, but the thing people have told me time again as having the most significant impact is the verbal praise received from those they worked with for so many years.

As the leader, you start this. You surround the person, look in their eyes, and speak truth. Dependent on their comfort and your relationship, I recommend including touch. You don’t need to prepare a speech — this should be spontaneous. Just speak what is in your heart and perhaps include an anecdote. Try to include something light to counterbalance the sorrow that everyone will naturally feel. As you lead, others will follow.

To be able to say goodbye like this clearly requires something of you. That you have relationship with your entire team. That you know them by name. That the stories are natural to come by because you have shared experiences.

What if the person leaving was a poor performer? All the more reason to celebrate!

And if anyone tells me they have no time to celebrate and say goodbye in an artful, thoughtful way … you need a new career.

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