Reuters reports that Truven Health Analytics is preparing for an IPO that will value the company at $3 billion. Truven was acquired by Veritas Capital Fund Management in 2012 for $1.25 billion.
The OIG investigates the VA Chief Business Office, concluding that it violated appropriations laws when it spent $92 million on a new IT system from a fund that was only authorized to cover medical, construction, supply, and research costs.
Nina Pham, the Texas Health Resources nurse that contracted Ebola while treating a patient last fall, is suing her former employer, claiming that a lack of training, established policies, and proper equipment led to her exposure.
The Wall Street Journal compares four hospital ranking sites (US News & World Report, Consumer Reports, Leapfrog Group, and Healthgrades) and finds that there is virtually no consensus among the lists. 27 percent of the hospitals listed among the nation’s best were rated among the nation’s worst on one of the other lists.
Reuters reports that Truven Health Analytics is planning an IPO that will value the company at $3 billion. Veritas Capital Fund Management LLC bought the company from Thomson Reuters in 2012 for $1.25 billion.
Reader Comments
From DejaVuAllOverAgain: “Re: Leidos Health. Laid off over 50 people last Friday, the third round of layoffs since Q3 2014. SAIC bought two $400M consulting companies (Vitalize Consulting and maxIT Healthcare) thinking they’d get $800M annually. Revenues now less than $300M. The typical acquisition story.” Unverified.
From LL Cool J: “Re: Allscripts and NantHealth partnership = desperate.” The wordy announcement wasn’t very clear on who’s doing what, but NantHealth seems to be signing up a bunch of partners and Patrick Soon-Shiong is drawn to TV cameras like a mosquito to a bug zapper.
From RutRoh: “Re: CareCloud. It was announced at the CloudUp corporate meeting that CEO Albert Santalo has been asked to step down.” Unverified. He’s still listed on the executive page and I assume that even if the rumor is true that he’ll remain as board chair. Update: CareCloud says Santalo will remain chairman and CEO but will be focusing his time over the next several months on advancing products, with emphasis on optimizing operations for larger practices.
From Dysf(n): “Re: microbiology interfaces. CAP Today puts out an annual review of laboratory middleware. New version is due in June 2015, I think. Here’s last year’s in PDF format. Data Innovations is in there, along with another six or seven. If that doesn’t cover the specific instruments / systems you’re looking to integrate, it may be a good start — search elsewhere through CAP Today online.”
HIStalk Announcements and Requests
Here’s a fun fact that everybody who orders HIMSS-related giveaways already knows: China-based manufacturing shuts down for two weeks each February for Chinese New Year. Last year we had to settle for inferior quality lapel pins because the factories where the good ones are made were closed.
Divurgent is offering all HIStalk readers the chance to attend summitHIT15 in Chicago’s best rooftop lounge on the 27th floor of theWit hotel on Sunday, April 12. RSVP here.
Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.
Webinars
March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.
March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Acquisitions, Funding, Business, and Stock
Becton Dickinson acquires CRISI Medical Systems, with which it co-developed a wireless, EHR-integrated electronic checking system for drug identification, dose, and allergies for drugs given by IV push.
Sales
Memorial Sloan Kettering Cancer Center will use PeraHealth’s Rothman Index health scoring system throughout its system to provide an early warning for patients whose conditions are deteriorating.
Cornerstone Health Enablement Strategic Solutions (NC) chooses Lightbeam Health Solutions for population health management.
People
T-System names Janie Schumaker, RN, MBA (Heartland Regional Medical Center) as chief nursing officer.
Rick Toren (Qpid) joins healthcare analytics vendor Atigeo as president of its healthcare division.
Announcements and Implementations
ScImage updates its PICOM365 systems to support the new ASA 2015 echocardiography cardiac chamber standards that were released in January.
NantHealth and Allscripts announce their collaboration on development of precision medicine solutions for cancer patients.
Spectrum Equity makes an unspecified investment in healthcare database vendor Definitive Healthcare.
Government and Politics
A Connecticut bill would require insurance-related companies to encrypt consumer information, introduced in response to the Anthem breach by politicians who clearly don’t understand that encryption is rendered instantly worthless once hackers obtain administrator account information by phishing (as they did in Anthem’s case).
The VA’s Office of Inspector General finds that the VA’s chief business office knowingly violated appropriations law by using $93 million in medical support and compliance money to help pay for development of a claims processing system to avoid going through the VA’s IT process.
Privacy and Security
ProPublica plans another article in its series about medical privacy and invites readers to contribute stories about problems they’ve had.
The New York Times runs pro-con arguments about genetic testing data. Negative arguments: drug companies are paying 23andMe big money to get their hands on test results, genetic testing is a minor disease predictor compared to lifestyle choices, DNA information could be hacked for manipulating crime scenes or medical records, and laws against genetic discrimination need to be strengthened. Positive arguments: shared data speeds up healthcare research, technology can protect the data, companies making millions from selling data should buy insurance of $500,000 per user since they claim the breach likelihood is low and if that’s true the insurance should be inexpensive.
Patient information in Minnesota’s doctor shopper prescription database was accessed hundreds of times by a former insurance company nurse after the state forgot to revoke his credentials when he was reassigned. The nurse was previously disciplined by the state nursing board after admitting to stealing narcotics from two hospitals, a fact the state says they were unaware of even though his record is in a public database. He still works for Blue Cross Blue Shield.
Technology
Antivirus maker AVG debuts prototype infrared LED privacy-protecting glasses that prevent facial recognition systems from identifying their wearer. The company says “invisibility glasses” are a valuable privacy tool because candid smartphone photos are often posted to Facebook, Google’s StreetView puts identities in the public domain, and Facebook’s DeepFace can match up different photos of the same person with human-like accuracy of greater than 97 percent.
Other
Texas Health Resources nurse Nina Pham, who contracted Ebola in the Thomas Duncan case, sues her employer for negligence, claiming lack of training and violations of her privacy that made her “a symbol of corporate neglect – a casualty of a hospital system’s failure to prepare for a known and impending medical crisis.” She says she told THR not to release information about her when she was hospitalized, but a doctor recorded her on video using a GoPro body-worn camera and released it publicly, with her attorney claiming THR “used Nina as a PR pawn.” She also claims THR announced her condition as “good” while simultaneously counseling her on end-of-life decisions as documented in the EHR. Her attorney has a history of successfully suing THR and other hospitals for her $750 per hour fee and has hit defendants with $675 million worth of settlements and verdicts in the past five years.
Named to the Forbes list of 2015 billionaires from healthcare IT are Patrick Soon-Shiong of NantHealth (#96, $12.2 billion, although he made his money from pharma), Judy Faulkner of Epic (#663, $2.8 billion), Neal Patterson of Cerner (#1006, $1.9 billion), and Cliff Illig of Cerner (#1605, $1.2 billion). The list omitted Terry Ragon of InterSystems, who should be worth about the same as Patterson and Illig based on previous reports. Elizabeth Holmes, founder of lab provider Theranos. is the youngest self-made woman at 31 years old (#360, $4.5 billion). Your best chance by far of being one of the world’s richest people is inheriting $40 billion each in Walmart money as did the four Waltons who hold spots in the top 12.
A note to PR people: they say there’s no such thing as bad publicity, but that might not hold true when a press release misspells the company’s name.
Chuck Denham, MD, the former co-chair of a National Quality Forum patient safety panel charged with taking $11 million in CareFusion bribes to have its product added to national standards, settles with the Department of Justice for $1 million. At least he sold his integrity for a great price, netting $10 million after expenses. Meanwhile, briber CareFusion settled last year for $40 million and it’s still a $12 billion market cap company whose shares have risen 50 percent in the past year. Anyone who says crime doesn’t pay needs to get into healthcare.
A Wall St. Journal article titled “The Next Marketing Frontier: Your Medical Records” highlights the alerts and reminders sent to patients in Practice Fusion’s EHRs, with some of those messages paid for by drug companies. Practice Fusion’s CEO defends the practice, saying that with regard to the alerts and presumably the company’s free EHR, “someone has to pay for it” and adds that new agreements have been signed to deliver sponsored alerts from Aetna and another drug company. He also states, “For every project we do that drives forth public health or gives data away, we need to make sure it’s balanced out by a monetizable exercise.”
The Wall Street Journal highlights a Health Affairs-published study that found major inconsistencies in the “best hospitals” lists published by four sources (US News & World Report, Consumer Reports, Leapfrog Group, and Healthgrades). Only 10 percent of the hospitals that were highest rated by one service received an equally high ranking from even one of the other three, while 27 hospitals that were named among the nation’s best by one service were named as among the worst by another (UCLA’s Ronald Reagan Medical Center being an obvious example). Lead author Peter Pronovost, MD, PhD says just about every hospital tops somebody’s list and urges better methods “so it isn’t just a beauty pageant.”
Sponsor Updates
Impact Advisors publishes a white paper titled “Selecting a Population Health Management Vendor: Taming the Wave.”
PatientSafe Solutions posts “Quality care and Mobility: Case 2.”
Caradigm is participating in the iHT2 CHIME & Health IT Summit through March 4 in San Francisco.
Aventura and Bottomline Technologies are exhibiting at the Spring Hospital and HealthCare IT Conference through March 4 in Orlando.
CareTech will host the New England HIMSS & Social Networking event March 10 in Warwick, RI.
AirStrip writes about “Bringing Up Baby: the Value of Remote Monitoring for High-Risk Pregnancies.”
CMS publishes a report measuring progress made on quality measures since 2006, finding that improvements have been made in 95 percent of the 119 publicly reported performance measures reviewed.
Allscripts and NantHealth will partner to develop genome-based clinical decision support features within Allscripts’ EHR that will help oncologists create personalized cancer treatment plans.
AMA applauds CMS’s decision to extend the MU attestation deadline for eligible providers, but complains that even with the extension the program is too rigid and still needs to be overhauled.
I received an email from ONC on Thursday that they were extending the deadline for nominations to the HIMSS Interoperability Showcase, citing “feedback that organizations needed more time to submit nominations for participation.” From the time the email arrived, that’s a whopping three business days until the deadline. It made me wonder exactly why the deadline was extended and what their current applicant pool looks like. If they were delaying because they didn’t have many applicants, then they hardly gave much of a window for organizations that weren’t already prepared. Was the announcement a way to raise awareness about the Showcase rather than being designed truly to solicit participants?
Perhaps organizations didn’t apply because they didn’t want to spend $8,000 to participate. That’s just for the kiosk at the Showcase, which includes a monitor, keyboard, mouse, power, and Internet connectivity as well as two exhibitor badges. Travel, meals, and lodging will be on top of that. We’re doing some cool things with interoperability at my health system, but they’re not about to spend upwards of $12K for developers to go show it off at HIMSS.
Whatever the reason, I can’t help but think about the ongoing list of government initiatives that have to be delayed, extended, or otherwise modified because they don’t seem to be achieving the desired results. Being a process improvement person, I’m always looking for the root cause when outcomes are not achieved or when projects run off the rails. Recently, we’ve had delays in ICD-10, Meaningful Use, and Healthcare.gov. Some of us, however, remember delays in the implementation of the 5010 claim standard and those of us deep in the weeds know about dozens of lesser-known parts of HIPAA and other omnibus legislation that are virtually unimplementable.
In medicine, we have a doctrine about ordering laboratory and diagnostic tests: don’t order it if it’s not going to change your plan for the patient. I do a lot of work with reporting from our EHR data and we have a similar dictum: don’t run the report if you’re not equipped to act on it. You’d think there would be a similar mantra about not making rules that people can’t actually follow, but that doesn’t seem to be a factor for those happily engaged in rulemaking. Only in healthcare do we come up with creatures like the “Two Midnight” rule and other similar nonsense.
My extended family is always asking about some of the wacky things that go on, such as provider-based billing, which allows hospital-owned practices to charge both a professional fee and a facility fee for outpatient visits. I’ve become as expert at explaining the Medicare Part D “donut hole” as I am at teaching patients to use a home blood glucose monitor. In trying to find some method to the madness, I stumbled on an article that attempts to explain why healthcare regulation is so complex. The first paragraph opens with a perfect summary: “Health care professionals may feel that they spend more time complying with the rules that direct their work than actually doing the work itself.”
The author contends that “regulation arises largely from a set of confrontations between opposing interests that created the system.” I agree that there are clashing agendas and learned that first hand as a young physician when the hospital’s chief of staff wanted to know why he wasn’t getting my referrals. It felt more than a little like a shakedown. He wasn’t aware that I sent nearly all of my referrals in his specialty to one of his partners, so at least his practice was seeing volume if he wasn’t personally. It didn’t matter, though, since it was apparently all about his ego. These conflicting agendas are ongoing, and “Doctored: The Disillusionment of an American Physician” talks about one physician’s struggle.
Although there are certainly turf wars at play, the regulatory soup includes rulemaking at so many levels that it’s nearly impossible to keep track of what needs to be done. I have to follow the rules of multiple hospital medical staff organizations, two state licensing boards, two specialty certification boards, one professional society, dozens of payers, the city, the county, the state, and the federal government. These rules (and non-rules that often have the force of law) sometimes conflict each other and often fail to make sense.
Several times in the last few decades, studies have looked at everything a primary care physician should be doing for his or her patients and how long that would take. An article in the Washington Post summarized the most recent data from the Annals of Family Medicine, which found that for a typical panel of 2,300 patients, the physician would have to spend nearly 22 hours a day to provide all the recommended care. That’s just delivering the care itself – it doesn’t factor in the time needed to comply with everything else a physician does such as arguing with payers, managing staff, dealing with regulations, worrying about compliance with programs, and trying to stay current with medical knowledge.
That’s what we’re dealing with in the ambulatory setting. Hospitals and health systems deal with many more rules and countless regulatory bodies. Similarly their IT departments are trying to keep the systems up and running, prevent breaches, avoid breaking something that’s required for Meaningful Use, and so on. It’s no surprise that people are not coming out of the woodwork to sign up for the Interoperability Showcase.
What regulations keep you hamster wheel spinning? Email me.
We’ve been around since 1996. The vision of the company is that providers should be in charge of how healthcare is delivered, and for them to be in charge, they have to be at risk financially. Our job is to help provider organizations decide on the level of risk, help them figure out how to organize around the risk, and then manage the risk.
We have products around analytics. We operate all the way to a provider-sponsored health plan. We manage those things, so we pay claims, we do care management, customer service … all the functions you would do to run a health plan. It’s moving groups through the value-based care spectrum to any level of risk that they want to be.
How do you think HHS’s seemingly ambitious goals in moving quickly toward value-based payment will go?
I think it’s good. The general issue for us has been that their approach to doing training wheels was a problem. The old version of the shared savings models — we don’t think they were good enough or strong enough. They tried getting into risk, but what’s happened is those organizations – from funding it and actually operating — are finding they are not being successful, most of them, and they just need to assume more risk. We would like to see more risk in those rather than less risk. We think the moves that they’re making now make a lot more sense.
Insurance companies and doctors have always been blamed for healthcare costs, but people are recognizing that hospitals and their increasing clout in driving favorable contract terms are a lot of the problem. Do you see HHS or CMS addressing the cost role of hospitals?
It’s interesting because the hospitals can play a major role in this if they do it right. You’re right that if they get market share, they certainly can drive pricing from that perspective. But I think if you get into more risk, where you’re actually getting a PM/PM amount, the hospitals are a large part of the cost and they’re going to be the organizers.
Hospitals should play a major role, but it’s not on a fee-for-service basis. They’re the ones who can organize the doctors and pull together an organization that can assume the risk, so I see hospitals having a major role. The market share issue is an important one, but if you’re getting into competitive PM/PM insurance-type rates, that’s where you need to go with this.
Back in the HMO days and attempts at moving to a capitated model, assembling risk pools that made actuarial sense was also politically awkward because you had to decide who you could afford to cover. If you’re a hospital and you’re trying to figure out the steps toward accepting risk, how do you define and measure your risk for the population that you have?
We still have conversations with some insurance companies that are saying, I get a PM/PM and I want the healthy people, I don’t want the sick people. I think that’s what you’re getting at. From a risk entity perspective, as provider groups get into risk, the population that really needs to be taken care of are those more expensive people.
What we need to do is make sure that the PM/PM that we’re getting for that population is the right PM/PM. That was a problem in the old models. You had in a market where say the commercial PM/PM was $200 and you had an academic medical center taking in a population and got adverse selection, their cost might have been $300 PM/PM. We need to make sure that for the population that you’re responsible for, we’re looking at the dollars that are being spent on that population, then managing for that as compared to the old insurance model. That’s an important element of this.
Nobody wants the high-cost patients, but it’s not usually acceptable to charge those patients more. How many ways can the buck be passed?
Somebody is paying for it now, right? Those people are getting coverage, or they’re not getting coverage and they’re just using the ERs and hospitals to get their care. It’s recognition of that population and making sure that they have coverage. There’s great opportunity to manage that population better than it’s being managed now and the overall dollars will go down.
You just need to make sure you tie the actual expense for an individual, so if X-person costs $1,000 PM/PM, that should be the basis for the risk of that particular patient or that particular population. You need to tie the cost of the person to the actual risk that you take, or the cost of the population to the risk that you take, as compared to saying, “The overall population is $200 PM/PM, so let me try to get all the people that are $100 and leave the $300 people out.”
Somewhere, that $300 person is getting healthcare. We just have to do a much better job of making sure that the dollars that we’re spending per person is where you take on the risk for that population at that dollar base.
As health systems and insurance companies start looking more alike, what technologies and information do each have that the other needs?
From a health system perspective, very few have the technology and the information to actually manage the population. A hospital has its information and each individual physician may have his or her information. The hard part has been aggregating the data for a population.
If you take any given market, you probably have some physicians that are employed by a hospital, you have independent physicians … they all have different EMRs and different practice management systems. One of the keys is data aggregation. Maybe 10 years from now it will be different, but right now the key is tying all those systems together into one platform. It sounds like an HIE, but it’s the analytics behind that data that becomes important. There’s got to be ways of collecting that data from everybody and then doing the analytics around that. It’s the pharmacy data, it’s the lab data. There may be 300 different practices that may have 70 different practice management systems and EMRs.
You’ve got to be able to tie that data together to do the analytics. To me, that’s the biggest gap that exists today — pulling that data together, figuring out what it’s actually costing for that population, and managing that data to manage the care better for that population.
What health system metrics will be important to monitor for long-term success?
Today they’re focused on a patient entering their system and how they manage that patient who’s sick. They have to move to a higher level of managing the population as a whole. They’ve got to get a whole different level of data.
Once you’re within a system and you’ve determined how care should be provided for that population, you now have to determine if the services that are needed are actually getting done within that village. If you have multiple health systems in a marketplace, which is usually the case, how do you make sure that the services are all getting done, especially if people leave the system? The physicians in that particular organization have agreed on how care should be provided. You need to push those services to within that organization and make sure that you’re tracking it and making sure things are getting done.
If a diabetic is supposed to get an eye exam, we need to make sure that the eye exam is done by the ophthalmologist that’s in the network and not outside the network, because if it’s done outside the network, we probably don’t have that information. It gets back to the data aggregation piece and managing the population as a whole.
Explain what “narrow network” means.
I think of it as a village of hospitals and physicians that have come together to agree on how care should be provided and agree on the level of risk that they’re going to take. Do they become a health plan, do they just do risk contracting with health plans, do they do a combination of things? It’s that organization that’s made that decision and then it’s got it technology that it needs to manage that in its operation.
What’s really important is that you don’t separate the technology from the operations. There are a lot of smaller technology firms or single-source technology firms that are doing one piece of this thing. But there really needs to be an overarching perspective on how the technology relates to the actual performance on these risk contracts. There’s operational pieces, there’s technology pieces, and then there’s just network development pieces.
For people on the IT side, the biggest thing is around data aggregation, the management of that data overall, and how that helps the operational people succeed in making sure that you’re caring for that population as best you can so you’re managing that population and the best quality of care is given at the lowest possible cost. Getting that information that’s not just from the hospital, but from these other independent sources, and getting it on a daily basis so that you can track what’s actually going on and manage the population going forward and helping your physicians and their practices figure out what needs to happen in the next six months with a population of people.
Do you have any final thoughts?
The main thing to me, and one of the things that I hear in the marketplace, is that as a health system doing this, you have to be really big. I don’t think that’s the case at all. There is a certain life threshold that you need to manage and there’s no question about that, but that life threshold doesn’t require you to be a mammoth system at all.
Groups, provider organizations coming together to cover a state is certainly an approach to do this, but again, I don’t think you need to be a 5,000-bed system in a particular marketplace. You don’t want to be a 50-bed hospital. There’s a certain size that you need to be to do this, but it’s not huge.
The level of risk for a provider assuming risk is very different than the level of risk for an insurance company to assume risk. If you’re UnitedHealthcare and you have a patient in a hospital and that patient cost $50,000, UnitedHealthcare has a direct expense of $50,000 for that patient. Now you take a health system that has that same patient in their hospital, what does it actually cost that health system to provide care for that patient? Eighty percent of the costs in a hospital are fixed. It’s much less costly for them to assume that risk as long as the care stays within that network. If it leaves the network, they have the same situation as United has. But as long as they stay within the network, it is much less risk for a health system to assume risk.
Another way to say that would be, if you’re a billion-dollar health system and I told the CFO tomorrow they were going to get a billion dollars in revenues next year, would they assume that’s more risk or less risk? I would say that everyone would say that it’s less risk. That’s full capitation from that standpoint. The concept of risk on the provider side is much less risky.
Comments Off on HIStalk Interviews Phil Kamp, CEO, Valence Health
Oracle escalates its legal battles with Oregon over the failed insurance exchange it was hired to develop by filing personal lawsuits against five Oregon campaign advisors to the state’s former governor, saying that they worked behind the scenes to kill the site for political reasons.
Allscripts CEO Paul Black acknowledges that the company is disappointed in its year-long revenue, citing lower patient portal sales and overall client fatigue driven by MU as primary reasons for sluggish sales.
Banner and the University of Arizona Health Network complete their merger. No decision has been made over whether UA will be allowed to keep their brand new $100 million Epic system, which experienced go-live delays and cost over-runs, or if they will be migrated onto Banner’s Cerner system.
A patient’s spouse writes an open letter calling out Rideout Health (CA) CEO Robert Chason for publically claiming that a recent EHR system failure did not result in patient harm. In the letter, a spouse states that his wife was treated at Rideout during the unplanned downtime and was sent home because test results indicating that she had a minor heart attack did not make it back to her cardiologist until two weeks after she was discharged. Hospital representatives contacted her to schedule additional tests and told her that the delay was caused by the EHR system crash.
Oregon and Oracle keep suing each other over the state’s health insurance exchange and its Medicaid system, but now Oracle takes things to another legal level as it files personal lawsuits against five staff and campaign organizers of former Governor John Kitzhaber, who Oracle warns may also find himself sued shortly. Oracle says the five were politically motivated in trying to shut down Cover Oregon and then blamed Oracle as a smokescreen.
Reader Comments
From Lab Retriever: “Re: microbiology interfaces. I’m looking for something that will interface with our three blood culture instruments – Bactec, VersaTrek, and BacT/Alert – to get the data into our LIS.” My first thought was Data Innovations, just acquired by Roper Industries and paired up with Sunquest, but I’ll invite more knowledgeable readers to offer their suggestions.
From Maple HIZZ: “Re: University Health Network, Toronto. Not proceeding with their HIS replacement project in which Epic was the preferred vendor due to the $600 million cost, including interest. Annual operating expenses are projected to be an additional $50 million per year even when legacy IT systems are sunset. Glad to hear that UHN decided not to write the cheque and spend taxpayer dollars wisely.” Unverified.
From Interoperability Blues: “Re: SMART project. Every vendor talks a big game about interoperability, but the public availability of C-CDA samples for each vendor is non-existent. The SMART project gathered several, but you will notice one major vendor is missing and most vendors provided only one or two. If there were thousands of C-CDAs available, the gaps would be more clear. Heck, it would even be helpful if all vendors just posted what they used to get through certification.”
HIStalk Announcements and Requests
Two-thirds of poll respondents say Epic’s App Exchange is a PR move to support its DoD bid. New poll to your right or here: is a health system CIO’s article or presentation always more believable than that of a vendor VP? Surely your vote deserves clarifying comments (which you are welcome to add).
Attention HIStalk sponsors: we’ve made contacts about attending the sponsor networking reception event Sunday evening of HIMSS week in Chicago, but have received few RSVPs. Contact Lorre if you want to meet your industry peers and enjoy great food and drinks. Otherwise, I may just start inviting random readers since I’m stuck paying the facility’s minimum anyway.
Our five patient advocate scholarship winners (along with Regina Holliday) have run into a HIMSS snag. They had anticipated that Chicago hotels would be expensive and planned to share a room to minimize cost, but they are now finding that availability is nearly non-existent. Let me know if you have ideas of a place that would be available for at least Sunday and Monday nights – I’m thinking perhaps someone’s occasionally rented apartment. They are even exploring couch-surfing options, so they could use some help. We’re checking VRBO and Airbnb.
I swear I’m going to throw up the next time some inspiration-impaired “thought leader” tries to draw parallels between anything healthcare-related and Uber. Or for that matter, who can’t come up with anything more original than drawing strained healthcare inferences from the death of Leonard Nimoy or something else they saw on TV. As Mark Twain said, “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.”
I say a lot of good things about Walgreens, but here’s a first-person “fail” experience. I had to switch pharmacies because of an insurance change and was initially thrilled at the apparent ease of transferring prescriptions to their store using its cool-looking app. Upon my first attempt at getting the prescription filled, it wasn’t on file there when I called for some reason, so I made another request via the app – it looked successful and the app told me to pick up the prescription any time after 2:00. I showed up at around 2:45 and the pharmacist on duty got snotty, saying he had been too busy to call the other pharmacy, that “the computer doesn’t work back here” in flatly declaring that the stated 2:00 time wasn’t his problem and he’d get around to it whenever he could because he was backed up with both in-store and telephone to-do items. He then suggested going back to the competitor’s pharmacy and paying cash since it would be faster. The pharmacist promised to call me when the prescription was ready – it’s now 24 hours later and nobody has called, but I drove to the store and it was ready. Lesson one: it takes only one unpleasant personal experience to wipe out a lot of corporate-level goodwill. Lesson two: the technology isn’t impressive when the people aren’t (I bet the store cuts staffing to the bone since he seemed to alone behind the counter). Lesson three: shop around (as I did) before buying electronic items at Walgreens since the Sony earbuds I was about to pick up for $20 were only $12.99 on Amazon and even better ones were just $5.99.
Last Week’s Most Interesting News
CMS reports that it correctly processed 81 percent of ICD-10 claims in its most recent testing round and says it is ready for the switch.
Merge Healthcare acquires DR Systems.
New York’s mandatory electronic prescribing date of March 27, 2015 will likely be delayed for a year, with only the governor’s signature remaining to make it official.
The FBI says it is close to identifying those responsible for Anthem’s breach.
Cerner offers voluntary separation to its older employees.
CTG says its services business is suffering as the EMR market cools.
A study finds that Googling medical terms sends personal information to third party websites 91 percent of the time.
A delayed $670 million EHR implementation in British Columbia involving IBM, Deloitte, and Cerner is rumored to be headed toward arbitration.
Webinars
March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.
March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
CEO Paul Black says Q4 sales were down due to lower patient portal sales driven by Meaningful Use Stage 2 timing.
Black says the company is disappointed both with its year-long revenue as well as the unrealistic Wall Street expectations the company allowed to be created.
The company will collaborate with MaineHealth on population health management projects.
Allscripts says that Meaningful Use Stage 2-required upgrades have caused client fatigue, with many of those clients deferring other upgrades.
When asked about the “barbell” effect in which Allscripts ambulatory clients either love or hate their products, Black says the company is offering them everything they need to manage populations and accept risk and that attrition won’t have a huge impact.
Black says the company loses clients to acquisition-related system replacements or a missed deliverables, but the list of reasons it loses a customer is a lot shorter now than than when he was hired two years ago.
Black said of the performance of the company’s professional services work, “Nobody’s pleased with it and we do still have some work to do. We’ve changed some of the talent that’s managing that organization.”
The company quoted KLAS numbers indicating that 453 provider organizations will buy acute care systems in 2015 and that Sunrise is “overlooked” despite being more competitive than when he was hired.
CEO Justin Dearborn says the acquisition of DR Systems gives Merge the #1 KLAS-ranked solutions in cardiovascular information systems, hemodynamics monitoring, and radiology information systems and consolidating providers want to deal with fewer vendors.
The company believe that attention will swing back from Meaningful Use and ICD-10, releasing pent-up demand for other solutions.
Merge put the DR Systems deal together so quickly that its debt holder didn’t have time to perform due diligence and DR Systems was reluctant to share information with competitor Merge, so if the due diligence doesn’t pan out, the company will have to find alternative financing to close the deal, “which could be challenging.”
The company expects to see opportunities given that providers who are going at risk know that a significant portion of unnecessary and redundant healthcare spending is related to imaging.
People
Vanderbilt University Medical Center promotes Titus Daniels, MD, MPH to executive director of Vanderbilt Medical Group and COO for adult clinical operations at the hospital. His new responsibilities include clinical documentation and coding and EMR design, adoption, and support.
Rex Adams (Children’s Healthcare of Atlanta) joins PaySpan as CEO.
Leidos Health hires Douglas Herr (Logic Healthcare) as VP of its Epic practice.
Announcements and Implementations
ADP AdvancedMD offers the free “ICD-10 Toolkit” app.
American Family Children’s Hospital (WI) is piloting Epic’s MyChart Bedside. The tablet-powered app providers patient-caregiver communication, a scheduling display, and the display of EHR information.
Privacy and Security
Security experts at ThreatConnect say evidence from the Anthem breach suggests that a Chinese espionage group is responsible. “They made an effort to hide, but they messed up,” says one of the experts, who also implicated a Chinese university professor who works with a China-based government contractor.
Technology
HP is rumored to be close to acquiring Aruba Networks, with speculation of a Monday announcement.
Other
Central Peninsula Hospital (AK) will replace its “clunky” Meditech system with a new system from Meditech, Cerner, or Epic. They’re planning to spend $5 million to $15 million.
Texas-based for-profit hospital operator University General Health System files Chapter 11 bankruptcy, blaming poorly chosen acquisitions and unfavorable managed care contracts. The hospital’s website shows plush facilities and boasts that it provides “exceptional personalized care in a luxurious, five-star environment” and declaring that its sole hospital of 69 beds offers “private rooms, where meals are served on fine china, comfortable, flat screen televisions, oil paintings, wood accented and marble flooring all compliment the hospital room, while a baby grand piano and soothing waterfall with valet parking greet each patient and guest.” Shares are trading at $0.004, having dropped 76 percent after the announcement. The corporation is run by pain management anesthesiologist Hassan Chahadeh, MD.
Banner Health was set to take over Tucson’s University of Arizona Health Network this weekend, prepending “Banner” to UA’s existing hospital names and most likely thinking about replacing UA’s Epic system with Banner’s Cerner one. The money-losing UA spent $115 million on Epic through June 2014, of which $32 million was unbudgeted due to a go-live delay. At the time, UA said installing Epic was “the biggest operational change this organization has every undertaken,” possibly failing to foresee that just a few months later, UA’s red ink would force it to sell out to Phoenix-based Banner. Every hospital operator should want to buy an academic medical center – easily identified waste and bureaucratic incompetence fertilize a lot of low-hanging financial fruit.
A letter to the editor by a patient of Rideout Health (CA) accuses the hospital’s CEO of lying when he claimed that its recent computer downtime caused no patient harm. The man says his wife had a cardiac test whose results indicated a possible heart attack and the need for intervention, but she didn’t receive them until two weeks afterward because of the computer problems, the hospital person told her.
The local North Carolina TV station profiles the use by Vidant Health and ECU Physicians of Epic’s Canto and Haiku mobile apps to share information.
A Florida nephrologist is accused of inappropriately touching an elderly patient, who explained that he had no reason to touch her since all he does during her visits is to read her kidney function levels to her from his computer.
The State of Washington indefinitely suspends the medical license of an anesthesiologist who repeatedly sent sexually explicit text messages during surgeries, used medical images for sexual gratification, texted a nude selfie to a patient, and had sex on the job.
A posthumous Los Angeles Times editorial by reporter Laurie Becklund, who died last month of metastatic breast cancer, says to forget Susan G. Komen-type “cures” and expensive pink ribbon awareness campaigns and instead treat every patient as a one-person clinical trial and store their information in a cancer database to which both doctors and patients can contribute.
Surely this is either a hoax or massively wishful thinking: a surgeon in Italy says he’s just two years away from being able to plant a person’s head on a donor body. Somehow I don’t think insurance companies are going to pay for that.
Sponsor Updates
Zynx Health VP of Clinical Informatics Victor Lee, MD writes about “Medicare Reimbursements for Value.”
ZirMed will exhibit at the Pay for Performance Summit March 2-4 in San Francisco.
The Sandlot Solutions-powered MetroChicago HIE reaches 1 million patient records.
Tamara St. Claire, chief innovation officer for commercial healthcare at Xerox, offers a recap of the company’s recent presentation on patient engagement.
Frisbie Memorial Hospital Healthcare Project Director Sally Gallot-Reeves, RN writes about “Achieving an 82% ROI with smartphones” in the latest Voalte blog.
VitalWare President and CEO Kerry Martin will speak at the HCP Hospital and Healthcare IT Conference March 3 in Orlando.
Verisk Health creates the Idea Hub, a virtual library that collects the company’s research, solution information, and social buzz.
ZeOmega Chief Strategy Officer Nandini Rangaswamy defines population health management in the first of a blog series.
Merge reports Q4 earnings: revenue remained flat at $53 million, EPS $0.02 vs. $0.00, missing analyst’s expectations for both. The company also announced that it has acquired medical imaging vendor DR Systems for $70 million.
In Australia, the nation’s $800 million Personally Controlled e-Health Record project is still sitting unused three-years after its launch. Just 10 percent of the general public has a medical record on the system.
I literally had almost 100 people forward me news articles about the CMS announcement pushing the Medicare Meaningful Use attestation and PQRS reporting deadlines to March 20. Although no specific reason was announced, possibilities include winter weather emergencies, the fear (or reality) of attestation site glitches, the complexity of preparing reports and audit documentation, and lack of vendor readiness as possibilities. Buried below the fold of several articles was the fact that this does not impact the Medicaid Incentive Program, so I hope those practices realize they’re still on the hook for the original deadline.
The hideous cold and repeated snows pounding a good chunk of the country have put a cramp in the style of many fitness enthusiasts. Although I once had a serious dislike of treadmills in general, I’m glad that I finally got one at home at least to be able to get some miles in despite the cold. I might have been more fond of treadmills sooner had I known about iFit, which allows compatible fitness equipment to automatically deliver uphills and downhills to match real-world routes while showing pictures from Google street view.
I’ve now run through Ireland, Paris, Norway, and my own neighborhood and definitely like it better than the standard programs on the treadmills at the gym. Once people’s New Year’s resolutions start failing, used equipment will start popping up for sale and I’m glad I have something to talk about with patients who think walking on a treadmill is boring. I also found a National Geographic “Everest” video workout on the site and although it bested me the first time, I’ll be back for more. Having the ability to track and quantify my efforts to stay in shape has been a benefit for me, although I draw the line at sharing every workout to Facebook.
A reader who has picked up on my running habit shared these high-tech socks from Sensoria that use sensors and conductive fibers to gather information about a runner’s speed, distance, steps, and how their feet strike the ground. They debuted at the recent Consumer Electronics Show and are from the same people who brought us shirts and running bras to sync with heart rate monitors. A magnetic anklet communicates with Android and Apple devices to provide real-time feedback. I’m not sure I want my socks to coach me and they aren’t cheap, so I think I’m going to take a pass this time. I do enjoy reading about wellness-related tech, so keep sending your finds.
I do some volunteering at a local school and they asked me to speak at an upcoming career day. When I get requests like that, I always have to ask whether they want me to talk about my “doctor job” or my “computer job” or both. When I decided to become a family physician, I never imagined myself on the cutting edge so I was happy to come across this piece on physician informaticists to help explain exactly what it is that I do all day. Apparently UCLA is thinking outside the box and is making their informaticists available for consultation with other Epic customers. It looks like a win-win situation to me – in addition to assisting other organizations, their team can also bring back successful approaches from other sites.
NCQA is offering the opportunity for the public to provide feedback on proposed change to 2016 HEDIS measures. There are a handful of proposed new measures and changes to several existing ones, so plan to get your comments in before the March 18 deadline.
Speaking of deadlines, Friday is the cutoff for HIMSS hotel changes. I’m mixing it up this year and staying somewhere swanky with a couple of my gal pals since I was able to get ridiculously cheap airfare. Although registration for HIStalkapalooza is closed, I know Mr. H is poring over the guest list and I’m looking forward to seeing many of you there (anonymously, of course). The event is one of the most fun parts of being on the HIStalk team, although I am feeling the pressure when it comes to finding a pair of outstanding shoes. Maybe Sensoria should make an insert to gather data on what happens to the feet of fashionable ladies and gents out for a night on the town.
Have you put together your HIMSS wardrobe plan yet? Email me.
Merge Healthcare announces that it has acquired DR Systems for $70 million.
Reader Comments
From Weapons of Mass Distraction: “Re: DoD EHR bid. Pretty sure Epic has already won and that’s been known to insiders since back in January. Not saying that as an Epic advocate, just saying it because this process of press releases, vendor elimination, etc. reminds me of watching a movie my friend already told me the ending of.” DoD is planning to announce the winner in June, so they should be far along in the process. Maybe an anonymous expert can help us understand what should be going on behind the scenes right about now.
From Mad City: “Re: Epic’s AppExchange. It’s funny that so many respondents in your poll believe it’s related to the DoD bid when it’s been discussed in Epic user groups for years and was announced last fall at UGM.” My sources say early adopter customers have already completed the paperwork and submitted their items, with developers coming up next once Epic locks down processes to review security and handling of PHI and most likely figuring out how to support turnkey installation. They’re working with Apple to understand the best ways to run an app store. Epic didn’t announce the AppExchange – sites picked up as “news” a third party’s comment about it that was followed by Epic’s confirmation of its plans, but customers have known about AppExchange for many months.
From Clinic Director: “Re: Meaningful Use audit hell. We started receiving pre-payment audits for MU in early January, with 96 requests for 139 providers. So far we have been able to pass all of them, but the amount of work necessary to provide the requested additional data has been a huge burden. So much so that we are unable to configure our system to start seeing how we are doing in 2015. In looking at the Epic user web, there are A LOT of other organizations experiencing the same thing. It is certainly a focused effort by the government to delay the payments and look for all options to penalize 2016 reimbursements for Medicare. This is ridiculous.”
HIStalk Announcements and Requests
This week on HIStalk Practice: MGMA welcomes new CEO. Physicians balk at the not-so-hidden costs of interoperability. Rock Health breaks down telemedicine. Illinois Telehealth Initiative launches at Matter Chicago. Practices worry payers won’t be ready for ICD-10. Partisan bickering stymies healthcare cost transparency efforts in New Mexico. Horizon House and Tidewater Physicians implement new HIT. Thanks for reading.
This week on HIStalk Connect: The FDA relaxes its regulatory oversight on personal genetic tests and clears 23andMe to resume marketing some genetic screening tests. DARPA announces that it is working on an implantable computer chip that will deliver headset-free augmented reality. TraceLink raises $20 million to bring serialized tracking to the pharmaceutical supply chain.
I was thinking about how EHRs are blamed for turning previously interactive doctor-patient conversations into form-filling exercises, where not only are physicians forced to restate their complex thoughts as fill-in-the-blank items, but even patients themselves are forced into that same mode by the doctor who just wants to feed the EHR screen’s demands and steers the encounter accordingly. Studies show that doctors interrupt patients quickly and often, which I suspect is due not only to the short encounter time allotted, but also the doctor’s need to complete forms (it’s like your tax guy – he wants documents and short answers rather than a deep financial discussion because he’s sitting in front of federal tax forms, not a freeform word processor). We’ve devalued the rich, nuanced doctor-patient conversation into a mutual form-filling exercise, which probably seems ideal to everybody except doctors and patients. I like the idea of having the patient complete intelligent questionnaires before the visit starts and send that information to the EHR to reclaim some of the lost encounter time for less-discrete activities.
Webinars
March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.
March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Here’s the video of the “Cloud Security Primer” webinar that was presented by Sensato CEO John Gomez last week.
Acquisitions, Funding, Business, and Stock
Merge Healthcare announces Q4 results: revenue flat, EPS $0.02 vs. $0.00, missing expectations for both. Shares dropped 12 percent Thursday following the announcement before the market opened. Above is the one-year MRGE share price chart (blue, up 57 percent) vs. the Nasdaq (red, up 16 percent).
Allscripts announces Q4 results: revenue down 3 percent, adjusted EPS $0.09 vs. $0.08, missing revenue expectations but meeting on earnings. Above is the one-year MDRX share price chart (blue, down 31 percent) vs. the Nasdaq (red, up 16 percent).
Orion Health opens an office in Glasgow, Scotland. The company also begins hiring another 100 people for its Scottsdale, AZ office.
Sales
Tidewater Physicians Multispecialty Group (VA) chooses Lightbeam Health Solutions for population health management.
GetWellNetwork announces several sales of its recently acquired Marbella data collection product.
In Australia, Cerner wins a New South Wales tender for a medication management system for Millennium-using hospitals. Districts that don’t use Millennium, such as those that use Orion Health, will be able to choose a different system.
People
Cureatr names three vice presidents: Kent Hiller (Indiana HIE), Karl Kiss (InteHealth), and Jay Smith (Sparta Systems).
Joining PerfectServe are Terry Hayes, RN, MSN (OptumInsight, above) as VP of client experience and Michelle McCleerey, PhD, RN (TeleTracking) as VP of product marketing.
Announcements and Implementations
SRSsoft launches its Essentials EHR for specialists and new EHR users, labeling it as “an alternative, non-MU EHR” that allows users gain benefits without having to change the way they practice.
InterSystems releases Cache’ 2015, which doubles the scalability of previous releases. Epic benchmarked the new release and was quoted positively in the announcement.
Convurgent Publishing releases the third edition of “Clinical Integration: Population Health and Accountable Care.” One of its editors is Divurgent CEO Colin Konschak.
Caradigm will include Cohort Designer in implementations of its Caradigm Intelligence Platform.
Government and Politics
CMS extends the date for Medicare EPs to attest for Meaningful Use to March 20, 2015, giving providers an extra three weeks for unspecified reasons.
Netsmart executives are meeting this week with their Kansas legislators to discuss HITECH’s exclusion of behavioral health providers for Meaningful Use incentives.
It appears that New York’s mandatory e-prescribing scheduled for a March 27 live date will be pushed back a year, or at least that’s the impression from an email sent by Healthcare Association of New York State, which is pushing for the delay. The governor seems inclined to sign S.2486/A.4274 that has already passed both houses, which would reset the date to March 27, 2016.
The US Supreme Court rules that state professional licensing boards can’t use their authority to limit competition, finding that North Carolina’s dental board (made up mostly of practicing dentists) can’t prohibit non-dentists from whitening teeth since the board’s motivation was to protect the income of dentists rather than the safety of the public.
Massachusetts Governor Charlie Baker replaces the four of 11 board members of the state’s health insurance exchange that were appointed by his Republican predecessor, among them MIT economist and Affordable Care Act key player Jonathan Gruber.
CMS reports that it successfully processed 81 percent of 15,000 ICD-10 claims in a week-long test, with 6 percent rejected due to invalid ICD-9 or ICD-10 and 13 percent rejected due to non-ICD problems such as missing information or invalid service dates.
The FCC rules on an open Internet, banning providers from blocking content, throttling traffic, or prioritizing traffic to give higher-paying content sources a “fast lane.” Chairman Tom Wheeler said of the 3-2 vote, “The Internet is too important to allow broadband providers to make the rules.”
Privacy and Security
The FBI closes in on the Anthem hackers and is trying to decide how much information about them to reveal publicly. China-sponsored hackers are the likely culprit, but naming them would require technical proof that might compromise future FBI cybercrime investigations.
Innovation and Research
Facebook releases tools to support suicide intervention that will be used when a user reports seeing a troubling post.
Healthbox changes its accelerator model so that participating companies won’t have to give up equity and “studio programming” won’t require full-time participation.
Technology
LG announces a new smart watch that doesn’t require a cell phone running Android Wear – it will connect directly to an LTE network to play streamed music, make device-to-device voice calls, and make mobile payments.
Orion Health adds FHIR support to its Rhapsody Integration engine.
Other
Epic is named #7 of “The 11 Best US Companies for Students to Get Summer Internships,” although the listicle’s methodology is shaky (reading intern ratings from Glassdoor). Facebook led the list.
The Pew Charitable Trusts highlights New Mexico’s NurseAdvice telephone hotline that is free for all state residents, saying it keeps 65 percent of its 15,000 monthly callers out of the ED. The hotline also generates real-time public health data, with CDC recommending that other states adopt a similar model.
The bond rating agency of Baptist Health Care (FL) notes that the health system may borrow money to replace its McKesson Horizon system in 2016.
Sovita Chander was inspired by Ted Reynolds’ recent HIStalk article about healthcare delivery in Europe vs. the US and wrote a Canada-focused piece titled “7 Reasons Why Healthcare Companies Get Stuck at the Border.” Item #1: “Canada is 10 markets (plus three). Healthcare delivery is driven by ten different provincial governments (and three territorial governments serving a population of about 100,000), so you have 10 different sets of IT-related requirements, regulatory frameworks, and buyer landscapes to address. Sales cycles are longer in Canada than in the US. You have more hurdles, and you will go to RFP in some provinces on just a $25,000 deal.”
Aetna sues a for-profit 139-bed Texas hospital that takes in $1.5 billion annually, claiming that the physician CEO pays doctors kickbacks disguised as “ownership interest” and has overcharged Aetna $120 million in the past six years by treating patients out of its network. The hospital says a similar Aetna lawsuit against it has already been dismissed and that the company is trying to strong-arm providers into participating in its network.
In Australia, the local paper calls out the $800 million (USD) Personally Controlled e-Health Record (PCEHR) that has been live for three years with minimal use by doctors and patients. The government blames its predecessor opposition party for a rushed implementation.
Moffitt Cancer Center (FL) sues one of its surgical oncology residents over a Google Glass-powered tumor visualization tool he invented. The hospital says it made the doctor sign over his rights for anything he developed while working there, but he reneged on the deal while filing for a patent. Since then, the resident and his partner formed a company and then sued the hospital for demanding credit for an invention in which it wasn’t involved.
Google buys 70 iPads for MUSC Children’s Hospital (SC) so that hospitalized children can use Google Hangouts to video chat with friends and family.
New York City eliminates a nearly universally ignored requirement that parents sign consent forms before their newborn boys undergo “oral suction circumcision,” an Orthodox Jewish ritual in which mohels suck blood from a baby’s circumcision wounds. Mayor Bill de Blasio says the consent requirement was offensive to some community members even though 17 babies have contracted herpes from the procedure and two of them died. The agreement requires mohels suspected of infecting babies to undergo DNA testing, although in previous incidents parents refused to name the person involved and parents can’t avoid them anyway because the city refuses to name those already identified as carrying herpes.
Sponsor Updates
Capsule Tech added 190 hospital users and 35,000 beds to its SmartLinx medical device information system in 2014.
Divurgent is in the running for the US Chamber of Commerce’s Community Excellence Award (voting is here) and will make a donation to the Shriners Hospital for Children if it wins.
E-MDs posts a preview video for its users group conference June 18-20 in Austin.
Greythorn offers a sneak peek of its HIMSS15 plans (and giveaways).
Ingenious Med President and CEO Hart Williford calls for “All Hands on Deck.”
Hayes Management Consulting’s Robert Freedman offers three steps to drive a compliance checkup.
The HCI Group will sponsor the Future Stage at the HIMSS UK Annual Innovation Conference March 3-4 in London.
Steve Zeller of Logicworks writes about “The Healthcare Cloud: A Journey.”
Influence Health will exhibit at the ACO & Payer Leadership Summit Spring 2015 March 5-6 in Las Vegas.
Tracy Kimble of Galen Healthcare Solutions asks “Are You Ready for the Shift to Value-Based Payment Models?”
The latest Healthfinch blog points out the ironic twist of technology as a cure for physician burnout.
Iatric Systems will exhibit at the Hospital and Healthcare IT Reverse Expo March 2-4 in Orlando.
Extension Healthcare is nominated for the Health Tech Award and Tech Company of the Year Award.
The DHMSM EHR procurement has moved to its final stage and the list of vendors has been narrowed to three finalists: CSC/HP/Allscripts, IBM/Epic, and Leidos/Accenture/Cerner. Sadly, the VA’s VistA platform, proposed by PwC, was eliminated.
Anthem reports that 78 million records were exposed during its recent cyber attack, including up to 19 million non-Anthem customers, and 14 million “incomplete” records. The newly released data also breaks down records breaches by state.
In other Anthem news, the FBI reports that it is close to identifying the group responsible for the attack, with signs pointing to a Chinese state-sponsored hacker group.
Want to Read the Briefs in the Epic vs. Tata Consulting Case? That’ll Cost $0.10 Per Page (Unless We Do Something About It) By Reluctant Epic User
As Americans, we tend to assume that we have the most open and transparent courts in the world. Unfortunately, that probably isn’t the case. The reality is that all of the public documents filed in a court case are locked behind the world’s largest paywall. Including the Epic Systems vs. Tata Consultancy Services Limited case.
It doesn’t have to be this way. The courts give every person in America $15 per quarter in free downloads. The Free The Law project has created a clever workaround which places these documents in the public domain.
Five of 82 documents in the Epic vs. Tata case are available to the public. You can increase that number. Follow these steps:
Click Query and enter 3:14-cv-00748 in the case number field.
Click Docket Report, accept the default values, click run.
Click on one of the document # hyperlinks which doesn’t have a “RECAP the law” logo by it (examples in green boxes).
Read the document if you’re interested. If you aren’t, click back and find another one. At most, a document will cost $3.00. Therefore, don’t open more than four documents and you’ll stay under the $15 free limit.
Some of you may be wondering, why do this? To date, documents like Epic’s Standard Consulting Agreement (circa 2005) have been unavailable to the general public. The case offers us the chance to get a glimpse behind the Epic’s veil of secrecy, something any HIT observer should happily support.
Since this will be an ongoing case, we’ll need people to regularly contribute. If you comment on this post, you’ll be updated on an ongoing basis as we gather all the documents we need.
Working Around Health IT: The Nurse, the Workaround, and the Question You Need to Ask By JoAnne Scalise, MSN, BSN, RN
Are nurses just BAD? (That’s not the question.)
Why are they so adamant about working around health information technology (HIT)? Is it to give the CIO chest pain? Annoy the IS people? Give their nurse leader heartburn?
How can a simple process — do this, then do this (perhaps multiplied a few or many more times) — turn into a spin with the Mad Hatter (teacup optional)?
It would be easy to leave it that “nurses don’t follow directions,” “nurses are difficult to deal with,” or my personal favorite, “nurses don’t like change” (of course, everyone else likes change!) Those crazy nurses are still wearing disco-era bellbottoms and a mullet. And if you are, that’s ok – it works for you. With 55 percent of the RN workforce at age 50+ (from a 2013 survey reported by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers), that may have been some of the best of times.
But what about making right now better? So much HIT is intended to make life better: for patients, for healthcare systems, and yes, for those crazy nurses. Better, as in efficient and safer for everyone – and in getting paid so we can take care of people tomorrow.
Even knowing that, why do nurses choose to work around the very things that could save their patient, their colleagues, their organization – and themselves? Why does an expert nurse scan a contraband wristband or label instead of the one on the patient for medication administration or specimen collection? Why circumvent the EHR when guidelines for use have been given? Why take that patient (and personal and professional) risk?
This is the opening of dialogue. Not to defend what many call “the bad apple,” “the bad actor,” or those who just act “bad,” as in, “I don’t care about people” people. I’m not talking about nurses or specific roles. I’m referring to those outliers who are clear that they don’t care about patient safety or care, their colleagues, or healthcare. Those people are the rarest of the rare because they don’t last long in our system – we can’t tolerate bad apples or bad care. Bad is about behavior and not the person.
As a perennial patient safety student, I know that the professionals who have chosen to be entrusted with providing care to every one of us who enters the healthcare system do not take their responsibility lightly. As a nurse, I know (as do my clinician colleagues) that we have chosen wisely. Our responsibility to our patients and the healthcare system are our primary motivators. Care excellence is the goal we must fulfill in every patient encounter every day. Safety never sleeps.
Why then, the confounding issue of the workaround?
I have been fortunate to work with nurses around the country to help them keep their patients and themselves safe. I have had other departmental staff stand up and point their fingers at me and ask, “How are you going to make these nurses BEHAVE?” And this is with nurses in the room. On occasion, I even get the same question from the nurse leaders. Laboratorians, CIOs, and patient safety and quality professionals have other direct questions on the same topic. I’ve even been invited to speak to groups of lab leaders on “how to communicate with the nursing suite.” When presenting on the topic in national forums, the topic is often addressed in hushed tones by nursing and other leaders who share that the workaround is an “epidemic.”
Indeed, the workaround is a real and persistent danger and with exponential significance: the possible patient safety breach, the trust eroded for collaboration and communication, and the financial loss from the wasting of resources of the healthcare organization.
Health information technology spending was projected to top $6.8 billion in 2014, with individual hospitals and healthcare systems spending millions annually. Not using the purchased technology causes challenges in safety, in culture and process, in data collection and analysis, and in budgets. When enough end users simply “end it” and stop using the technology, the technology can end for that organization. With that end comes significant loss.
At the same time, some organizations decide to not engage the nurse or other end user for a variety of reasons, often because of time for conflict (“we can’t get caught up in nursing demands — they’re going to have to do it.”) I’ve been in meetings where the issue came up of end users (who were not represented or in attendance) and the statement was made, “We’re just going to ram it down their throats.” Tough love, but probably not so effective in the long run. Fortunately, they were eventually receptive to the benefits of end user inclusion and engagement in the decision process, with a very positive outcome.
When nurse and hospital leaders ask me, “What is the most important lesson you’ve learned about adoption?” I tell them that the most important lesson may seem to be a simple one. Engage your end users. You must engage them as you decide that you have an issue to solve. You must engage them before any technology decision is made. If you don’t, they will use the only opportunity that they have to influence this decision – and that is not to use it.
Some technology doesn’t make life easier. Not all technology is the best it can be. We all need to help make these products better through objective feedback and end user engagement in the decision process and ongoing use.
I believe we can support clinicians in moving from compliance to commitment, and not just in technology. I’ve developed a MAP (mindful leadership, authentic communication, personal accountability) to help you do just that so we can do less “around” and more “work.”
I’ll leave you today with what I think is the best question for responding to a workaround. So many times we ask, “Why won’t you do this?” The question implies resistance, and depending on how we say it, frustration and even accusation. The answers may tend to be defensive and deflect the true reason.
Ask instead, “Why can’t you do this?” You will get thoughtful and real answers that may benefit your practice and eventually improve the technology. And the work.
Let’s continue the conversation on how we can work through the workaround. I’ll bring my MAP.
JoAnne Scalise MS-Patient Safety Leadership, RN is the manager of nurse consulting for Sunquest Information Systems.
Following its acquisition of Siemens, Cerner is encouraging some employees to consider “voluntary departure,” despite the company’s plans of hiring 16,000 new employees over the next 10 years.
An ICD-10 readiness survey finds that 81 percent of practices feel they will be ready when the ICD-10 transition goes into effect, but that only 67 percent believe the transition will happen on October 1, 2015, without further delays.
The Hub interviews Walgreen’s chief marketing officer Sona Chawla, who says “I think of our customers as shoppers, unless they want to be patients. When they are in our clinics and they are sick, they want to be patients and we recognize them as patients. But no one is in a constant state of being a patient, and we have to be very sensitive to that because we offer a wide range of trip missions. So, when they are coming in to shop for lipstick, they are shoppers. That’s how they want to be recognized, and that’s how we recognize them.”
Cerner offers “select associates” an opportunity to “consider a voluntary departure.” The company didn’t define “select,” but it wouldn’t be too surprising if many of them are located in Malvern, PA and are older (one report says employee age plus years of service must exceed 65 to be eligible).
Reader Comments
From Dim-Sum’s Little Brother: “Re: DHMSM down-select. Two of the five bids were eliminated. According to my network, IBM (Epic), CSC/HP (Allscripts), and Leidos/Accenture (Cerner) made the down-select. InterSystem (TrakCare) and PwC/GDIT/DSS (Medsphere) were eliminated from the competition.” Unverified, but reported by multiple readers. I said upfront that the chances of DoD choosing VistA from their IT rival VA were zero. A couple of sites reported just in the past week that DoD would choose an open source solution, although I doubt you’ll see a “we were wrong” follow-up if indeed VistA has been shown the door as it appears. That also means the late and sexy addition of Google to the PwC bid didn’t impress DoD (and rightly so since their participation, as described, was minimal).
From Stanley Kowalski: “Re: HIPPA. I was surprised to see such a bold subject line.” Not only was HIPAA spelled wrong, a hyphen should appear between the first two words. At least they didn’t say “complaint” instead of “compliant.”
HIStalk Announcements and Requests
Regina Holliday and Lorre have chosen our five HIMSS15 scholarship winners and they all seem excited. I’ll be running a short bio of each shortly, along with their description of what they hope to accomplish at the conference.
Webinars
March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.
March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
March 12 (Thursday) 1:00 ET. “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.
Acquisitions, Funding, Business, and Stock
CTG reports Q4 results: revenue down 4 percent, EPS $0.08 vs. $0.22, not including a $0.07 expense associated with the October death of CEO James Boldt and a $0.06 write-down of the company’s investment in poor-selling medical fraud, waste, and abuse software. CTG expects its healthcare revenue to drop 14 percent in 2015 and says the year will be a ‘transitional” one for its healthcare business as the EMR market cools. Above is the one-year CTG share price chart (blue, down 49 percent) vs. the Nasdaq (red, up 15 percent).
Imprivata announces Q4 results: revenue up 34 percent, adjusted EPS –$0.04 vs. $0.84, meeting revenue expectations and beating on earnings. IMPR shares are trading down around 14 percent from their June 2014 first-day trading price.
Sales
Horizon House (PA) chooses CoCentrix for EHR, care coordination, and billing.
Temple University Health System (PA) chooses Strata Decision’s StrataJazz for financial planning, rolling forecasting, capital planning, and capital equipment replacement.
Bobbie Peterson (Medsphere) joins Apprio as EVP of health IT.
Announcements and Implementations
NextGen adds the CompletEPA electronic prior authorization solution from Surescripts.
Cleveland Clinic and the VA will provide “seamless access” to each other’s EHR information starting this month. The clinic uses Epic Care Everywhere.
Government and Politics
The Federal Trade Commission fines two developers of melanoma detection apps for falsely claiming that their products work. MelApp and Mole Detective didn’t have the evidence to prove that taking a photo of a mole and then specifying its characteristics can reliably detect melanoma. It’s interesting that the companies were charged by FTC for false marketing rather than by FDA for providing medical advice.
An FDA-funding Brookings Institution report recommends that FDA strengthen its post-market medical device surveillance system to include tracking those devices by a unique ID. EHRs would provide device usage information for national safety surveillance, with such capability being required to meet ONC certification and Meaningful Use requirements. FDA says the system “will require significant financial resources to be sustainable” and recommends paying data contributors.
FCC and FDA will convene a March 31 workshop on test beds for wireless medical devices, saying that the “hospital in the home” concept requires wireless co-existence.
New York Governor Andrew Cuomo wants to close NYDoctorProfile.com, a state-run doctor search tool that he says is too expensive to taxpayers at $1.2 million per year given that similar information is available elsewhere.
Privacy and Security
Researchers find that Googling diseases and medical terms sends information to undisclosed third parties 91 percent of the time, most often because company servers are set up to use free tools such as Google AddThis social sharing as part of Google Analytics. Even CDC.gov and May Clinic pass along search results with user-identifying information such as IP address. WebMD, for instance, sends disease search data to 34 sites including those of data brokers Experian and Acxiom. Healthcare.gov was found to be doing the same, probably due to technical negligence.
A new report finds that medical identity theft jumped 22 percent in 2014.
Anthem says its giant data breach included information on up to 19 million non-Anthem patients who were seen out of network in addition to that of its own customers.
Technology
Microsoft adds a cycling module and a virtual keyboard for its Band fitness tracker, also introducing a Microsoft Health-powered dashboard of Band-collected information.
@AlexRuoff tweeted this screenshot from an AHRQ Meaningful Use Stage 3 readiness webinar, which finds that 71 percent of participants use non-electronic means to share information. You’ll probably be in good hands if you keel over in the fax machine section of Office Depot since odds are it’s a healthcare person browsing them.
Other
Former CIO and current vendor SVP Dale Sanders says in his personal blog that taxpayer-benefiting EHR vendors are intentionally obstructing interoperability via prohibitive contract terms and add-on interoperability license fees while publicly proclaiming their support of open standards (he doesn’t name Epic specifically, but they seem to be the target). He says EHR vendors should offer open APIs and that courts should intervene to stop interoperability-impeding terms and conditions. He quotes a peer who doesn’t think FHIR in its planned form is the answer:
Several EHR vendors are banning together around a new magic bullet technical standard called HL7-FHIR based on JASON technology. While this new standard is great from a technical perspective (XML, REST, etc.), in its current form, based largely on existing HL7 v2, v3 and CDA concepts, it does not improve the accessibility of proprietary EHR data types, and those data types are needed for quality and cost performance improvement in healthcare. While FHIR could be expanded to include this type of data, it appears the first efforts are focused on reinventing the technology for currently defined interoperability data types.
An interview with Walgreens Chief Marketing Officer Sona Chawla contains some interesting quotes, the last of which is pure genius and a useful lesson for providers trying to become more consumer friendly:
“I think the concept of ‘well’ is broader than ‘wellness.’ It really encompasses the ‘happy and healthy’ feeling. ‘Wellness’ has a more specific meaning than ‘well,’ which is limited to the ‘health’ part.”
“The service that’s delivered online or in the store should be the same and feel the same in spirit. If you are in the store, you can have face-to-face interaction. If you are online, we offer things like 24/7 pharmacy chat. Those elements of customer service happen in a very specific way based on the channel, but when we put it all together it should feel like one Walgreens.”
“We have an all-in-one app that is a connecting point between the physical and the virtual for us, to really serve our customers. Our mission was to think about what customers were doing and how we could improve it.”
“With digital health, it’s really about reinventing the core experience. For example, we launched an immunization app within our main app which records your immunization history and also reminds you to immunize as well as take your pills on time. Technology is changing the way customers behave and we are leveraging the technology to make things easier, but at the same time, enhanced. Then there is the concept of unification, which is connecting these experiences not just within Walgreens, but also with our partners. It gives us a great platform to think of our customers, wherever they are.”
“I think of our customers as shoppers unless they want to be patients. When they are in our clinics and they are sick, they want to be patients and we recognize them as patients. But no one is in a constant state of being a patient and we have to be very sensitive to that because we offer a wide range of trip missions. So when they are coming in to shop for lipstick, they are shoppers. That’s how they want to be recognized and that’s how we recognize them.”
A Navicure survey finds that 81 percent of physician practices are optimistic that they’ll be ready for ICD-10’s October 1, 2015 implementation date and two-thirds of respondents don’t think it will be delayed again. Practices say their main concern is that payers won’t be prepared.
A newly built hospital in England issues bells to patients housed in treatment rooms to use as a call system, explaining that it didn’t expect to need electronic call buttons in that location but will now add them.
Weird News Andy wants to know who will pay the CT scan bill. A Chinese statue of Buddha from 1100 BC is found to contain the body of a mummified Buddhist master.
Sponsor Updates
CTG’s Managing Director of Data Analytics Joseph Eberly will co-present “Using Data Analytics to Improve Care Valuation, Management, and Outcomes” at the Hospital & Physician Relations Executive Summit March 1-3 in Scottsdale, AZ.
Fujifilm’s Synapse RIS earns ONC HIT 2014 Edition Complete EHR certification.
PerfectServe will participate in two March annual conferences, the Society of Hospital Medicine and American Medical Group Association.
Cumberland Consulting Group donates laptops to Back on My Feet to assist the nonprofit’s residential members look for jobs and permanent housing.
CitiusTech will exhibit at SCOPE Summit 2015 through February 26 in Orlando.
Clinical Architecture posts a video on “Temporality” as part of its blog series on the road to precision medicine.
CenterX CEO Joe Reinardy will speak at the 2015 Emdeon Pharmacy Insights event in Nashville on March 4.
CareSync offers “Ten Ways Medicine Today can Outrun Every TV Doctor You’ve Ever Seen.”
Besler Consulting’s Jim Hoffman offers an “Overview of CMS Readmission Penalties for 2015.”
Divurgent will exhibit at the HIMSS SoCal Annual HIT Conference on March 2 in Los Angeles.
A KLAS report on acute EHR purchasing decisions asks hospitals that are in the market for a new system who their likely next vendor will be: 25 percent reported Epic, 14 percent reported Cerner, 13 percent reported MEDITECH, and 5 percent reported McKesson, while 41 percent are undecided.
A Columbia University study published in the Journal of Nurse Practitioners finds that diagnosis rates for obesity, smoking, and depression were much higher when nurses used a smartphone app that explained evidence-based guidelines and triggered clinical decision support prompts during routine exams.
February 23, 2015Dr. JayneComments Off on Curbside Consult with Dr. Jayne 2/23/15
I’m leaning heavily towards staying with my current employer as we move to a single platform for all our hospitals and practices, but lots of people keep sending opportunities my way. Today a juicy CMIO position came across my desk. It’s in a great location and with a well-known health system that I’ve had some dealings with previously.
It looked pretty exciting until I got to the part about the heavy inpatient focus and complete disregard for those of us who have come up through the ambulatory ranks. I started to move it to my recycle pile until something caught my eye. They’re looking for someone “politically savvy with a high tolerance for ambiguity… who can put all the pieces together and deliver on time and on budget.”
I’ve got a lot of experience delivering the undeliverable and creating successes despite some of the people I work with. Usually hard work and pixie dust are involved, but we never admit it. My general rule of thumb is that organizations are typically 30-50 percent more dysfunctional than they admit, so I’m wondering what that looks like when they’re already warning candidates about ambiguity and the need to be able to patch things up to get a project out the door. They also mention frequent interruptions and constantly changing priorities. I’m not rushing to submit my CV.
Another prospective position (thanks to the reader who sent me an opportunity in a warm climate) looks like it’s much more up my alley. The nine responsibilities bulleted in the job description are things I’ve been doing for years. I’m less sure, however, about the tenth one – supervising and assigning projects to physician informaticists on the CMIO’s team. Sometimes it feels like I’m lucky to get an administrative assistant to support me, so the idea of multiple physicians helping deliver value from healthcare IT is awfully tempting. They’re also looking for someone either board certified in clinical informatics or with a masters degree in the field, so that tells me they value the education and training that many of us can bring to the table.
In the mean time, I’m still waiting to find out how my health system is going to handle the clinical leadership structure for the EHR consolidation project. I don’t have a lot of time to dwell on it, however, since we’re preparing more than a dozen practices to seek recognition as Patient-Centered Medical Homes.
The first time I went through the process was on paper. Although there are certain aspects of the requirements that are significantly easier with an EHR in place, there are still elements that are much simpler in the paper world. Some of our practice managers have actually laughed out loud when I ask them to use a simple three-ring binder for some of the requirements. Although I’m obviously a fan of technology, sometimes a manual process is quicker, easier, and doesn’t require anyone from IT to give it a blessing.
I’d estimate that three-quarters of our practices are ready, with stable processes and solid physician buy-in. The other few still need some work. We’re likely to urge the others to move forward while we continue to tweak workflows in those that aren’t quite ready. They also need some refinement in staff roles and responsibilities. We’re finally helping our administrators understand that PCMH is not a technology project so much as an operational initiative. I want to try to get as many of our joint operational and technical projects completed before the transition to the new system begins in earnest.
I’m also staying occupied looking for interesting ways to use some of my accumulated vacation time. As of January 1, our health system has gone to a “use it or lose it” philosophy and has capped the vacation hours we can have on the books. I’m dangerously close to the limit and certainly don’t want to leave any hours on the table. I’m planning a wilderness adventure for July, and if I don’t get eaten by a bear, I’m looking for a trip in the fall that will provide not only some R&R but some continuing education hours. I also hope to take some long weekends once the weather gets nice. The new policy should make for some interesting resource challenges as everyone tries to lower their balances.
Such compassion for the relative you showed--not likely to be built into EHR/AI soon, as it is increasingly so lacking…