I attended a continuing education seminar the other day. It was a rare treat since I’m usually on the speaking side of continuing education engagements. I get most of my continuing education from online sources, reading my specialty society’s journal, and answering continuing ed quiz questions.
The seminar I attended was put on by one of the local hospitals. It targeted physicians who have been using their EHR for some time, but who need tips and tricks to make documentation faster.
A friend of mine was teaching the class and invited me to attend. She is relatively new to being a clinical informatics administrator, although she’s been an end user for a very long time. This was her first time teaching a “techy” class and she was looking for feedback on her delivery. She also wanted my opinion on whether she had prepared a good blend of clinically relevant information and technical suggestions.
I’m not on staff at her hospital, but wanted to help her out. Not to mention it was an easy way to get CME while getting a sneak peek at their state of the art (aka “hundreds of millions of dollars”) system and hear feedback from users of a system I don’t usually work with.
Physicians tend to think the grass is always greener on the other side of the fence. Being able to peek under the hood of another system usually shows that although the grass may be different, it’s not always greener. Many of the physician comments made during this class were the same ones I hear when working with users of other systems: not enough user-level configurability, alert fatigue, too many clicks, etc. Half the physicians in the room might love a particular features while the other half hate it.
This group was no different. Some of the lines of disagreement split as anticipated, whether specialists vs. generalists or procedural specialties vs. cognitive specialties.
My friend did a great job covering some of the nuances of the EHR. Whenever she covered an area where physicians were particularly struggling, she was not only able to show the best practice workflows, but often provided commentary on why the system was set up in a particular way or why a feature might or might not be enabled. Many of the attendees were in agreement that understanding the “why” behind a given feature can make it seem less clunky if it’s clear the benefits outweigh the annoyances of the workflow.
This allowed for a lot of dialogue among the end users, the IT department, and the administrators. Usually I don’t see IT or administration attending sessions like this and it went a long way towards convincing the providers that their organization really does care what they think about the EHR and that they are committed to making the workflows as good as they can possibly be. It also allowed them to hear directly from the physicians without the help desk or a physician services liaison trying to translate or summarize the concerns.
My friend did a fantastic job with her training. After the initial lecture portion of the class (which granted continuing education hours), there was a 45-minute lab time where trainers were available to work with attendees on particular workflows or sticking points. That way, any outstanding questions could be addressed immediately and the learners could also practice and solidify the new workflows they had used in class. She also incorporated hot button clinical issues into her examples, leading several of the providers to go in and update their order sets or modify their preferences accordingly.
Having immediate lab time after the formal lecture is something that many workflow classes lack. Attendees are often excited about learning, but then have to go back to their department or patient care area and have difficulty finding the time needed to try new workflows in a protected environment or to update system configuration. It was also great having trainers to work one on one with attendees so that those who might have been struggling or had more questions knew that they would be able to get help and didn’t derail the rest of the class with questions.
I met with my friend after and gave her a couple of ideas for changes to her presentation style as well as a heads-up about some speech habits that might be distracting to learners. As a clinician who was thrown into the administrative and training realm without a lot of formal support, I know that kind of feedback can be valuable. I have a mentor who sits in on some of my presentations from time to time and does the same thing for me and the advice I’ve received has been extremely valuable.
Depending on the medical school and residency training program a physician attends, there may be solid presentation skills training or none at all. I remember my first presentation as a student, using overhead projector transparencies and a carousel projector. I may be dating myself, but that required a lot more advanced preparation to get slides organized and transparencies created. I definitely appreciate being able to throw together a presentation on the fly, but sometimes we lose the formality we had when we were lower tech.
Hospitals that don’t offer this kind of ongoing EHR training and optimization sessions are short-changing their end users. They don’t always have to be this formal and with this many resources involved, but having them available to users on an ongoing basis (whether live or recorded) is critical to long-term success and user satisfaction.
Does your hospital offer ongoing EHR training? Email me.
November 2, 2015Readers WriteComments Off on Readers Write: Financial Health of Patients Is an Afterthought
Financial Health of Patients Is an Afterthought By Jonathan Wiik
Most healthcare providers offer exceptional levels of care to their patients. After all, we patients expect it. But what most patients don’t expect is the rising cost of healthcare, and unfortunately, financial health is often an afterthought for both parties.
The average deductible for a single person enrolled in an employer-sponsored health plan reached $1,217 in 2014, just under a 7 percent increase over the previous year, says a 2014 study published in JAMA. What’s more, the Affordable Care Act (ACA) Bronze Plan—the new 2015 HDHP (high-deductible health plan) entry plan for patients—establishes its average annual deductible at $5,203.
By 2019, providers could see a 50 percent increase in the amount of revenue requiring a collection from patients. Of that amount, 30 percent (as much as $200 billion) will be written off as uncollectable, according to estimates from Citi Retail Services, a division of Citigroup. Among households with incomes over 400 percent of the poverty line, almost half cannot afford the higher deductible amounts.
For these reasons, many healthcare consumers are reluctant to pursue adequate and timely medical care. The fact is, they simply cannot afford it.
Consider these facts:
A recent report issued by the Consumer Financial Protection Bureau (CFPB) found that medical debts account for a majority of debt-collections actions appearing on consumer credit reports.
An earlier Kaiser Family Foundation report found that one in three Americans struggle to pay medical bills, in spite of 70 percent of them being insured.
Unpaid medical bills are the highest cause of bankruptcy filings, outranking both credit card and mortgage debt.
Once in debt, many people may delay or forego other needed care to avoid incurring further unaffordable medical bills.
The number one complaint from patients typically concerns confusion with their medical bills, an issue that could be alleviated with proactive, data-rich discussions on the front end of the cycle. Accordingly, financial clearance—an industry term—is gaining momentum. Screening patients for eligibility under their insurance plan, confirming benefits are payable for the services they are about to receive, and ensuring they can afford to fund their out-of-pocket costs are paramount processes that should occur as early as possible.
Similarly, 501(r), a component of the IRS tax code covering not-for-profits, is garnering a lot of attention. The rule, which takes effect in January 2016, requires that not-for-profit hospitals demonstrate the effectiveness of their financial screening for charity programs, among other initiatives.
Additionally, under certain provisions in the law, providers must offer charity care to qualified patients and refrain from pursuing aggressive collection actions for those who would have otherwise been eligible. Documentation of charity assistance, processing, discounting, and collections must all occur prior to billing.
From a high level, financial clearance helps ensure three important things:
That patients are paying within their financial means and are receiving financial assistance where possible.
That providers and government programs are maximizing their scarce resources for charity and other programs.
That bad debt, bankruptcy, and collection issues are reduced for provider and patient alike.
A patient’s financial health is becoming increasingly important in healthcare. Providers, for their part, must ensure that they have sophisticated tools and workflows to put both parties on the same page from the start.
CPS reports Q3 results: revenue is down 16 percent at $44.6 million, EPS $0.31 vs. $0.83. Stock prices fell 15 percent after the results were published.
Peer60 publishes a report on the UK EHR market, finding that Epic, Cerner, and Allscripts have replacement vendor mindshare among hospital executives, with Epic leading among the three. Epic’s only live customer in the UK is Cambridge University Hospital, where its $300 million implementation resulted in the resignation of the hospital’s CEO and CFO, and an investigation from the NHS Monitor.
Medication management technology vendor Omnicell will acquire Aesynt, which offers pharmacy robotics, for $275 million. As reader WhoKnows points out, McKesson bought the former Automated Healthcare in 1996 for $65 million and then sold it in late 2013 to Francisco Partners for a rumored $52 million. That’s either horrible McKesson mismanagement or a truly spectacular performance by Francisco Partners, which gets a five-bagger in just two years. The only acquisition I recall Aesynt having made was Italy-based Health Robotics, which was having limited success with its IV room robotics technology. FP didn’t even change the CEO when it bought the company – Kraig McEwen came on board in November 2011 and remains to this day.
Reader Comments
From All Hat No Cattle: “Re: John Glaser. I noticed his CV lists his HIStalk Lifetime Achievement Award from 2011. I wonder if any of the other HIStalk award winners list theirs?” Probably not, but someone new will have that chance in around four months when we do it again.
From Over Easy: “Re: Hoag Hospital in Orange County. Rumor is another senior IT leader was released or resigned, which makes the third in the last four months. The hospital has implemented drastic budget cuts in IT and overall in the past two years.” Unverified. I don’t think I know anyone there.
From Wayne Tracy: “Re: VA-DoD interoperability. As a retired Naval Officer having commanded a field hospital (Fleet Hospital 13B) I have come to the conclusion that until Congress holds the Surgeon Generals of the Army, Air Force, and Navy as well as the head of the VA personally responsible, nothing is going to change. Give them a two-year deadline and withhold all medical computer budget funds until they are fully interoperable in real time (say, using HL7’s FHIR) or the budget goes away. It seemed to work when the railway system was not going to meat the end-of-year (2015) deadline — the New York to Washington line miraculously got done in two weeks. Somebody with big brass ones needs to be put in charge. Congressional oversight hasn’t worked to date, just more deadline extensions. Congress, grow some!”
From Wealthy and Wise “Re: Highmark. As patients grovel for care and medications, these guys are raking it in. No wonder they are struggling financially and cutting care and services. Shameful and despicable.” It’s big money in Pittsburgh healthcare, where Highmark Health’s former CEO earned $10 million in 2014 having worked there less than two years before he was paid to go away. Highmark paid its human resources chief $2.7 million and its treasurer $3.3 million. The CEO of arch-rival UPMC made $6.4 million.
From Purple Hay: “Re: UnityPoint Health System, Iowa. VP/CIO Joy Grosser is gone.” Unverified. Her LinkedIn profile is unchanged, but her patch of real estate on the health system’s executive page is now vacant. I searched their site for information and found only that she was paid $591K last year, with other fun information from their Form 990 being that their largest-expense contractors were all IT related: Epic ($7.8 million), McKesson ($4.7 million), and IBM ($4.5 million). Fifth-highest was a “branding agency” that earned $4 million for doing whatever vital, patient care-focused work that branding agencies are known for doing.
From Maven PR: “Re: headlines. You need sexier ones to bring more attention to what you write. I can help you.” I won’t stoop to the level that many or most sites do in shamelessly fooling readers into clicking over to crap stories by using CNN-type click-bait headlines, mind-numbing slide shows, pointless stock photos, and “listicle” articles that start with a number (in the form of “6 Tricks You Won’t Believe that Lame HIT Sites Use to Suck In Readers.”) I would hope that health IT people and advertisers are smart enough to realize that the steak they hear sizzling is usually just cotton candy, but regardless, I would rather have 100 smart, influential, engaged readers than 1,000 who mindlessly click on whatever shiny object is thrust in their face without recognizing that they’ve been had.
From Atom Heart CIO: “Re: DonorsChoose. I think your legacy will be more about the charitable work you have done than with HIStalk, which is amazing given how successful HIStalk has become.” I don’t seek or expect a legacy either way, but it’s exciting thinking about how the donations readers make to DonorsChoose might, through some unlikely chain of events, help some kid become a legacy themselves. One of these days I’ll either decide to quit writing HIStalk or just die in the saddle, in which case I’ll fade away with my planned or unplanned final post being the only artifact of my anonymous existence (and leaving Weird News Andy homeless).
From The PACS Designer: “Re: ICD. With our first month under ICD-10-CM with no major issues, it’s time to focus on the next aspect, ICD-10-PCS (Procedure Codes). Since it will be done first here in the US, it gives us the opportunity to choose where we do it initially. TPD proposes that we do it with the VA and DoD so that a breakdown occurs to the barriers each of them currently have against each other working together to improve healthcare for our military and veterans.”
HIStalk Announcements and Requests
Poll respondents were evenly split on whether they’d want Theranos running their lab tests. I agree with Don, who said that using the company’s services has nothing to do with a pinprick blood sample and everything to do with convenience and pricing. I enjoy visiting LabCorp and Quest about as much dealing with the people at the driver’s license office. New poll to your right or here: if your customers (or patients) knew what you know about your employer, would they be more impressed or less impressed?
Mrs. G sent photos of the printer supplies, reading games, and early literacy books we provided to her Los Angeles pre-kindergarten class via her DonorsChoose grant request, adding, “There are no words to describe the impact this has had on my life. My students and I feel so blessed for your kind donations.” Ms. G from Oklahoma sent photos of her students using the earbuds we provided to her elementary school class for online math intervention work.
I thought sure Facebook would collapse this weekend under the weight of every single parent in America posting pictures of their costumed children. Speaking of which, I was also thinking that people seem to like spending Halloween prowling around old buildings where people have died, making any former hospital an ideal choice since the number of deaths inside any of them must be huge.
Last Week’s Most Interesting News
A diverse group of lawmakers slams the VA and Department of Defense for their expensive and stubborn failure to integrate their electronic medical records systems.
Theranos restructures its board and takes another hit when the FDA labels its proprietary Nanotainer blood draw system as an uncleared medical device.
CMS reports a quiet, non-eventful October following the ICD-10 switchover.
The AMA and MedStar Health rank EHRs on user-centered design without actually doing any research or measuring usability.
Xerox and Lexmark announce poor quarterly results and announce plans to review and possibly restructure their operations.
Athenahealth shares jump sharply after beating quarterly expectations, while those of Huron Consulting tank on lowered guidance due to delays in two academic medical center projects.
Webinars
November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Quality Systems Inc. will acquire cloud EHR vendor HealthFusion for up to $190 million. QSI announced just over a week ago that it sold its NextGen hospital business to QuadraMed.
CPSI announces Q3 results: revenue down 16 percent, EPS $0.31 vs. $0.83. Shares took a 15 percent dive Friday on the news. The company seems to be struggling now that HITECH-fueled hospital EHR sales are drying up, leaving it to hope that a replacement market emerges. Above is the one-year share price chart of CPSI (blue, down 39 percent) vs. the Nasdaq (up 9 percent).
People
Sarika Aggarwal, MD, MHCM (Fallon Health) joins XG Health Solutions as SVP of population health and chief medical officer.
LifeImage names Matthew Michela (Healthways) as president and CEO. He replaces co-founder Hamid Tabatabaie, who will move to EVP and remain on the board.
Former Siemens Healthcare North America President and CEO Gregory Sorenson, MD takes a minority interest in Deerfield Imaging, which offers image guiding technology, and will become its executive chairman.
Jim Macaleer, co-founder, chairman, and CEO of Shared Medical Systems until he sold the company to Siemens in 2000, died last Thursday.
Announcements and Implementations
Fitch Ratings holds its rating of MetroHealth’s bonds as stable, concluding that the Ohio health system “has demonstrated the ability to be profitable with its challenging payor mix due to its longstanding electronic medical record (Epic), closed medical staff, and care management processes.”
Other
Peer60 publishes “Healthcare IT Trends in England.” NHS hospital executives say their top challenges are physician and nurse shortages, care coordination, and managing and analyzing data. Allscripts, Cerner, and Epic hold high mind share in both EPR (above) and PAS, suggesting they are well positioned to gain business in both clinical and administrative areas.
Greencastle Associates Consulting is named as one of three finalists for the US Chamber of Commerce Foundation’s “Hiring Our Heroes” award for hiring veterans and military spouses. Malvern, PA-based Greencastle was founded by Army Rangers and its three primary executives are all veterans.
Struggling Kinston Hospital (NC) ends its shared services agreement with Novant Health — which included IT improvements — after less than a year,
In Northern Island, Belfast NHS Trust underpays 1,500 employees due to a software error. The union declares the situation to be “totally unacceptable,” apparently finding it even worse than just “unacceptable.”
A healthcare IT entrepreneur says entrenched software vendors are stifling innovation by refusing to open up their systems to startups, causing new companies to burn through their seed rounds without sales to sustain them. He concludes that patients are harmed because “interoperability into the legacy systems of their customers still remains a primary roadblock.” To which I would offer a counterpoint: rightly or wrongly, we’ve defined healthcare (and therefore healthcare IT) as a business. As with any business, it’s irrational to expect competitors to behave in any way that isn’t self-serving, as much as we like to pretend that everybody’s primary motivation is altruistic patient care. Provider or vendor, you are naive and likely to be insolvent if your business plan assumes that your computers will voluntarily lower your barrier to entry.
I asked Vince Ciotti if he would write something about Jim Macaleer in way of tribute for the folks who knew him and who may not have heard that he passed away.
Sponsor Updates
DataMotion publishes an infographic titled “A Brief History of Data Breaches and Security Regulations in Healthcare.”
Ear, Nose and Throat Associates of Texas describes its easy implementation of Talksoft’s RemindMe application.
Vital Images will exhibit at HIMSS Latin America November 4-5 in São Paolo, Brazil.
VitalWare SVP of Operations Doug Picatti is featured in a CNBC report on key issues in the presidential debate.
Huron Consulting Group releases the latest edition of its clinical research management briefing.
ZeOmega will exhibit at the TAHP Managed Care Conference & Trade Show November 2-3 in San Antonio, TX.
Zynx Health will exhibit at the Meditech Physician and CIO Forum November 5-6 in Foxborough, MA.
The Government Reform and Oversight Committee met alongside the House Veterans Affairs Committee to hear the testimony from DHMSM and GAO representatives on why the VA and DoD has failed to integrate its EHR systems, despite having spent billions in taxpayer dollars.
McKesson repots Q2 results: revenue up 10 percent to $49 billion, adjusted EPS $3.31 vs. $2.79, beating analyst expectations on both. McKesson also announces that its board has approved a $2 billion stock buy back plan.
Theranos announces a restructuring of its board of directors, reducing it from 12 to just five members and establishing a supplementary board of counselors and another board that will give medical advice.
October 29, 2015Dr. JayneComments Off on EPtalk by Dr. Jayne 10/29/15
October is finally coming to an end, and with it, Breast Cancer Awareness Month. Several of my clients did population health outreach campaigns around mammograms and breast cancer screening. It’s rewarding to see that so many patients were reminded of the need to stay on top of preventive health care.
I literally ran across one of these pink carts on my morning jog, with its “Kick Cancer to the Curb” slogan. Definitely an interesting campaign, but I’m wondering how long it will be until a veritable rainbow of carts for other diseases starts to appear. They could probably get some traction with medical offices and shredding services, replacing the standard boring carts with disease-awareness ones.
I’m a big fan of focused population health outreach campaigns, which we used to refer to as “disease of the month” at my practice. With the advent of unquestionably powerful population health applications, it can be overwhelming to start robo-calling or texting patients who are overdue for multiple screening and interventions.
I recommend that my clients gradually work their way into full-scale reminders, selecting first a disease or condition that is either of high prevalence in the community or of key importance to the practice. Once the staff is familiar with managing patients who respond to the outreach messages and can handle the volumes it may bring in, it becomes easier to incrementally add additional outreach campaigns.
I also recommend they put signage in the offices and provide relevant patient education material as well as educating the staff through in-services. That way everyone in the office can assist as patients respond. It’s tempting to fire up multiple campaigns at the same time, but unless your system is sophisticated enough to combine reminders, it can quickly become annoying. Even if the reminders are combined, I’m not sure I would want to be a patient on the receiving end of a laundry list of preventive services being read to me by a disembodied computer voice.
I’ve spent a fair amount of time over the last decade helping practices redesign their offices, not only from a workflow perspective, but also architecturally. Transitioning to an EHR works best with appropriate exam room layouts. Getting rid of the chart room usually frees up space that can be used either for employee engagement or revenue generation.
I’ve worked with quite a few office designers and am always interested in looking at computer carts and other equipment at HIMSS. One of my designer friends shared information on the Beam Virtual Playground, which is a ceiling-mounted projector that creates a “touch screen” on the floor for games. I like the idea, and the fact that it’s germ free is a big plus. I’m always astounded when I see well-chewed books and slobbery toys in medical waiting rooms.
‘Tis the season for vendor user groups, and apparently I’m attending all the wrong ones. This week’s IBM Insight conference featured an exclusive performance by Maroon 5, sponsored by Rocket Software. Talk about a client appreciation event. And for those working the show from the vendor side, not a bad day at the office.
I had a couple of days off this week and spent most of them trying to tame the email monster and complete long-overdue tasks. Thank goodness for being able to work anywhere. As I was hanging out at the car dealer having my oil changed, I got a glimpse behind the scenes at something that resembled a medical chart room. I was surprised since this is a high-tech dealer who appears to do everything electronically from checking you in with the electronic code on your car key to sending email reminders. Apparently they have a dark secret, however. I’m glad that the people who make chart tabs and other filing accessories found another line of business since we don’t need them very much any more in medicine.
I’ve got two conferences to attend in the next three weeks, so it will be good to get things squared away before I go back on the road. The only thing left to do is purchase candy for Saturday night. Thanks to Travel+Leisure magazine for providing these wine pairings for Halloween candy. I’m not sure I agree with some of their selections (Hot Tamales and Riesling, anyone?) but I can definitely get on board with Raisinets and Merlot.
What’s your favorite candy and beverage combination? Email me.
Rep. Tammy Duckworth (D-IL), a former Army helicopter pilot who lost her legs when her Black Hawk took rocket-propelled grenade fire in Iraq, joins several other members of Congress who are fed up that the VA and Department of Defense still haven’t integrated their systems. Lawmakers are reviewing VA-DoD progress in a joint hearing of two House committees this week. Duckworth says that as a former VA employee, she regularly saw the DoD stonewall the VA’s projects in defending its turf. She’s also still mad about her first VA visit where she was asked to take her clothes off to prove that she was still an amputee since the VA wasn’t allowed to accept her DoD medical records, to which she replied to the physician assistant, “I’m not a gecko. They don’t grow back.” Chris Miller, who runs the DoD’s DHMSM project, testified that connecting the VA with DoD is harder than it seems, while the GAO’s IT director observed that her watchdog agency still doesn’t understand why the DoD and VA decided not to build a single system together in the first place. The GAO still wants that answer, but says that neither the VA nor DoD are responding to its inquiries. The GAO suspects that the VA and DoD have spent more than billion dollars in trying and failing to share information, which doesn’t even include the countless mega-billions of taxpayer money that was spent building and supporting their systems.
Speaking of the VA-DoD imbroglio, some members of Congress are convinced that the only way to get the VA and DoD play nicely together is to have the President personally make them. Rep. Dan Benishek (R-MI) says of his peers, “We can’t stand the fact that we’re spending a billion dollars on integrating healthcare and you tell us it can’t be done. We get sick of this.” DHMSM’s Chris Miller says the organizations weren’t ready in 2011 because while the IT part is easy, nobody wanted to address the people and process issues. He opined that interoperability is worse in civilian healthcare, raising the ire of Rep. Gerry Connolly (D-VA), who scolded him by saying that both agencies deal with a specific population but “can’t get their acts together on behalf of the men and women we’re serving.”
Reader Comments
From Don’t Mess with Texas: “Re: vendors pressuring clients. I heard that the day Texas Health Resources issued its press release blaming Epic for its improper treatment of its Ebola patient, Judy and Carl flew to THR that night to pressure the CEO into putting out a retraction, which they did. Epic plays hardball – they’ve done it at our site, too. I don’t blame Epic for being unhappy with the press release, and while veteran CIOs like me knew to take the release with skepticism, flying down in person to get a retraction is pretty heavy handed. I’m sure Epic’s spin is that they care so much for their clients that they wanted to show up in person and offer their help.” That entire process was bungled, although nothing in the THR recap describes a visit by anyone from Epic. THR leadership appears to have thrown Epic under the bus as a knee-jerk reaction without even talking to their own IT folks, who would have been involved with the configuration of the system that was blamed incorrectly (given their quick retraction) for missing their patient’s travel history. Any EHR vendor would have protested and asked for proof of their customer’s claim, although I agree that Epic is among the most vigorous enforcers of its own interests and I’m sure calls were made. THR wasn’t great at managing the Ebola virus, but it was much more aggressive in trying to manage the viral spread of unfavorable publicity.
From Uneasy Detente: “Re: vendor gag clauses. I’ve never seen them pre-loaded into one of my contracts, but I’ve signed a few with a major health IT software vendor as condition of contract settlement, where software doesn’t work and we refuse to go live, for example. The vendor may offer concessions or a refund conditional on signing a number of terms, which generally includes not going out and talking about the problem we’ve discovered. Here’s an example for your eyes only.” I can see why both parties would approve that condition given that they are reaching agreement on either a parting of ways or deciding not to implement a specific application. I’m on the fence about whether that’s a gag clause, but leaning toward no since the customer never actually went live. You would think that customers who did actually implement the application would see and report the same issue, but that’s wishful thinking. That leads us back to the same challenges we have with interoperability – as much as we as patients would like providers to publish and share information that might benefit us, there’s no incentive for those providers to do so and therefore they don’t bother. In fact, going public with software problems introduces the near-certain risk of creating an adversarial relationship with the vendor to which they’ve expensively hitched their wagon. I don’t know of any solution except maybe FDA-type oversight that requires companies to report the patient-endangering defects they discover. Just about any solution that requires providers – competing or otherwise – to voluntarily share information is not likely to succeed. Replace “providers” with “attorneys” or “car dealers” in the previous sentence to put it into a less emotional perspective.
From QM Employee: “Re: NextGen Hospital Solutions. Can anyone explain why QuadraMed acquired it? QuadraMed has not sold their current solution for three years and their product has so many holes (surgery, emergency, scheduling, etc.). There are constant layoffs and some really great employees have left. NextGen customers are in the under-100-bed hospital range and their product is unstable.” The Canada-based parent of QuadraMed (Constellation Software) seems to have broken its own acquisition rules in buying both QuadraMed and NextGen Hospital Solutions since it claims to be interested only in companies that are #1 or #2 in their market, have at least “hundreds” of customers, and face “unimposing” competitors. I can see why QSI wanted rid of its failed hospital business, but agree that it’s puzzling why someone else would want it, although that brings up the strong possibility that it was basically given away just to eliminate distraction and appease torch-wielding QSI shareholders.
From Erstwhile ICD-9er: “Re: Georgia Medicaid’s stance on ICD-10 coding specificity. The CMS leniency was limited to Medicare. Medicaid was given the authority to make the decision for themselves. Georgia is the first to come out with aggressive messaging around their acceptance of ICD-10 specificity. An important distinction is that they related all of their ICD-10 edits for UB claims, but are holding firm on CMS 1500 claims. They have posted notice of this to providers along with a list of codes that will likely be denied. They are accepting feedback from providers about which codes should be accepted.” Thanks for that clarification.
From Kilt Lifter: “Re: ICD-10. Select Health Medicaid in SC refused to do any user testing prior to implementation. They are now telling practices they will not pay any claims until the end of November at the earliest.” The company’s ICD-10 FAQ page brags confidently about their testing, remediation efforts, and overall readiness for October 1.
From Public Health Helpful: “Re: public health. I’m a long-time HIStalk fanboy, but you hit it out of the park with your comment that we ‘irrationally celebrate advancements that are very narrow in scope.’ We should be doing what will benefit the most people in the most significant way – immunizations, blood pressure control, weight loss, cancer screening, following preventive guidelines, and using proven treatments.” The only way to fix “healthcare” is to embrace public health as other countries have done rather than tinkering with how we deliver reactive health-related interventions. We don’t like thinking about that because it requires uncomfortable discussions about social services and the role of government that quickly degrade into political divisiveness. It’s easier and much more profitable to focus on expensive interventions that benefit a small percentage of the population while the far larger population suffers (and drags down economic growth) with chronic conditions whose management standards are well known, just not well practiced by either providers or the patients themselves. We have all the knowledge we need to make the country healthier and therefore more economically competitive, just not the will to use it.
HIStalk Announcements and Requests
I put the $750 raised by Dana Moore’s Epic vs. Centura basketball game to immediate use, applying matching money from my anonymous vendor executive as well as from other charitable organizations to fund these DonorsChoose projects:
A document camera for Mrs. Marler’s third-grade class in Phenix City, AL.
A video camera and accessories for recording advanced placement calculus and physics lessons so that absent students can review them later for Mr. Blachly’s high school class in Indianapolis, IN.
A STEM bundle for Ms. W’s elementary school class in Englewood, NJ.
An iPad Mini to support STEM studies in Mrs. K’s middle school class in Brooklyn, NY.
Four science activity tubs for Mrs. N’s elementary school class in Dothan, AL.
Two tablets for Ms. S’s first grade class in East Haven, CT.
A laptop and accessories for Ms. M’s class of eight emotionally disturbed first grade boys in South Bronx, NY.
Hands-on materials for Ms. M’s advanced placement statistics seniors in Denver, CO.
This week on HIStalk Practice: The wave of physician "Just Say No to Meaningful Use" movements rolls on. American Well digs further into the employer market. AdvantageCare Physicians achieves Stage 6 EHR adoption. ZocDoc and Kareo top the list of US-based deals with Q3 VC funding. A GAO "sting" results in further Healthcare.gov scrutiny. The Interstate Medical Licensure Compact Commission meets for the first time. Maine ups its healthcare price transparency efforts.
This week on HIStalk Connect: the FDA releases its inspection findings from an unannounced visit to Theranos, concluding that their nanotainer technology is an uncleared medical device. IBM Watson will debut on the Apple Watch in 2016 within a patient engagement app being developed by Welltok. Carnegie Mellon University researchers create an app that uses iBeacon technology to provide navigational support for blind users. The team behind the app hopes to add facial recognition features in the coming years. HealthTap launches a suite of new patient engagement apps in a bid to move into the enterprise healthcare space.
Webinars
November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
McKesson announces Q2 earnings: revenue up 10 percent, adjusted EPS $3.31 vs. $2.79, beating Wall Street expectations for both. The company raised guidance and announced an additional $2 billion in share repurchases. Technology Solutions revenue dropped 6 percent, much of that due to “our decision to exit the Horizon hospital software business,” with good performance from payer solutions and RelayHealth.
Theranos continues its fascinating, overly defensive implosion by eliminating seven of its 12 board member positions – including those held by Henry Kissinger and George Shultz – but creating a new board of counselors (which includes all of the old board members) and a medical advisory board. CEO Elizabeth Holmes claims the changes were made in July, although as in the case of the company’s proprietary lab methods, she provides no data to back up that assertion. The company’s new board includes Holmes, her COO, a billionaire who inherited his grandfather’s construction business, a retired general, and a wealthy lawyer who sues big companies. Some speculate that the departed board members wanted to distance themselves from the company and any potential litigation that may result. Meanwhile, Theranos, which has already raised $752 million, authorizes new shares that will value the company at over $10 billion, although that happened right before the critical Wall Street Journal came out.
Leidos reports Q3 results: revenue up 2 percent, adjusted EPS $0.71 vs. $0.65, beating expectations for both.
Sales
Carilion Clinic (VA) chooses Sagacious Consultants, now owned by Accenture, for revenue cycle improvement.
People
Timothy Johnson, DO, MMM (Children’s Mercy Integrated Care Solutions) joins Valence Health as SVP of pediatrics.
Ingenious Med names Scott McClintock (Have Marketing, Will Travel) as chief marketing officer.
Corepoint Health names Dan Simenc (3M HIS) as sales VP.
Announcements and Implementations
Analysis by The Advisory Board Company finds that hospitals are increasingly implementing CDC-recommended antibiotic stewardship programs to reduce inappropriate use, but many of them are too short on staffing and data to be effective. Most organizations have pharmacists rather than the prescriber review orders, most don’t record monitoring overall antibiotic use by prescriber, and few have adequate data to determine whether their programs are improving patient outcomes.
UV Angel announces an ultraviolet-powered patient room IT device disinfection system that automatically runs a cleaning cycle up to 40 times per day when it detects that a targeted device has been used.
Atlantic Medical Imaging (NJ) goes live on patient self-scheduling from OpenDr.
Hackensack University Medical Center (NJ), which self-styles itself with the annoying one-word nonsense of “HackensackUMC,” will integrate Gauss Surgical’s iPad-powered Triton blood loss estimation system with Epic.
Government and Politics
A study finds that the FDA is approving cancer drugs based on short-term patient response rather than their effect on overall survival, with the agency often neglecting to require manufacturers to perform the post-marketing studies that FDA required as a condition of approval. That means many of the most expensive and most important drugs on the market haven’t proven that they actually work, which has been a problem with oncology drugs for decades – drug companies, oncologists, and hospitals make tons of money pumping them into patients with soothing optimism but no guarantee that the patient will live longer or better.
While deaths from overdoses of heroin and prescription narcotics are skyrocketing – the former because addicts are switching from expensive and heavily marketed prescription drugs to cheaper heroin – 80 percent of addicts couldn’t get treatment even if they wanted it because capacity is lacking. I was talking to a first responder the other day who said exactly the same thing – in his tiny, rural town, heroin deaths are common since addicts can buy it on the street for a few dollars per dose vs. the high cost (no pun intended) of oxycodone and other prescription narcotics. The so-called war on drugs has been lost as prisons and morgues fill up and suppliers get even richer as reduced availability drives up prices (a lesson possibly learned from their legal but equally morally challenged pharma counterparts). As usual, these studies are coming from public health experts (Johns Hopkins Bloomberg School of Public Health in this case) since it’s not considered a healthcare or medical issue that provides a business opportunity.
The Department of Justice arrests the former president of drug maker Warner Chilcott, owned by Allergan, for conspiring to pay kickbacks to doctors who prescribed its drugs. The company will also pay $125 million in fines and plead guilty to criminal charges. Meanwhile, Ireland-based Allergan and competitor Pfizer begin merger talks in what would create the world’s biggest drug company with a combined market value of $340 billion, making that $125 million fine look like a valet tip. It would also provide a way for US-based Pfizer to dodge US taxes in declaring the headquarters of the newly created company to be Ireland.
CMS announces that it’s been a quiet October for ICD-10, with the number of claims submitted due to incomplete or invalid information remaining unchanged at 2 percent. The denial rate and percentage of claims rejected due to invalid ICD codes also hasn’t changed much. It a bit early to declare ICD-10 victory, but CMS seems to have defied the naysayers who didn’t believe its optimistic testing status reports.
Other
The AMA and MedStar Health publish their review of EHRs for user-centered design, which instead of looking at actual user usability or testing anything against standards, simply reviewed ONC’s certification test results for use of best practices. The top-scoring products were Allscripts Enterprise, Allscripts Sunrise, McKesson Paragon, McKesson IKnowMed, and Athena Clinicals. Bottom-scoring products are EClinicalWorks Version 1.0, Dr Systems, Greenway PrimeSuite, Epic EpicCare Ambulatory, and NextGen Ambulatory. The analysis used factors such as the vendor’s self-reported UCD process, the involvement of clinicians in testing, and the design of rigorous use cases for testing. It’s a puzzling list when the ancient Meditech Magic finishes one spot behind Cerner in the top 10. I also wonder how meaningful it is to critique user-centered design process by repurposing certification submissions for individual products – you would think a given vendor would use the same design and testing methods for all of their products. The end result will be what it always is in healthcare IT: the top-ranked vendors will brag loudly about the results while glossing over the methodology and applicability, while the low-ranked ones will criticize the methodology and applicability while glossing over the results.
Santosh Mohan, a management fellow at Stanford Health Care and long-time HIStalk reader, sent over this photo if the IT department’s Halloween celebration, in which the three folks above are dressed up as the (a) electronic (b) medical (c) record. I like subtle humor like this because once you get it, you can feel superior in imagining folks who didn’t get the joke.
Meanwhile, PatientSafe Solutions tweeted out this photo of its team. It brings back not-so-fond memories of my hospital’s IT department Halloween celebration, which despite featuring nothing more interesting than pumpkin bowling and orange-iced cupcakes, had to be renamed to the politically correct “fall festival” when a couple of employees complained that it celebrated devil worship.
Weird News Andy cries, “Bring out your dead” as he reads how New York’s health insurance exchange enrolled 354 dead people for health insurance, paying out $325,000 in claims to 230 of them. Design flaws, including people having multiple identification numbers, caused another $3.4 million in overpayments in the program’s first year.
Sponsor Updates
Healthcare Data Solutions publishes a white paper titled “Understanding the Opportunities & Challenges of Telehealth 2015.”
Impact Advisors sponsors an article titled “A Unique Approach to Business Analytics: The Scottsdale Institute Health IT Benchmarking Program.”
Stella Technology and DataMotion will participate in the interoperability showcase at the New Jersey and Delaware Valley HIMSS chapters conference in Atlantic City October 29-30.
InterSystems CEO Terry Ragon is featured in MIT’s Spectrum Magazine.
PDR and Leidos Health will exhibit at the NextGen User Conference November 1-4 in Las Vegas.
LiveProcess will exhibit at the New England Rural Health Round Table November 5-6 in South Bridge, MA.
Wellcentive CEO Tom Zajac will present at the inaugural meeting of The Leader’s Board for Population Health Management November 5 in Dallas.
MedCPU is recognized as one of Entrepreneur’s “Best Entrepreneurial Companies in America.”
Navicure will exhibit at Michigan MGMA October 30 in Mount Pleasant.
Recondo Technology and Sutherland Healthcare Solutions will sell each other’s solutions.
Over 1,000 health and human services leaders attended Netsmart’s Connections 2015 client conference, which featured mental health advocate and former Congressman Patrick J. Kennedy.
NTT Data will exhibit at the 2015 LeadingAge Annual Meeting and Exposition November 1-4 in Boston.
Obix will exhibit at the 14th annual Perinatal Conference November 5 in Dublin, OH.
Epworth Eastern Hospital (Australia) realizes improved outcomes with Oneview interactive patient care technology solutions.
PerfectServe will exhibit at ASN Kidney Week November 3-8 in San Diego.
The SSI Group will exhibit at the Georgia HFMA Fall Institute November 4-6 in Savannah.
Streamline Health will exhibit at the Health IT Leadership Summit November 3 in Atlanta.
Surgical Information Systems will exhibit at HealthAchieve 2015 November 2 in Toronto.
Surescripts will exhibit at the NextGen 2015 user group meeting November 1-4 in Las Vegas.
The Senate passes the Cybersecurity Information Sharing Act, a bill designed to curb cyberattacks by providing US companies legal immunity for sharing protected information with the federal government. CHIME published a statement of support just after the bill cleared the Senate.
AMA publishes findings from its EHR user-centered design study, with McKesson and Allscripts finishing at the top with perfect scores, and Epic falling behind both Cerner and Meditech’s legacy system. AMA evaluated 20 EHRs in the study, choosing a mix of inpatient, ambulatory, current, and legacy systems.
HealthTap launches an all-in-one patient engagement platform designed to help health systems roll out telehealth, secure messaging, online appointment booking, appointment reminders, and a population health analytics system.
The FDA releases the findings from its unannounced inspection of the Theranos laboratory, concluding that the proprietary blood draw container used by Theranos is an “uncleared medical device” that will require a full review.
US investigators conclude that Chinese hackers targeted Anthem to learn how medical coverage is setup in the US, as the country struggles to deliver on a promise of providing universal healthcare to its aging population by 2020.
Walgreens will reportedly acquire Rite Aid for $9.4 billion, offering $9 per share, a 48 percent premium to Rite Aids closing price Monday. The acquisition will also transfer Rite Aid’s $7.4 billion in debt to Walgreens. An announcement is expected as early as Wednesday.
Roper Technologies, the parent company of Sunquest Information Systems, acquires CliniSys Group, a European laboratory information systems vendor, and Atlas Medical, which connects diagnostic testing facilities with patients.
FDA declares the proprietary nanotainer blood draw containers used by Theranos to be an “uncleared medical device” following a Wall Street Journal report that the company had voluntarily already stopped using the finger-stick containers for all but one test. A September FDA inspection of the company’s Alameda, CA facility noted a number of deficiencies, including shipping its nanotainer collection tubes across state lines without having them approved by the FDA; not performing quality audits; and documenting required software validation on a shared Excel worksheet. Meanwhile, Theranos says it will now publish data proving the effectiveness and accuracy of its methods.
Reader Comments
From Prostetnic Vogon Jeltz: “Re: ICD-10. Georgia Medicaid is denying claims that use unspecified ICD-10 codes even though CMS said that wouldn’t happen. When I first see a patient with atrial fibrillation, I might not know whether it is paroxysmal, persistent, or chronic – that’s what the unspecified codes are for. I think this is important for HIStalk readers to know about.” The agency didn’t say it wouldn’t be ready for ICD-10, so it appears to have simply made the decision that it will not conform to CMS’s policies.
From Unbridled: “Re: PatientSafe Solutions. They have parted ways with CEO Joe Condurso.” Joe is still listed as president and CEO on the company’s web page, but an internal email sent my way says he resigned last Friday in a mutual decision and that Chief of Staff Si Luo will take over as president. The company announced last Wednesday that it has acquired readmission technology vendor Vree Health.
From Publius: “Re: VA. I predict the VA will go full Epic, forcing Epic and Cerner to get serious about developing interoperability with each other since DoD will be on Cerner. This will benefit all customers. A Cerner-Epic ROI exchange will be as seamless as Care Everywhere (Epic to Epic ROI module).” Politicians seem to be fretting that since VistA uses old technology (just like Epic), it therefore should be replaced with a commercial product despite the VA’s decades-long satisfaction with its internally developed system. The VA and DoD always seem to find reasons to not work together, so perhaps choosing Epic would prolong the hostilities.
From All-Around Good Guy: “Re: Lee Marley, SVP/CIO, Presbyterian Healthcare Services in Albuquerque. She has left and will be missed. The data center was built and Epic was installed during her tenure.” Unverified.
HIStalk Announcements and Requests
A reader who wishes to remain anonymous donated $250 to my DonorsChoose project, to which I applied double matching (from my anonymous vendor executive and from charitable foundations) to purchase materials for Mrs. Sandler’s elementary school class in Aurora, CO (math games), Mrs. Jones’s K-2 class of intellectually and emotionally disabled students in Galivants Fry, SC (math manipulatives), Ms. Sobczak’s Grade 1-3 class of students with communication disorders in South Holland, IL (math games), and the elementary school class of Mrs. Bowers of Oklahoma City, OK (headphones for online math intervention programs).
I’m regularly puzzled when people email me story links that I covered days before, apparently thinking that because other sites ran the news days later that I missed it. I don’t think I’ve ever missed a significant story, so I can only implore you to read all of HIStalk each time I post news on Tuesday and Thursday nights and over the weekend. Reason: other sites keep repeating the same news over and over trying to get more clicks, while I assume readers are smart enough to only need to see it once and therefore I don’t run repeats. Obviously my logic is incorrect if folks are either skimming or skipping certain posts. My other suggestion is to avoid assuming that just because I can summarize a big story in a few sentences doesn’t mean it’s not important – I don’t pad out the content with a lot of filler.
Who should I interview? Tell me someone who: (a) doesn’t work for a for-profit organization; (b) is smarter than most people; (c) is interesting and opinionated; and (d) I haven’t already interviewed recently. I like to expose fresh viewpoints, but those who possess them don’t always volunteer to be interviewed.
I was thinking that what we need to learn in this country that advancing health for a tiny percentage of the population (via precision medicine, expensive celebrity surgeons and surgical gadgets, and dramatic and expensive interventions) is the wrong goal. Our overall health (and health expense) isn’t driven by new developments for the wealthiest and best informed, but rather how well we can move the public health needle for the most people who are involved alongside the medical experts. Research and new medical technology aren’t needed when we can’t even broadly roll out basic services such as prenatal care, end-of-life counseling, mental health treatment, and addressing the social determinants of health. I worry that we irrationally celebrate advancements that are very narrow in scope and outcomes.
Gag Clauses: I Find No Evidence They Exist
Some of the worst and most sensationalistic healthcare IT reporting I’ve seen (and I’ve seen a ton) involves so-called gag clauses, where IT vendors supposedly insert standard contractual terms that prohibit users from openly discussing patient-endangering software errors. That inflammatory topic, like the Loch Ness monster, has generated a lot of rhetoric (some of it political) despite the lack of proof that gag clauses actually exist.
Take the above hype-filled story, in which the reporter not only provides no examples of the gag clauses he claims to have seen, he completely confuses standard intellectual property (IP) terms — like not being allowed to post source code or product documentation on the Internet — with prohibiting EHR-using providers from speaking publicly about product problems via a non-disparagement clause.
The folks at HIMSS Analytics gave me access to its CapSite Database, which contains actual vendor contracts they obtained using Freedom of Information Act requests. I reviewed dozens of contracts from Epic, Cerner, Meditech, Allscripts, EClinicalWorks, Athenahealth, and several other vendors.
I didn’t see a single clause that prohibits customers from speaking out about software problems. I had previously challenged readers to give me a real-life example of a gag clause and I didn’t receive any there, either.
My experience working for providers is that any pressure to keep quiet about software problems is self-imposed. Health system executives don’t want to jeopardize an expensive implementation or annoy their vendor “partner,” so internal policies require that employees obtain approval before making any public comments or publishing articles. The CIO of one of the health systems I’ve worked for said outright that nobody in the IT department (including clinicians) was allowed to publicly comment on anything without his explicit review and approval (“I’ve been burned by that before”) or they would be subject to termination, which may give you insight as to why I remain anonymous.
Epic has raised the most ire by enforcing the intellectual property provision to include screen shots. Customers can’t publish or share Epic screen images – even those involving customizations of Epic they perform themselves – without approval from Epic. The company’s rationale is that screen design exposes IP, where just seeing what fields are captured provides a lot of insight as to what’s happening under the covers such that a competitor could steal the logic. They give permission to publish the screenshots when that isn’t the case.
That doesn’t prevent users from talking about or describing Epic software problems. It just means they can’t publish screen shots, documentation excerpts, or source code (yes, Epic customers receive source code) to make their point without the company’s permission. I saw nothing to prohibit or even discourage that kind of discussion in any of the contracts I reviewed. Perhaps it is included elsewhere, such as in the particulars of Epic’s support fee rebate program where customers get money back for voluntarily following Epic’s suggestions, but I haven’t seen it or heard of a real-life example. I’ve also not heard of a vendor taking formal action against a provider for making unflattering software comments.
I’ll throw out one more challenge and them I’m calling gag clauses a Snopes-like false rumor spread by misinformed people. If you’ve seen an example of a vendor software contract that includes anything resembling a gag clause that prohibits customers and their users from talking about product or company problems, send it my way anonymously and confidentially. I would also like to hear of examples where a provider has spoken unfavorably about a company or product and was pressured to stop, either from the vendor or from their employer, since I suspect that information pressure is far more common.
Webinars
November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.
Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Sunquest owner Roper Technologies acquires CliniSys Group and Atlas Medical, which offer laboratory information systems to 2,000 labs in Europe and lab-customer connectivity in the US, respectively.
Walgreens is rumored to be preparing for a Wednesday announcement that it will buy competitor drugstore chain Rite Aid for up to $10 billion and will take on its $7.4 billion debt load. The deal would give Walgreens 17,800 stores worldwide vs. the 7,800 owned by CVS. Walgreens would also gain Rite Aid’s walk-in clinics, wellness stores, and EnvisionRX pharmacy benefits business. Italian-born businessman Stefano Pessina became the CEO and majority shareholder of Walgreens when it acquired his British pharmacy chain Alliance boots Group in 2012, giving the 74-year-old net worth of $14 billion.
Xerox reports Q3 results: revenue down 10 percent, EPS –$0.04 vs. $0.22 following a $385 million write-down after pulling out of two state Medicaid system contracts. The company says it won’t sell itself, but “a comprehensive review of structural options for the company’s portfolio is the right decision at this time.” Above is the one-year share price chart of XRX (blue, down 28 percent) vs. the Dow (red, up 4 percent). Shares dropped 8.3 percent Tuesday to a 52-week low on 13 times average volume.
Lexmark announces Q3 results: revenue down 7 percent, adjusted EPS $0.57 vs. $0.96. The company’s board has authorized “the exploration of strategic alternatives to enhance shareholder value and unlock the intrinsic value created by the company.” Shares dropped 13 percent following Tuesday’s announcement before the market’s open. Above is the one-year share price chart of LXK (blue, down 25 percent) vs. the Dow (red, up 4 percent).
San Francisco-based, 15-employee medical image analysis vendor Enlitic raises $10 million from an Australian diagnostic imaging company.
HCA announces Q3 results: revenue up 6.9 percent, adjusted EPS $1.17 vs. $1.18. The company blames lower profit on patients who were previously insured but stopped paying their Affordable Care Act premiums. The board authorized the repurchase of up to $3 billion of the company’s shares.
Dialysis Clinic (TN) chooses the EClinicalWorks EHR.
UNC Health Care (NC) and UF Health Shands Hospital (FL) choose Lexmark’s vendor-neutral archive.
Catholic Health Initiatives will expand its agreement with Allscripts to include managed services and its FollowMyHealth patient engagement platform. Mineopie reported as a rumor on October 21 that CHI had signed managed service agreements with both Allscripts (outpatient) and Cerner (inpatient). CHI signed a three-year, $200 million infrastructure outsourcing deal with India-based Wipro in March 2013 with little fanfare since except for IT employees complaining on Glassdoor that outsourcing, layoffs, and marginal management has put IT in shambles. The CEO said in 2010 that the organization would spend $1.5 billion on EHRs and other IT systems.
People
Jyotishman Pathak, PhD (Mayo Clinic) is named chief of health informatics at Weill Cornell Medicine.
Announcements and Implementations
IBM releases Datacap Insight Edition, which can classify and route scanned documents using advanced imaging, natural language processing, and machine learning. It provides an unconvincing healthcare example: “Where doctors and hospitals are transferring hand written notes and images into electronic health records for analysis or filing.”
Truman Medical Centers (MO) and Cerner will work together in piloting healthcare IT and giving Cerner employees on-site experience.
Peer60 publishes “Into the Minds of the C-Suite 2015.”
The American Dental Association’s ADA 2015 conference chooses DataMotion to provide Direct Secure Message and secure e-mail solutions as the technology backbone for secure digital exchange demonstrations.
Privacy and Security
In a remarkable statement, an FBI cyberattack expert says the agency often advises people to just pay cybercriminals the demanded money when a PC is infected with ransomware, which locks their computer information until payment is made to release it. He suggests that the malware is so sophisticated that payment is the best option, with the others being to revert to a backup or pay a security expert to try to remove the malware. Knowing that most people never make backups means they’ll pay either way. It’s a bit surprising that people still store their one single copy of valuable data on their local hard drive, which is a problem we’ve always had in hospitals where employees ignore strong suggestions (or policies) to store everything on the shared drive only. You can easily determine those who didn’t by the volume of their whining when they report a problem that requires immediately replacing or re-imaging their laptop or desktop.
Investigators conclude that China-based hackers breached insurer Anthem because the Chinese government is desperate for ideas on how to care for its aging population. Chinese citizens were promised universal access to healthcare by 2020, but they are not satisfied with the cost, quality, and gaps between the rich and the poor. Somehow the hackers missed the fact that the US has failed equally spectacularly on those same issues despite spending many times more than China and everybody else, so perhaps our cyber-retaliation involves hoping they follow our pitiful example.
Celebrity gossip site TMZ says several employees of Sunrise Hospital (NV) have been fired for trying to take photos and look up the medical records of former NBA star and comatose brothel patron Lamar Odom.
Other
A observational study by Massachusetts General Hospital finds that medication errors were made in half of its surgeries, a third of which caused patient harm. The most common errors involved mislabeled drugs, incorrect doses, failing to treat situations indicated by vital signs, and documentation mistakes.
In Australia, the Queensland government will provide an extra $4.2 million to support the Cerner rollout at the newly opened Lady Cilento Children’s Hospital, which has had many planning-related problems since its opening including an IT budget estimated at $29 million now standing at $67 million.
A state audit finds that South Australia’s Cerner Millennium pathology information system implementation skipped project steps and will fall short of money to complete the project, as additional costs for an unplanned disaster recovery center, legacy system decommissioning, and absence of an electronic ordering module are expected to exceed originally estimated costs of $22 million by several million dollars.
UMass Memorial Health Care (MA) will staff its $700 million Epic implementation by moving its 500-employee IT team to downtown Worcester to create room to house the 250 new hires needed. That’s what the local business paper says, although I would bet a lot of those new IT people are assigned there temporarily for the Epic implementation only. A common Epic implementation model is to choose existing IT team members for the Epic project via interviews and scores on Epic-mandated personality tests, hire new people as needed using the same interviews and tests, bring on temporary resources from clinical and administrative departments to provide subject matter expertise, and move everybody to a sequestered location where they won’t be bothered by unrelated IT work. A lot of those folks are borrowed until after go-live, when they return to their home departments. Hospitals usually hire experienced consultants as well to get them through implementation, after which they go away.
I mentioned previously that I had run into problems using Stride Health to look up available health insurance in various parts of the country to see how many plans involve high deductibles (answer: just about all of them). The company quickly responded with a request for details, then let me know that they had fixed the problems, one of which they hadn’t heard of until my report. It’s working great now.
In bizarre irony, the SXSW festival cancels two panel discussions covering the bullying of females in the online gaming industry after it receives threats of on-site violence. Members of Gamergate, whose members claim a lack of game journalism transparency, have threatened gaming industry women, vowing to publish their personal information or to rape or kill them.
Weird News Andy calls this story “You Don’t Know Squat.” A hospitalized woman in labor passes on the nurse’s recommendation that she perform squats to hasten her delivery, instead choosing to dance down the hall to a rap tune.
Sponsor Updates
Medecision will sponsor the HIMSS Summit of the Southeast 2015 October 29-30 in Nashville and HIMSS Big Data and Analytics Forum November 5-6 in Boston.
AirStrip will exhibit at The Health Management Academy’s CMO and CMIO Forums October 28-30 in Deer Valley, Utah.
Bernoulli becomes a sponsoring partner of the AAMI Foundation’s Coalition for Alarm Management Safety and Coalition to Promote Continuous Monitoring for Patients on Opioids.
Bottomline Technologies sponsors the nonprofit Leadership Seacoast for the fourth consecutive year.
Divurgent wins Business of the Year and Executive of the Year awards from the Business Intelligence Group.
EClinicalWorks will exhibit at the 2015 NJPCA Annual Conference October 28-29 in Las Vegas.
Extension Healthcare receives a 2015 Innovation Award in the Technology category from the Greater Fort Wayne Business Weekly.
FormFast will host a virtual user group meeting November 3 and 4.
HCS will exhibit at the LeadingAge 2015 Annual Meeting November 1-4 in Boston.
HDS will exhibit at Summit of the Southeast 2015 October 28 in Nashville.
Healthcare Growth Partners advises Lavender & Wyatt Systems on its sale to Netsmart.
Zynx Healthcare SVP of Mobile Strategy Siva Subramanian, PhD will participate as a panelist at Partners HealthCare’s Connected Health Symposium October 29-30 in Boston.
Burwood Group becomes one of the first Citrix Solution Advisors to complete three Citrix specializations in virtualization, networking, and mobility.
CitiusTech will exhibit at the NAHC Annual Meeting 2015 October 28-30 in Nashville.
Researchers at Massachusetts General Hospital analyze records from 277 operations and observed that 124 of the operations included at least one medication error, one-third of which resulted in harm to patients.
Truman Medical Center (MO) expands its partnership with Cerner, a fellow Kansas City organization. Under the new partnership, Truman’s IT staff will become Cerner employees and TMC will provide Cerner with a nearby “living lab” to research new solutions.
In preparation for its Epic implementation, UMass Memorial Health Care (MA) will relocate its 250 employee IT staff to a new 94,000 square foot office space in Worcester, MA that will provide enough room to expand the department to 500 people.
With the goal of expanding the number of meetings and conferences we report on, Mr. H is sending me to the AMIA Annual Symposium this year. I’ll be reporting on the activities each day. I’m looking forward to it as I haven’t attended previously. I’m also eager to log some hours towards Maintenance of Certification (MOC) for my Clinical Informatics board certification.
I’m not the only one looking forward to getting the continuing education credits. The AMIA listserv for the Clinical Informatics Community of Practice (CICOP) has been hopping with quite a few complaints about the whole MOC process for those of us in this new specialty. With the first cohort passing their exams in the fall of 2013, we’re decently into the first part of our 10-year recertification cycle. Those of us certified through the American Board of Preventive Medicine (the American Board of Pathology also certifies) are required to obtain a certain number of ABPM Lifelong Learning and Self-Assessment (LLSA) hours every three years in addition to regular continuing education hours.
Most of the current LLSA-approved continuing education offerings are within ABPM’s longer-standing subspecialties such as Aerospace Medicine, Occupational Medicine, General Preventive Medicine, and Undersea/Hyperbaric Medicine. The number of courses for clinical informatics are few and far between and typically involve on-site courses. AMIA has completed the process to offer LLSA hours for the fall meeting, and for those of us unable to get hours over the previous two years, it’s a huge help.
When I initially decided to try to become part of the first class of board certified clinical informaticists, I really didn’t think about what it would be like to maintain certification with two different board organizations. The American Board of Family Medicine already requires me to do 150 hours of CME each year, of which a certain percentage has to meet specified criteria. Certification by the AMA or the American Academy of Family Physicians are two of the criteria that count. Finding AMA- or AAFP-approved CME is easy. It’s everywhere, and can be earned not only through face-to-face symposia but also by reading journal articles and taking CME quizzes or doing online coursework.
We’re one of the first specialties that required Maintenance of Certification. Although the policies are a little tedious, they’re well documented and pretty straightforward. With Clinical Informatics being relatively new (coupled with the fact that many of us in the first two certification cohorts are, shall we say, fairly Type-A personalities) there’s a lot of tension around MOC. In addition to the LLSA credit, we’re also supposed to complete a “patient safety module” which is somewhat ill-defined (although ABPM did offer a link to a discounted course from the National Patient Safety Foundation that they’ll accept). A friend of mine got his university course approved as well, but the rest of us may not have that option.
I’m grateful that the Board has agreed to recognize some of the MOC (called Part IV) activities that physicians are already performing for their primary board certification. The current Clinical Informatics subspecialty certification requires physicians to maintain full certification in another American Board of Medical Specialties sanctioned discipline so it seems only fair, especially considering that the Board has yet to come out with a recognized clinical informatics module. I have to admit that the process to have my Family Medicine credits recognized was fairly straightforward, although it did require printing and completing a paper form and emailing it to the Board.
One of the respondents on the AMIA email thread mentioned that as a specialty deeply involved in computer-based projects, we should be at the forefront for virtual and online courses. Unfortunately one of the major challenges is completing the paperwork from the board to have your course recognized, which I hear is not exactly straightforward. I don’t know if there are fees involved with submitting a course offering, but that could be a de-motivator for some providers of continuing education credit.
There aren’t any well-known online providers for the kind of credit we need. Although some of our colleagues in academic settings are going to try to get their local courses certified, that doesn’t help those of us who are in parts of the country where we’re thinly populated. I’m one of two certified informaticists in my metropolitan area of over three million people, and I’m sure there are others even more sparsely arranged than we are.
One of the AMIA representatives mentioned being in contact with the Board and that we’re going to get an extension on some of the initial deadlines, but as a diplomate of the Board, I haven’t received that communication directly from them nor has it been posted on their website or in any other print media that I’m aware of. It’s understandably frustrating then for those of us who don’t want to fall behind but are somewhat stuck about what we need to do to be successful.
We’ll gather at AMIA, though, and see what kind of credits we can rack up and whether they’ll be enough to get us through the first checkpoint at the end of Year Three of our certifications. Hopefully some virtual offerings will be approved soon, or at least some recordings for those of us who aren’t willing or able to spend several thousand dollars (not to mention the time out of practice) to attend a conference in person.
It’s exhilarating to be on the cutting edge of things, but like being in the health information technology industry, it can also be frustrating and at times downright exhausting. I’m hoping that attending AMIA and networking with others in the field will help recharge some of my depleted energy and give me ideas for future projects. If nothing else it’s an excuse to visit San Francisco, which I’ve never done in the fall.
Joseph Pocreva, MD is an emergency physician at Keesler Medical Center at Keesler Air Force Base, Biloxi, MS. He is a colonel in the United States Air Force. His views and opinions are his alone and do not necessarily reflect the official policies or positions of the Air Force.
Tell me about yourself and your job.
I’m an emergency medicine physician. I’ve been practicing for about 15 years. I am in the Air Force. I have been working in various emergency departments, Special Operations, and different areas of the Air Force.
I have been here at Keesler for approximately five years and have had various roles while I’ve been here, including flight commander, medical director, and a practicing doctor on the floor.
How much of your career is more military than medical?
Sometimes it’s not very easy to answer that question. There are some physicians who feel like they’re more doctors than they are officers. Some feel they’re more officers than doctors. I have felt both ways.
Obviously when I’m on the floor and I’m engaged with patients, I’m a doctor. Yet when I walk away from the floor, I have to interact with other places, not only in the hospital but throughout the Air Force or with engagements with the Army or the Navy. Then my role oftentimes becomes more of an officer in the Air Force. That’s in my current position.
I’ve had other positions where I had no medical role at all. It was all about being in the military and functioning as an officer. It is a switch that gets toggled quite frequently. I’m not sure if I answered the question very well. I wouldn’t be able to give you a 60 percent, 40 percent answer — it all depends on the day and the demand.
You served on a humanitarian mission to Haiti, correct?
I was in Haiti. That was in 2010, just months before I was assigned here. I was the lead medical officer in Haiti when we went into the country to open up the airfield.
Have you had other assignments or deployments to other locations?
Oh, yes. If you’ve spent any time in the military in the last 20 years, you will have deployed.
My initial assignment was at Eglin Air Force Base in Florida. I deployed to Iraq in that timeframe. I was also stationed at Hurlburt Field, which is the Air Force Special Operations base. I did a lot of shorter missions, primarily to the Philippines. That’s where I went to Haiti as well.
I’ve traveled quite a bit doing a lot of diverse things. A lot of forward medicine, dealing out in the field without a lot of hospital support, just “what I can carry on my back” type of medicine.
How have you used that front line experience from Iraq in your ED job?
I was in a forward hospital there. We had a pretty decent sized staff, but we didn’t have a lot of resources. Practicing emergency medicine in today’s world is very lab- and radiology-intense. In those settings, we just don’t have those kinds of resources. You have to rely on your clinical abilities and your ability to make a decision, which is oftentimes paralyzing to the younger clinician who depends a lot on labs and radiology and their consultant staff.
If you don’t have it, you have to make decisions. Your decisions have serious implications, because if you want to transfer somebody in that setting, you have to get an aircraft to come in and take your patient away. If you can take care of them there versus putting them on a very expensive aircraft … You have to make those kinds of decisions. There’s a lot of differences between forward medicine and medicine back home.
What it’s like practicing in an Air Force hospital ED versus a civilian one?
Some very important key differences. We practice socialized medicine. We have a very captive patient population. They all have primary care doctors. They all have access to medications. There’s a social structure which is well defined. All of our active duty people have supervisors who we can call.
It’s a very different world from the outside. I’ve worked on the outside as well. I’ve moonlit for years at many different institutions and things.
There are advantages and disadvantages to both settings, but working inside the military is what socialized medicine is, in a nut shell. Actually, I would go on to say that, as far as I can tell, it is the best example of socialized medicine that we would be able to maintain.
People forget that military medicine isn’t just taking care of active service members, but their entire families as well, so you have pediatrics, oncology, and other services.
Right. The active duty population is only a small portion of who we take care of. The majority are their dependents and then our retirees as well. It’s everything from cradle to grave.
Is military medicine care at least comparable to what is offered in civilian settings?
It is somewhere in the middle. I’ve worked in plenty of hospitals that had nowhere near the capability that we have. Then you go to some of the major medical centers which have comprehensive care … When we have patients that are beyond our capability, then we will refer them to, in our case, the University of South Alabama or the Jackson Medical Center up in Jackson, Mississippi or over to Ochsner in New Orleans. We rely pretty heavily on them.
As far as the bread and butter basics of medicine, into surgery, into your medical specialties, and what have you, what we have is quite comprehensive.
What technologies and IT systems do you use in your practice?
We have CHCS, which is our basic underlying database., It’s been in place since the late 1980s and we’re still using it to today. That is where we record all of our labs and radiology and that’s where we do our prescribing from. As old as it is, it’s solid as a rock. It never goes down, ever. Everything else can go down, but CHCS still manages to keep plugging along.
On top of that, we have a graphical interface software solution called AHLTA. When it works, it works all right. [laughs] It is a program which is designed to interface with CHCS and pull data from it, as far as all of CHCS capability. But it’s also for record-keeping and and electronic medical records. We use it primarily just as an interface to get to the CHCS data.
In our emergency department, for our recordkeeping, we use T-System, which is hands down much better when it comes to data entry than AHLTA is. Much, much, better.
Those systems may be replaced in the DHMSM project. Are you looking forward to that or concerned by it?
I don’t really know a great deal about it. I understand that Cerner won the contract to provide the next generation. There’s generally the understanding that it’s going to be coming sometime in the future. After that, I think I know enough in my career that I don’t get too excited about dates of when it’s going to come, so I don’t know when we’re going to actually see that.
I would be very surprised if it has an interface which is more user friendly than T-System. Hopefully we can find a way to integrate T-System into it. But beyond that, that’s just all conjecture, and I don’t know — I’m not a part of that whole process.
I’ve read that 60 percent or more of care delivered to military members happens outside of military facilities. How do you communicate with external providers?
That 60 percent probably reflects most of the places not around the larger institution. Around here, we probably deliver considerably more than that in our facility. But so many of the smaller bases have been reduced to clinics. A lot of that referral work and surgical procedures and things are going to be done on the civilian side, so I think we do a great deal more of it here.
However, when we do refer people out to the community, they are not on our informatics databases. We have to rely on them doing a consultation and sending the reports back to us. Then our information people enter that data back into our system. It’s a rather slow and cumbersome process.
Do you have a lot of overlap in the information that you either need from or provide to the VA?
No. We see a lot of VA patients. We have a pretty robust interventional cardiology practice here, so virtually all of their cardiac caths come here. We have a lot of vascular surgery. A lot of the VA patients come here, but we don’t use their systems, nor do they use ours. If we want that data, we’ve got to go and request it old-school style.
How long do you plan to stay in the military?
I have been in the military for 23 years right now. I will be getting out next year. I’ve already put in my paperwork to retire. I should be retiring somewhere around the first of August in 2016. I will likely be joining a local practice here in the area.
What will you miss in not being part of the military?
The people, without a doubt. My grandfather was career Navy. My father was career Air Force. I’ve been on the Air Force welfare system since I was born. I don’t know anything different.
Not only taking care of this population, which is something that is very important to me, but working alongside a lot of people who really care about being here and doing the mission and being part of something much bigger than themselves is one of those intangibles that is very difficult, if not impossible, to find anywhere else.
It will be a sad transition for me, I’m sure. Although the local hospitals around here are wonderful by any marker, it’s going to be difficult to walk away from an institution like this.
People with no military connections admire the patriotism, discipline, and sacrifice involved. Is it equally impressive from the inside?
Oh, yes. Yes. You see people with talent and abilities and what have you. You look at them and you think, "Man, you could be making a million dollars on the outside, and yet you’re in here doing this job.” I really appreciate it.
That really comes through and shines when we’re deployed. When you’re out there and you’ve been away from your family for a couple of months and people are still putting their shoulders to the grindstone and just working hard.
Sometimes the situation and the environment we’re in is less than ideal. We’ve yet to go and occupy a really great place. [laughs] We tend to deploy to less-than-ideal locations. It’s very impressive when you see people step up and do the amazing work that they do. It’s an honor to be a part of that.
Athenahealth stocks jumped 28 percent on Friday after reporting better than excepted quarterly results. The company added 4,800 new physicians to its platform this quarter, a 40 percent increase. It also now has three critical access hospitals billing inpatient claims through AthenaNet.
AMA vice president of professional satisfaction Christine Sinsky, MD reports that EHRs are cited as the biggest driver of physician job dissatisfaction. She suggests utilizing scribes and medical students to reduce the amount of data entry required of physicians.
Walgreens announces that it will halt the roll out of Theranos blood testing centers within its stores until the startup resolves questions about its technology. Walgreens, which has an equity stake in Theranos, clarifies “We’re trying to figure out where we are and what we do going forward. We need to understand the truth.”
A revamped Healthcare.gov goes live Sunday, with updates expected to increase speeds by 40 percent and add features to help consumers compare the cost vs. benefit of each insurance plan.
October 25, 2015NewsComments Off on Monday Morning Update 10/26/15
Top News
Athenahealth shares jump 28 percent Friday after the company announces better-than-expected quarterly results. It’s now valued at $6.3 billion, with Jonathan Bush holding $51 million worth.
From the Athenahealth earnings call:
Jonathan Bush says three small hospitals are submitting inpatient claims via AthenaNet using what is basically an interface to the acquired RazorInsights hospital information system.
When asked about the company’s direction as HITECH winds down, Bush said, “The satisfaction and the feeling of being on-mission as opposed to on the tip of an Obama spear is phenomenal for us. No offense, Barack, I know that you’re Mr. President, but that’s just how it feels.”
Bush described telemedicine and the addition of Chiron to its “More Disruption Please” program as, “Imagine a store whose entire inventory rots instantly at the end of each day. That’s a doctor’s office … We’ve tried hammering them too much and that hasn’t been great, e-mailing and texting and auto-calling. We’re working on a partnership with a bunch of different makers of apps. We’ve got a small team that’s toying with a universal Athena app … I imagine someday the store brand of telemedicine for Athena will expand, of course. But right now, I think the right focus is getting those new players with their new energy into the tent.”
When asked to compare the company’s position vs. that of its competitors, Bush said, “We are the only company that’s selling a cloud-based service … No one has even a plan to think about starting to try in the sector that you guys think of as our competitors. I think of them as just a business model from a different era … That you run faster than a three-legged horse is not good enough. We really got to think about what’s emerging in the venture world and what’s possible in our business model and compare ourselves to that. We still feel like we have a long way to go on those results.”
Bush said of the impact of Medicare’s merit-based incentive program, “The thing about the MIPS program is it creeps up on you. This year’s performance is then submitted and the government takes a year to look at the performance. Then in two years, your rates are adjusted according to this year’s performance … It’s trickier to jolt the market with it, but it’s a really big deal. It’s an 11 percent, 12 percent swing in a doctor’s Medicare take-home pay based on how he performs, or she, on this program. So we should be able to sell against it. It’s just harder to explain and to create urgency around.”
Reader Comments
From Dixie Whistlen: “Re: top 25 blogs to read. Why did the magazine list Ed Marx on HIStalk but not the rest of HIStalk? Some of those they mentioned are not even popular.” You would have to ask the magazine. I don’t read those sites or pay attention because, like all such “awards,” it’s just a scheme to get people to click through the endless slide show to fool advertisers with a higher but meaningless metrics. One of the blogs that made the Top 25 hasn’t posted anything new since March 2011 and another winner’s newest post is from December 2013, which suggests a superficial editorial vetting process.
Speaking of junk health IT reporting and meaningless reporting intended to sell ads, I just noticed that US News and World Report is announcing its “Most Connected Hospitals” list, which it has apparently been running for years. That must offer competition to the equally pointless “Most Wired” list from H&HN that achieves little except allow CIOs to pad their resumes and hospital marketing people to place yet another logo on their ads that attempt to convince the locals of their organizational competence.
From Bob Wyer: “Re: cancelled sponsors. You said you would list them each month with the new and renewing ones, but I haven’t seen any.” I did promise to do that but I promptly forgot. Companies decide to stop sponsoring for a variety of reasons: they decide to spend their marketing money elsewhere, they are unreasonably obsessed with ad clicks, I wrote something unflattering but true that made them mad, they don’t have money in the budget, or the decision was made by a marketing person who knows nothing about HIStalk or the industry in general. Anyway, here’s the list of dearly departed sponsors going back several months. I appreciate their previous support, especially those that had sponsored for several years.
From Exotic Delicacy: “Re: Caremark. They won’t allow my prescription to be filled locally, so they ship by next-day air a 12×10 inch carton containing a 9×11 inch Styrofoam cooler packed with five ice packs. The actual meds are about 1×3 inches. Besides the cost, all of that (including the chemicals) goes into the landfill.” I was musing this week of what I call the Amazon Prime effect, where my near-daily Amazon orders create a never-ending mountain of boxes and packing material that I have to scrunch and tear to squeeze them into the large recycling bin that goes to the curb weekly. It reminds me of the department store stock boy job I had while working my way through college, in which the fun chore was feeding heaps of big, flattened boxes into the mall’s paper crusher deep in the bowels of the building. I also learned to hate Christmas gift wrap since it was stored in huge quantities in a truck trailer parked out back, causing me to freeze several times a day in November and December in bringing in more big boxes of it. It wasn’t nearly as fun as my summer job working at a public radio and TV station, which didn’t require me to do a whole lot except download satellite programs like “All Things Considered” to tape for later broadcast and to read the news for our infrequent live programming.
HIStalk Announcements and Requests
It’s apparently not just me that doesn’t see Dell as a significant healthcare IT player from my extra poll last week. Machete’s comment is an admirably concise interrogatory: “Dell’s in healthcare?”
The results of my regular poll are sobering, in which 6 percent of males and 52 percent of females say they’ve been sexually harassed at work in mostly unreported incidents. Woodstock Generation hopes a lot of the harassment happened in the 1990s when reporting was uncommon, while It’s Everywhere (Unfortunately) adds, “I was harassed by multiple attending physicians in medical school and witnessed them harassing other students and even patients. It was disgusting. As a practicing physician, I have been harassed by peers. Working with software vendor employees and consultants, I have seen entirely too much harassment, mostly fueled by alcohol and testosterone.”
New poll to your right or here: would you be willing to have your lab tests performed by Theranos?
I was interested after running a TV station’s photo of a hospital documentation sheet for a chemo overdose that a couple of readers complained that I had violated HIPAA, which is surprising since we’re supposed to be the HIPAA experts. First, the family took the photos and sent them to the TV station, presumably to bolster public opinion for their lawsuit against the hospital that was involved. Second, only covered entities (health plans, clearinghouses, and providers) are covered by HIPAA. Any other perceived breach of patient privacy can be addressed only through a lawsuit, which has nothing to do with HIPAA.
Reader Derek sent $50 for DonorsChoose, which thanks to the magic of matching funds from my anonymous vendor executive and The NEA Foundation, will provide four tablets that will be shared by three pre-K classrooms in Buffalo, NY, which they will use for math practice. Meanwhile, the photos above are of Mrs. Cole’s Minnesota first graders using the math games we provided and Mr. Burnitt’s Florida elementary school class working with the model rocketry equipment we bought.
Last Week’s Most Interesting News
Quality Systems sells its NextGen Hospital Solutions division to QuadraMed.
Lab upstart Theranos melts down after reports question the validity and limited use of its proprietary methods.
Vendors and providers agree on objective measures of interoperability, although not stating what those measures are or how they will be used.
IBM turns in another unimpressive quarter despite high-profile investments in Watson.
EClinicalWorks announces a cloud services platform, free client interoperability, and an Internet of Things cloud.
Webinars
None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
Acquisitions, Funding, Business, and Stock
Lab innovator Theranos continues to unravel as its highest-profile partner, Walgreens, says it won’t open any new Theranos testing centers until the company answers questions about its technology and why nearly all the samples it draws are full-volume ones that are analyzed by traditional lab equipment rather than its proprietary microfluidics machines. In more bad news for CEO Elizabeth Holmes, CMS says its surveyor found nothing innovative in the company’s facilities but did observe quality control problems; some of its claimed partners (Pfizer, GSK, Cleveland Clinic) say they’ve never actually done anything with Theranos; and records show that the company has hired poorly qualified lab directors, including a part-time dermatologist who is not certified by the American Board of Pathology. Questions are also swirling about why the Theranos board is made up of old, politically connected white men without scientific or medical expertise.
Huron Consulting Group shares dropped 24 percent Friday after the company turned in decent Q3 results but also lowered revenue guidance due to expected delays in two big academic medical center projects. The company also says it has “seen a softening in demand for our performance improvement solutions,” which it attributes to stabilized hospital margins due to ACA-insured patients such that “cost reduction work at some hospitals is no longer seen as an urgent concern.”
Fort Lauderdale, FL-based healthcare business services vendor Intermedix will open an operations center, innovation lab, and executive offices in Nashville, TN, creating 116 jobs. The company says the state and city “have welcomed Intermedix with open arms,” not mentioning the open taxpayer wallet that must have influenced its decision.
Announcements and Implementations
Westchester Medical Center Health Network (NY) opens its $7 million, 5,500 square foot eHealth operations center, which contains 20 telehealth monitoring stations that will be staffed around the clock by physicians and nurses.
Government and Politics
CMS goes live with an upgraded Healthcare.gov, saying the site will be 40 percent faster and will include the ability for users to see their estimated yearly costs for each plan. Features not yet ready will eventually allow consumers to filter the list of plans to those that cover a specific doctor, hospital, or drug.
Privacy and Security
A Springfield, MA gynecologist is indicted for accepting drug company bribes for prescribing its drugs and allowing its sales rep to dig through the medical records of her patients. The smoking gun is that as soon as the drug company stopped paying her, she stopped prescribing its products.
Local police in North Carolina speculate that scammers are using data from one of the recent high-profile healthcare data breaches to send unordered diabetic supplies by mail to people who who don’t need them. A recipient whose name, Social Security number, and doctor information was included on the unordered package tried to call the pharmacy number on the invoice, but it was phony.
The Miami-Dade division of Florida’s children’s medical services program mistakenly faxes a clinic roster to four vendors, exposing the information of 150 clients.
Technology
Israel-based MobileODT offers an $1,800 cervical cancer screening tool that connects a mobile colposcope to a cell phone, allowing clinicians to quickly take a cervical image that can also be sent out for a second opinion. The technology, which was trialed at Penn and Scripps, is being used in developing countries that can’t afford a traditional $15,000 colposcope. It will be sold in the US once the company obtains FDA approval.
Other
AMA’s VP of professional satisfaction says EHRs are the biggest driver of physician dissatisfaction. She cites studies that show doctors waste 80 percent of their time performing activities that don’t benefit patients, suggesting that they hire scribes.
A study of nephrology patients finds that patient portals are being used more widely but also more selectively, with less involvement by patients who are poor, black, and elderly.
Like that old Chicago song, nobody really knows what time it is in Turkey, whose government decides to push back the end of daylight saving time until after upcoming elections. The government doesn’t control computers and smartphones, which change time automatically based on rules rather than last-minute political pronouncements, so everybody is confused.
Centura Health SVP/CIO Dana Moore, whose ideas launched my DonorsChoose project during the last HIMSS conference, sent photos of the fundraising basketball game between the tie-dyed Centura team (which eventually won the game) and Epic. He said everybody had a great time and he’s sending me the $620 raised to fund more classroom projects, which will actually fulfill more grants when I apply the matching funds I have available. Good work by Centura, Epic, and Dana.
Weird News Andy deems Sunday’s Dilbert as “HIStalk worthy.” It’s a big panel – click the image to see it full size.
Sponsor Updates
T-System and Wellsoft will exhibit at the ACEP Scientific Assembly October 26-29 in Boston.
TeleTracking will host its client conference October 25-28 in Las Vegas.
Health Catalyst releases a documentary titled “Measured Outcomes: A Future View of Value-Based Healthcare.”
Valence Health will exhibit at the Arkansas HFMA Chapter Fall Conference October 29 in Little Rock.
Versus Technology helps cancer clinics nationwide enhance the patient experience with real-time workflow technology.
Huron Consulting Group will exhibit at the Connected Health Symposium October 29-30 in Boston.
Athenahealth reports Q3 results: revenue for the quarter was $236 million, up 24 percent, adjusted EPS $0.36 vs. $0.27, beating analyst projections on both.
Healthgrades publishes a report concluding that patients treated in a 5-star rated hospital have “a 71 percent lower risk of dying or a 65 percent lower risk of experiencing complications” as compared to patients treated in a 1-star hospital.
San Diego-based Imprimis Pharmaceuticals will begin selling a generic version of Daraprim for $1 per pill, down from its current price of $750 per pill, after national attention was drawn to the drug’s current manufacturer Turing Pharmaceuticals and its business model of buying the rights to rare but necessary medications with no generic equivalent and raising the price astronomically.
This week is one of those “you can’t make this stuff up” kind of weeks. It’s been filled with plenty of hard work, a fair amount of organizational dysfunction, and some pretty cliché observations.
Despite the challenges, I’m working with some genuinely nice people who seem to want to be successful and that makes all the difference. I’d rather work with people who know they have issues and want to try to be better than with people that think that everything is just fine when it’s not.
The practice I’m working with provides a fair amount of cash-based services (mostly cosmetic) and we dealt with some complaints about the lack of support for those workflows by their EHR vendor. It’s been interesting trying to explain why vendors have been spending all their time and energy on MU-related features and functions when the providers don’t care about being meaningfully used.
We did get some quick documentation templates done for a couple of their most common procedures, so that was a big win. One of the partners was so happy with the new workflow that he offered to give me some complimentary services. I wasn’t sure whether I should be excited about that or offended that he obviously thinks I need some work.
The physicians also have traditional primary care patient panels, but it feels more like a sideline rather than their focus. They’re trying to get in step with current primary care trends, but it’s a hard sell when you can make more money smoothing wrinkles, lightening dark spots, and making irksome leg veins go away.
Since they’re in a building on the hospital campus, several of the physicians hit the physician lounge for lunch every day even though they don’t admit their own patients. They’ve been taking me with them and it’s been enlightening to see what some of their peers think about the state of healthcare IT since I haven’t done much work in this part of the country.
I almost spit my sweet tea across the table when one physician said that since he was going to switch EHR vendors in the spring, he was going to go ahead and apply for a MU hardship exemption. He’s got connectivity issues with his current “lousy” system and has decided to just stop charting electronically. I’m not sure that qualifies as an extreme and/or uncontrollable circumstance, but he’s welcome to try. The vendor in question has tens of thousands of physicians who have successfully attested, so it’s an interesting position to take.
The practice is one of the first I’ve been in recently that still has pharmaceutical representatives call on the physicians. Most of the reps I’ve encountered over the years are hard-working and spend a lot of time dealing with cranky physicians as they haul samples from their company cars (used to be a lot of Ford Taurus-equivalent sedans, but now I’m seeing a fair number of minivans). The highlight of the week was the sales rep that pulled up in a new Maserati that cost more than my first house. He turned out to be EHR vendor’s regional sales exec. I guess he’s not hurting for business.
While I was fielding agenda changes from the client (who apparently thought of 20 other projects for me to work on during the time I was en route), I got a couple of emails from family members. My grandfather had a bone marrow biopsy last week and was told the results would be available in eight days. He dutifully called the office at the end of the eighth day after hearing nothing, only to be told that the physician would be out of town until October 29 and no one else in the office could give him results.
He sent his primary care doc a message through his patient portal trying to get the results, but was asking me for advice (as were his wife and my aunt). I thought it would be better to try to get in touch with the hematologist’s partners, who would presumably have access to his chart and would know what question the bone marrow biopsy was to answer or what condition was to be confirmed or ruled out. Even if he could see the results in the hospital system, I didn’t think this particular primary care physician would be likely to give them since he wasn’t the ordering physician.
I suggested that they call the hematologist’s office again and ask what the physician’s coverage arrangements are while he is out of town, and if they were told there aren’t any, that they mention the words “patient abandonment” and see what happens. This isn’t a question of a patient misunderstanding how he was to get the results – his discharge instructions clearly said to call for results in eight days. As a physician, I’m horrified at this kind of a process failure and the stress and worry it’s causing the patient and his entire family.
A couple of hours, later the PCP responded, basically saying he doesn’t know much about interpreting bone marrow results but that it “doesn’t look that bad.” That’s not exactly a vote of confidence for a worried patient. I saw the screenshot of the secure message and he definitely could benefit from a little coaching on how he explains things to patients. We’re still waiting to hear back from the hematologist’s office, who said their office manager would be calling to explain the cross coverage arrangements. Like I said, you can’t make this stuff up.
Turning my attention back to the client’s workflow issues, we identified several more commonly-seen conditions where the EHR didn’t fully meet their needs. I headed back to the hotel to get some additional custom templates built before selecting my next dining adventure. Several readers have commented or emailed about their BBQ preferences. The Carolinas are leading Texas two to one and I’ve received some suggestions I can’t wait to try. Tomorrow I’m finishing the day with a tour of the local Bass Pro, which promises to be something to behold.
The CEO sentenced to jail for massive healthcare fraud will get pardoned in a week.