Morning Headlines 12/12/14

Data Breach Industry Forecast

Experian publishes its annual “Data Breach Industry Forecast,” which lists a “persistent and growing threat of healthcare breaches” as one of the top security trends for 2015.

Data centre outage hits all Queensland hospitals

In Australia, 40 hospitals lose EHR access and are now running on downtime procedures after a routine upgrade caused memory issues that eventually took out the network’s SAN.

VA Hospital Project Grinds to a Halt Amid Budget Overruns

Construction on VA hospital being built in Denver is suspended after federal judges ruled that the VA was in breach of contract and that the project was $400 million over budget.

News 12/12/14

Top News

Experian’s 2015 “Data Breach Industry Forecast” says increased EHR adoption, lax security, and the popularity of wearables will make healthcare an attractive target, although as in all industries the biggest security threat involves an organization’s own employees. The report also says that cloud-based user credentials are increasingly attractive to hackers, with a Twitter login being worth more on the black market than a credit card number.

Reader Comments

From Bimbo Ears at DOH Pa: “Re: Pennsylvania physician licenses. The Licensing Bureau deployed defective software that lost renewal documents for doctors, affecting hundreds if not thousands of doctors whose licenses expire 12/31/2014. The vendor is System Automation, which claims on its website to make government more efficient.” Unverified. I didn’t see anything mentioned.

From Joey Cheesesteak: “Re: Dr. Michael Rosenberg of Health Decisions. Dies in a Maryland jet crash.” Michael Rosenberg, MD, MPH, CEO and founder of the Durham, NC-based contract research organization for drug and device companies Health Decisions, died when the business jet he was piloting crashed into a house in Gaithersburg, MD, killing all three occupants of the plane and a mother and two young sons who lived in the house.

From Ink-Stained Wretch: “Re: Epic’s Judy Faulkner. She never does interviews, but came out of her cloister to speak with VentureBeat and attempt to debunk a critical New York Times story. Perhaps Epic is feeling pressure from the Hill, where Epic is widely blamed for the perceived failure of EHR stimulus and is associated with the unpopular Obama.” Keeping a low profile (or declining all media contact) is great until there’s a PR problem. It appears that Epic is worried about being perceived as an uncooperative vendor of closed systems, especially with the Department of Defense’s EHR bid on the line. I’m guessing the VentureBeat “interview” with Judy was actually a quick email response since only a few sentences were quoted. VentureBeat isn’t the ideal platform for convincing either the industry or the federal government that a New York Times article was unfair or inaccurate, but odd publications seem to get through to Judy every now and then to get a couple of sound bites in the form of a quick denial of statements made in other publications.

From Dr. Herzenstube: “Re: new federal health IT strategic plan. It’s actually a pretty quick read at only 28 pages and a bit less platitudinous than one might expect. One item of particular note is the prominent acknowledgement by ONC that the potential safety hazards of HIT need to be better understood and addressed. Among the high-level objectives for the five-year period is, ‘Increase user and market confidence in the safety and safe use of health IT products, systems, and services.’ The document notes, ‘Evidence suggests health IT improves patient safety; however, health IT products can also lead to medication errors and other adverse outcomes. Additionally, poor implementation or improper use of otherwise safe systems can also lead to adverse outcomes. Clinical and other health providers and individuals must be able to rely on health IT systems to perform safely.” The optimist in me appreciates ONC’s recognition that the federal government’s healthcare IT bailout program has had both positive and negative effects on patients. The cynic in me wonders if this isn’t a pitch for ONC to save itself from irrelevance by elbowing its way into the health IT safety business via its self-proposed Health IT Safety Center, which Congress seems unwilling to support financially or otherwise.

From ICD Lay No More: “Re: ICD-10. Someone started a petition on the White House website to “Implement ICD-10-CM/PCS on October 1, 2015 – no further delays.” The signature count so far is 239.

HIStalk Announcements and Requests

This week on HIStalk Connect: Happtique, a digital health startup that spent several years working to bring legitimacy to the mHealth market through its app certification program, is acquired by SocialWellth for an undisclosed sum. Doximity, the LinkedIn for doctors, hits 400,000 users, meaning that it has now penetrated more than 50 percent of the US physician population. Walgreens announces that it will partner with MDLive to begin offering telehealth visits through its digital health app. 

This week on HIStalk Practice: Health First selects PatientKeeper software. Allscripts inks an ePA deal with Express Scripts. Tandigm Health goes with Lumeris population health tech services. Johnson County Mental Health Center connects to the Kansas HIE. Wearables finally make it to the ear. Survey results highlight HIPAA’s education problem. Thanks for reading.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

McKesson launches a strategic venture capital investment fund that will take minority positions in early- and growth-stage companies, with rumored investment totals in the hundreds of millions of dollars range.

Diagnostic device vendor Welch Allyn acquires the assets of Omaha, NE-based remote vital signs monitoring technology vendor HealthInterlink, saying it will offer US customers the FDA-cleared mHealth solution.

Streamline Health reports Q3 results: revenue up 2 percent, EPS –$0.14 vs. –$0.50, missing analyst expectations for both. Above is the one-year share price chart of STRM (blue, down 40 percent) vs. the Nasdaq (red, up 19 percent).

Madison, WI-based health IT incubator 100health, announced less than a year ago, shuts down, with the former Epic employees who founded it refocusing their energy on one of its startups Redox, which is working on APIs to access EHR information. One of those founders, Niko Skievaski, says the incubator’s model of taking 5 percent equity in very early startups didn’t provide cash flow, questions arose about how investors would be repaid when companies exited, and the founders of the participating startups relied too much on the partners as day-to-day managers.

SocialWellth acquires what’s left of Happtique from Greater New York Hospital Association. The highly hyped application certification service Happtique outlived its questionable usefulness a year ago when some of the apps it had approved were found to have ridiculously obvious security flaws (like storing PHI as plain text). SocialWellth offers “balanced living apps” that it describes as murkily and buzzword-heavily as possible in the hopes of sounding like it offers whatever a prospect might want to buy:

DIGITAL HEALTH ENABLEMENT TOOL KIT. Delivering Connected Consumers with Contextualized Experiences. As a leader in consumer and prescriptive digital health, SocialWellth enables payers, providers, and employers by delivering a wide spectrum of white label experiences and facilitating a connected experience between members and their payers. SocialWellth enables the curation of digital health experiences by leveraging mobile health technologies that allow for integration and aggregation of all digital assets, which improve the overall consumer experience.

Sales

Hartford HealthCare (CT) chooses RightCare’s assessment, referral, and care coordination software to reduce readmissions.

Cook Children’s Health Care System (TX) chooses Strata Decision for budgeting, capital planning, long-range financial planning, rolling forecasting, and reporting.

Health First (FL) selects PatientKeeper charge capture, expecting to go live with 90 hospitalists in January with integration to its GE Healthcare systems.

University of Vermont Medical Center (VT) will replace pagers with Imprivata Cortext secure communications.

Banner Health (AZ) chooses Craneware’s Chargemaster Corporate Toolkit.

Physician management services vendor Women’s Health USA chooses athenahealth’s EHR, revenue cycle, and patient engagement services for its 250 providers. The companies will also jointly offer their bundled services to other physicians.

People

Jamie Coffin, PhD (Clarify Healthcare) is named CEO of ambulatory surgery software vendor SourceMedical.

Eric Poon, MD, MPH (Boston Medical Center) is named chief health information officer of Duke Medicine (NC).

MedAssets promotes Mike Nolte to president and COO.

ADP AdvancedMD hires Arman Samani (Medhost) as CTO.

MedSys Group appoints President Steven Heck as board chair, replacing Luther Nussbaum, who will remain on the board.

Leidos Health names Steven Russell (Quantros) as SVP of sales and strategic accounts.

Philip Loftus (Aurora Health Care) joins SSM Health (MO) as CIO.

Announcements and Implementations

Allscripts announces its eAuth electronic prescription prior authorization module for Express Scripts patients.

Summit Healthcare offers the Express Connect web services adapter, allowing its interoperability platform customers to connect to applications using universal standards such as HTTP, XML, SMIME, SOAP, and JSON.

Health Catalyst announces its collaboration with Microsoft centered around the latter’s Analytics Platform Services.

Microsoft profiles the use of its technologies for the volunteer cleft palate surgery missions of Operation Smile, including Windows 8-powered Asus tablets running a digital patient assessment system, Slainte Healthcare EMR, Office 365, and OneDrive for Business.

Time names “The Ebola Fighters” as its Person of the Year.

Government and Politics

Federal judges shut down a billion-dollar VA hospital construction project in the Denver area after finding that the poorly planned and managed project is so over budget ($400 million or more) that the agency can’t pay for. It’s the fourth huge VA construction project that failed to hit budget and schedule targets. The VA’s contractor says it is owed $100 million and suggests letting the US Army Corps of Engineers replace the VA in managing the hospital’s completion.

Other

The New Orleans newspaper features the recent HIMSS EMRAM Stage 7 accomplishment of Ochsner Medical Center – North Shore (LA), an Epic user.

A Madison news site profiles Epic’s 122-member culinary team, whose head chef says he’s “never worked with a more talented group of cooks,” of which only five have left since he arrived in 2009. He’s planning the opening of a new 51,000 square foot dining hall in May that will require 42 new team members to operate. The chef says kitchen working conditions are family friendly and nearly all menu items are made from scratch. This is the most interesting factoid to me: 80 percent of employees eat on campus at subsidized prices, saving the company $450,000 per day in otherwise lost productivity. That’s not so great for area restaurants, but brilliant in terms of keeping salaried employees at their desks longer.

Up to 40 hospitals in Queensland, Australia go to downtime procedures when a data center storage controller software upgrade fails. Some systems were set up to fail over, but those that weren’t include an endoscopy system that’s used by 33 hospitals.

Minnesota state investigators blame a resident’s death on a “cheat sheet” that incorrectly indicated DNR (do not resuscitate) and missing code status in the EMR. An aide notified nurses when she found the man gasping, but the licensed practice nurses who responded did not attempt to revive him because of confusion about his DNR status.

I like Practice Fusion’s eight tips for maximizing patient engagement while using a computer in the exam room.

Weird News Andy titles this article “Disappearing Docs.” Federal investigators find that half of the Medicaid providers listed in its directory either don’t exist or aren’t taking new patients.

A federal judge sanctions Aetna and its subsidiaries ActiveHealth Management and Medicity for the company’s response to a patent infringement lawsuit brought by HealthTrio. Aetna’s attorneys designated 90 percent of the 862,000 pages of information it submitted as viewable only by its own outside attorneys, which the judge declared to be “absurd.”

Guam Memorial Hospital says it received inadequate training for its October conversion to NTT Data’s financial system, causing the CFO to have an uncertain picture of the hospital’s financial situation. It’s asking the company to send people back on site for a month.

Orlando ophthalmologist Jack Parker, MD sues his office’s former medical software specialist (and former fiancee, who moved out of his mansion in September), demanding that she return her $60,000 engagement ring, $70,000 Porsche, and a dog he spent $3,500 to train. She responded, “It’s my stuff.”

Jordain Shlain, MD pens (or keyboards) a completely brilliant poem that sums up the practice of medicine over many centuries that could be turned into perfect music as in REM’s “It’s The End of the World as We Know It (And I Feel Fine)”. An excerpt:

Sponsor Updates

• Medicomp is integrating Quippe and the MEDCIN Engine with the Soteria clinical management system of Infocare in South Africa. Above are Medicomp team members Jay Anders, MD (chief medical officer), Dan Gainer (CTO), Jason Valore (senior manager of solutions), and Dave Lareau (CEO) at the Cape of Good Hope.
• Forward Health Group is designated as a “High Performing” vendor in a new KLAS report on population health performance, with a 100 percent “Would Buy Again” score and a top ranking in categories such as “Money’s Worth,” “Keeps Promises,” and “Ranked Client’s Best Vendor.”
• SyTrue and nVoq will jointly market their respective smart data platform and speech recognition systems.
• EDCO Health Information Solutions publishes a case study of the use by City of Hope National Medical Center (CA) of the company’s Solarity medical records scanning and indexing system, which is 50 percent faster than paper processing and adds HIM quality and productivity tracking.
• Impact Advisors publishes an article titled “Population Health Management – Development a Roadmap.”
• The HCI Group lists its “Top 10 Most Popular EHR Articles of 2014.”
• The CoCENTRIX Coordinated Care Platform receives ONC-ACB EHR Complete 2014 Edition Certification.

EPtalk by Dr. Jayne

My inbox has been humming since this week’s Curbside Consult appeared. In addition to getting quite a few comments about the original Forbes piece, readers have had a lot to say about the overall idea of fashion advice for conference attendees and presenters.

From Handbags Ta Di For: “Perhaps the mHealth ladies can purchase this ‘fussy’ purse. Space Cadet ?!?” Although it’s from Kate Spade, who is one of my favorites, it’s probably not going to make my holiday wish list.

From Roy G. Biv: “Is it my imagination or are two of those accessories a stethoscope and doctor’s bag?” Not exactly. I think it’s a fussy necklace and a pretty big satchel. I’m pretty sure neither an otoscope nor an ophthalmoscope has ever seen the inside of that one.

From Mountain High: “There is a lot to be said on this topic beyond the presentation at a conference. Do people care about the dress of their provider? Do people look at their doctors and expect a certain amount of dress? Our hospital has banned ties for clinicians, which has resulted in a hodgepodge of male dress, and has almost completely eliminated dresses/skirts for clinical women as well, which has resulted in an army of khaki pants. Since nurses are still clad in scrubs, what is the expectation of your provider, should they wear their white coat? Many of ours are not donning the lab coats as they just don’t like them (and they come in three horrendous sizes unless you wish to buy, wash, and maintain your own). Currently my otherwise well-dressed partner is wearing a white muu-muu, as the sizes of lab coats run from men’s large to Andre the Giant XXXXXL.” A close friend of mine works at a prominent integrated health system that shall remain nameless. Several years ago they lived through “hosiery-gate,” which started with complaints about male physicians wearing loafers without socks. It ended up requiring “hosiery for all personnel.” She protested the idea that the hospital should dictate wardrobe to that degree by wearing various combinations of crazy socks with dresses so everyone could see them. Her patients know she’s a free spirit and got a kick out of it but the administration was not amused.

From Mixed Marriage: “Can we please address the Dansko clog? There are now over 250 variations of them, from the basic black or brown, to the most artistic floral patterns. Does your hospital provide any shoe-cleaning service? Because it should. As an IT person, even though I limit my clinical area time to as little as possible, I still religiously clean and polish my shoes not to make them look good, but to eliminate bringing germs and hospital funk into my car and house. How many other people think that through?” If I’m going to wear clogs, my personal favorite is Medimex Plogs. They’re bleachable and you can even autoclave them, although I doubt my hospital would let me just throw them in. You do have to watch out, though, because some of them are vented on the sides, so if you’re going to be anywhere gooey, you need to wear shoe covers. They also have massaging nubbins on the inside which is great during a long shift in the ER.

From Selfish: “Dr. Jayne, I think you have it all wrong. Everyone knows the real reason that people – especially women – go to conferences is to network and be seen. It’s not about learning or selling or presenting. I mean, really, do people actually listen to all 55 minutes of a conference presentation? Of course not. While we are pretending to listen, we are really asking ourselves if the presenter’s hairstyle would look good on us or if we could pull off that color scarf. Everyone knows that what really matters is whether one’s eye shadow is coordinated with their belt. After all, we live in the world of Instagram, Facebook, and Match.com, where image is everything and where we spend hours a day just looking at pretty pictures. Don’t be fooled people: all those mHealth folks aren’t staring at their iPhones looking at medical apps – they’re checking Instagram to see how many likes they got for their latest selfie.”

I’m giving this reader the inaugural Jonathan Swift “Modest Proposal” award for using satire to make us think. For many attendees, networking is the only reason to go to a conference. Whether you’re looking for your next opportunity or wanting to solidify or renew business relationships, looking successful is a key part of the event. For those that are addicted to social media, it is taken to a whole new level. Of course HIMSS is the granddaddy of “see and be seen” events and I’m certainly no stranger to critiquing fashion, shoes, or booth attire at the show.

I’m still receiving feedback as I write this and have even received a special guest post photo essay straight from the halls of the mHealth Summit. Stay tuned for Monday’s Curbside Consult. You won’t want to miss it.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Contact us online.

Morning Headlines 12/11/14

Congress reaches deal for $1.1 trillion U.S. spending bill

The omnibus spending bill making its way through Congress will not include an ICD-10 delay or Meaningful Use-related language. However, the bill does put stipulations on DoD and VA funding that requires both organizations to submit progress reports on their EHR integration efforts.

CMS reports rising Stage 2 attestations; CHIME says it’s not enough

CMS reports that 11,478 eligible providers and 840 eligible hospitals have attested to Meaningful Use Stage 2 thus far. CHIME quickly responded pointing out that the total stage 2 attestations represent just 35 percent of EHs and four percent of EPs. The deadline for hospitals to attest is December 31, while providers have until February 28.

Patients Increasingly Value Electronic Health Records, Eager for More Access and Features

A new survey measuring consumer interactions with health IT finds that online access to medical records has doubled from 26 percent in 2011 to 50 percent in 2014. 86 percent of the patients with online access to their medical records reported logging in at least once in the last year, while 55 percent report logging in more than three times per year.

Patient Engagement: Digital self-scheduling set to explode in healthcare over the next five years

An Accenture report finds that 77 percent of patients think that being able to book, cancel, and edit appointments online is important. The report predicts that by the end of 2019, 38 percent of appointments will be self-scheduled.

Readers Write: Automate Your Informed Consent Process: Lessons Learned from the Joan Rivers Tragedy

Automate Your Informed Consent Process: Lessons Learned from the Joan Rivers Tragedy
By Tim Kelly

A number of errors have recently come to light in the investigation of the tragic death of Joan Rivers. The endoscopy clinic that treated the 81-year-old comedian was cited by the New York State Department of Health for numerous deficiencies, including failing to obtain informed consent for each procedure performed. Organizations should review the following processes and ensure that they are in place to avoid deficiencies such as those cited at Yorkville Endoscopy.

• Append the consent to the electronic medical record at the time it is executed. A recent study published in JAMA Surgery found that signed consents were missing for 66 percent of patients at the time of surgery, resulting in delays for 14 percent of the cases. It is clear that Ms. Rivers agreed to a specific treatment when she presented at Yorkville Endoscopy on August 28. It also appears that the documentation of that consent may not have been adequate to address all aspects of the procedures that were ultimately attempted.
• Ensure that the informed consent document states the exact procedure(s) or treatment(s) to be performed. Many hospital consents are one-size-fits-all consents or fill-in-the-blank consents. The former are of little value in verifying the patient’s understanding of the planned procedure if the document is reviewed retrospectively. The latter are frequently flawed by illegible handwriting or abbreviations. An analysis of the Rivers case suggests that consent may have been obtained for an esophagogastroduodenoscopy (EGD) but not the two nasolaryngoscopy procedures that may have resulted in complications that in turn may have contributed to her death. Automated systems can force the clear delineation of planned procedures while also documenting possible treatments and interventions that may be pursued intraoperatively.
• Identify and confirm the providers who will perform the treatment or procedure. Many organizations employ electronic credentialing systems to identify which providers have privileges to perform certain procedures. Yorkville Endoscopy was cited for allowing a physician who was not privileged at the facility to participate in the treatment of Ms. Rivers. Automating the consent process, and integrating that process with a credentialing system, ensures that only providers authorized to perform the contemplated procedures are documented on the consent form. This practice can mitigate the potential for deviations involving non-credentialed providers.
• Obtain the patient’s permission for observers and photography. It is vital to teaching organizations to allow for the presence of observers and sometimes the recording of surgical procedures. It is also essential that the patient give his or her permission to the presence of observers and use of photography. It appears in the Rivers case that unauthorized observers were present and unauthorized photographs were taken during the procedure. Automating documentation of consent, including allowance for observers, authorization for photography, preferred disposition of tissue samples, and similar permissions, allows for those preferences to be communicated to other HIT systems. This practice can help ensure that patients’ wishes are followed.
• Leverage the consent in the time out. Yorkville Endoscopy was cited for not following an acceptable time out procedure. Review of the consent form immediately prior to the start of a surgical procedure is a key component of the Joint Commission’s Universal Protocol. Significantly, verification of informed consent documentation – documentation that lists the procedures and well as the surgical site – has been found to be the most effective mechanism for avoiding wrong person / wrong procedure / wrong site surgery.

It should be noted that informed consent documentation alone cannot correct all of procedural deficiencies that were identified by the Department of Health in the Joan Rivers case. However, a well-prepared, procedure-specific consent can serve as both a contract and a roadmap for how a procedure or course of treatment should be performed. When the consent process is facilitated electronically and that process is integrated with other HIT systems, including the EHR, the risk of deviations or errors may be minimized.

Many of the findings in the New York State Department of Health report were not that policies were lacking; it was determined that established policies were not followed. Automation, by its nature, helps ensure compliance with an organization’s policies and procedures.

An excellence policy on automating the informed consent process has been developed by the Department of Veterans Affairs.

Tim Kelly is director of marketing of Standard Register Healthcare of Dayton, OH.

Readers Write: The Case for Smarter Clinical Workflows

The Case for Smarter Clinical Workflows
By Sean Kelly, MD

The practice of evidence-based medicine can promote patient safety, increase quality of care, and improve clinical outcomes. Providers are increasingly being held accountable to abide by regulatory standards, Meaningful Use guidelines, and Centers for Medicare and Medicaid Services incentive and penalty programs.

The move toward measuring quality and patient safety as key performance indicators in healthcare makes sense, but accomplishing these goals relies in large part upon improving efficiency. Unfortunately, inefficiency is inherent in many of today’s clinical workflows, which detracts from the patient care process by bogging down providers and disrupting the care team’s collective thought process.

The answer is to implement technologies and processes to enable smarter clinical workflows that promote efficiency while also improving quality of care.

Take, for instance, clinical communication. As an emergency physician, I see firsthand the need for faster, more effective communications. If I am able to quickly receive information, share with colleagues and coordinate next steps, I can better care for patients. Unfortunately, relying on pagers and other outdated technologies creates barriers that can delay care and can have significant impact on patients, especially in critical care situations.

Consider a heart attack patient. It is essential that providers are able to diagnose and treat the patient as quickly as possible to ensure that no permanent damage occurs. In cases of ST elevation myocardial infarctions (STEMIs), streamlining clinical workflows to speed the time from door to balloon — the time from patient arrival to catheterization of the coronary arteries to alleviate the occlusion—can mean the difference between complete recovery and a life of struggling with congestive heart failure … or worse.

Cath lab activation is a coordinated effort which may involve many different care providers and care teams. This makes the workflows vulnerable to the negative impacts of inefficient communications. In this situation, invaluable time is potentially wasted from step to step, time that could substantially impact the patient outcome.

This scenario highlights the need for—and benefits of—a smarter clinical workflow. For example, if the care team could use secure communications solutions to send group messages to the care team, coordination and activation of the cath lab would be far more efficient. In this scenario, the smarter clinical workflow includes technology that allows:

• Immediate, synchronous, bi-directional secure messaging with the ability to send high definition images to assist in rapid diagnosis and collaboration over best treatment option (resuscitate and open up the cath lab).
• Direct integration into scheduling and on-call systems to facilitate tracking of team members, complete with read receipts, send receipts, and auditability to enable accurate, rapid messaging capabilities (ensure that the correct people are on call, aware they are on call, and rapidly respond when called, complete with escalation if any delays in response).
• Group messaging capabilities to send code team activation directly to multiple devices so team members get alerted more quickly, simultaneously, and messages and responses are easily tracked and acted upon, instead of multiple pages (and waiting for callbacks).
• Multi-site communication systems to allow the notification of other clinicians needed for complete care delivery, such as the patient’s primary care physician, specialist, or case manager, to provide notifications about the patient’s condition and follow-up instructions for care (which could also prevent unnecessary readmissions).

This is just one of many examples of how more efficient communication can impact the healthcare continuum. Giving physicians, nurses, and other care providers the tools to do their jobs more effectively can help hospitals meet quality and patient safety goals, support accountability, and most importantly, improve the overall quality of patient care.

Sean Kelly, MD is chief medical officer at Imprivata and emergency physician at Beth Israel Deaconess Medical Center in Boston.

Morning Headlines 12/10/14

Saying Epic is a ‘closed’ health records system is an oversimplification

VentureBeat profiles Legacy Health (OR), an Epic customer, as they work through their interoperability options while trying to share data between a network of community hospitals and the primary care offices that refer patients to them. Epic CEO Judy Faulkner weighs in, “There are multiple standards, and we do most … if not all of the ones that are most frequently used.”

Jonathan Gruber is very, very sorry about Obamacare ‘gaffes’

MIT economist and former healthcare.gov advisor Jonathan Gruber testifies before Congress, apologizing for his disparaging remarks about the Affordable Care Act.

Computer says no: NHS IT was not designed to operate at this level

In England, a physician laments about life as an EHR user as the NHS transitions its hospitals away from paper charts.  

News 12/10/14

Top News

ONC issues its Federal Health IT Strategic Plan 2015-2020, which will serve to set the stage for the Nationwide Interoperability Roadmap that will be released early next year. The 28-page plan, open for comments through February 6, is the result of input from 35 government agencies. It describes the government’s strategies to achieve five goals, which include improving interoperability, patient engagement, and the expansion of IT to parts of healthcare that have been without it, such as long-term care and treatment of the mentally ill.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock 

MetaMD acquires Patient Education Programs, including its Digital Diabetes Educator tool and an interactive educational game for kids with sickle cell disease.

Texas Medical Center and Village Capital select a dozen startups to participate in their inaugural VilCap USA: Health IT 2014 assessment program. The two highest-ranking startups will walk away with $50,000 each at the end of the three-month program.

National Research Corp. acquires Digital Assent and launches the DA-developed Reputation tool, enabling healthcare organizations to collect, display, and syndicate authentic patient ratings and reviews across owned and affiliated websites.

Avizia merges with Emerge.MD to offer hospitals a complete telemedicine platform consisting of Avizia’s telehealth devices and video conferencing tool and Emerge.MD’s telemedicine software. The combined company will continue under the Avizia name.

Sales

Greenville Health System (SC) selects Healthier Populations Solutions from Orion Health to support its population health and ACO initiatives. GHS is in the midst of a five-year, $97.2 million, system-wide Epic implementation.

Major Hospital (IN) implements the Diagnotes secure texting system across its facility, which includes 89 beds and 300 clinical staff.

Torrance Memorial Medical Center (CA) rolls out the Allen Technologies Interactive Patient System at its new Melanie and Richard Lundquist Patient Tower. The hospital hopes to implement the system across its 446 beds once all of its TV systems have been updated.

Paladina Health (CO) selects the eClinicalWorks Care Coordination Medical Record for population health management. The primary care provider, a subsidiary of DaVita Healthcare Partners, already uses eCW’s EHR.

E+CancerCare (TN) installs Equicare CS oncology patient management software at 13 of its outpatient cancer care centers. Implementation took just three months.

Announcements and Implementations

CareFusion and Kit Check, both players in the medication administration space, partner to connect their hardware, software, and RFID solutions for improved medication handling from pharmacy dispensing to OR point of use.

BlackBerry partners with NantHealth to develop the NantOmics Cancer Genome Browser, its first app. Slated for availability early next year, the app will connect a physician’s Blackberry Passport with a NantHealth system that analyzes tumors and recommends treatment options.

Vector Oncology integrates its Patient Care Monitor with Flatiron Health’s OncoEMR to give oncology care providers an easier way to gather and view patient-reported symptoms at the point of care. Lee Schwartzberg, MD, president and CMO of Vector Oncology, will serve as a medical advisor to Flatiron Health during the partnership.

Vital Care announces that its HealthPatch MD wearable biosensor is now available for use in clinical trials in partnership with Medidata. The sensor can be used with Medidata’s Clinical Cloud platform and mobile app for patient-reported outcomes.

Walgreens offers consumers in California and Michigan access to MDLive physicians through its Walgreens mobile app. The new tool, which will be rolled out to additional states in the coming months, builds on the app’s Pharmacy Chat feature launched last year. (Check out Lt. Dan’s thorough recap of the news at HIStalk Connect.)

Research and Innovation

Five researchers at the University of Texas Health Science Center at Houston School of Biomedical Informatics receive $7.3 million in grants to improve healthcare and biomedical discovery through the use of healthcare IT. Projects underway include patient safety research, enhancing the use of EHRs in research, developing software to make EHRs more user-friendly, and using analytics to improve heart-disease care.

Government and Politics

MIT professor and former Healthcare.gov consultant Jonathan Gruber apologizes profusely for his recent “foot-in-mouth comments” on healthcare reform during a House Oversight and Government Reform Committee hearing on the ACA. CMS Administrator Marilyn Tavenner also took advantage of the hearing to apologize for overstating the number of Healthcare.gov enrollees. Both, likely with tails between their legs, reiterated the party line that the ACA has been a success thus far. 

People

Naomi Fried (Boston Children’s) joins Biogen Idec as vice president of medical information, innovation, and external partnerships.

Joel Shu, MD (Jersey City Medical Center) joins Catholic Health Services (NY) as vice president of clinical transformation and population health.

Non-profit Healtheway announces its 2015 Board of Directors.

Other

The Brookings Institution offers a roadmap for effective unique device identifier implementation. The 94-page document offers recommendations on integrating UDIs into provider systems such as EHRs, administrative transactions, and patient-directed tools.

The local paper profiles Mayo Clinic’s (MN) big data research partnership with UnitedHealth Group. Two-year-old Optum Labs is the nation’s largest and most comprehensive healthcare database, and includes de-identified claims data from 150 million UnitedHealth customers spanning the last 20 years. It will eventually be linked to 44 million medical records, including 5 million from Mayo.

This article puts Epic’s interoperability efforts (or lack thereof) in the spotlight, focusing on the journey of customer Legacy Health (OR). CIO John Kenagy puts things in perspective: “No vendor solves this problem completely. There’s a natural inclination to blame Epic because they’re just a big target.” Judy also weighs in: “One hundred percent of our customers that are live with our EHR are also live with our Care Everywhere software built in. We have even gone back and retrofitted it into old versions so that every one of our customers can send and receive to others, to anyone who uses industry standards, whether they use Epic software or if they use other vendors’ software who also follow the standards.”

UVM Medical Center (VT) deploys two Xenex Germ-Zapping Robots in its ORs to the tune of $100,000 each in an effort to reduce HAIs. The hospital, which won the 2014 Partnership in Prevention Award for its HAI elimination efforts, plans to deploy them next in isolation rooms.

A clinician bemoans the state of NHS IT (and its interference with her gambling habits), eloquently fuming that, “It’s not just the doctors who struggle; the ageing bones of the crumbling hardware system creak ever louder as it cranks up to process another new data load.”

President Obama makes a guest appearance on The Colbert Report, poking fun at himself and Healthcare.gov.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 12/9/14

The Federal Strategy For Collecting, Sharing, And Using Electronic Health Information

ONC has updated its Federal Health IT Strategic Plan: 2015-2020, establishing a set of goals that focuses on advancing interoperability, improving care delivery, engaging patients through digital health tools, and supporting medical research efforts through data mining and retrospective studies.

Why So Many New Tech Companies Are Getting into Health Care

Bob Kocher, MD, a former healthcare economics advisor to the Obama administration, publishes a piece in the Harvard Business Review analyzing the digital health innovation boom in the US, and the cost-saving opportunities that the new startups should be targeting.

Walgreens app makes virtual doctor visits a reality

Walgreens partners with telehealth vendor MDLive to provide virtual visits through its mobile app. The new service now available for residents of California and Michigan, with additional states coming online in 2015.

Readers Write: Summary of RSNA and My Takeaways

Summary of RSNA and My Takeaways
by Mike Silverstein

I just returned from the 100th Radiological Society of North America (RSNA) conference at McCormick Place in Chicago. It was my fifth time attending this show. It is always well attended given the core importance of diagnostic medical imaging within the healthcare provider community.

I was particularly paying attention to the messaging of the vendors in the room and the value propositions they put forward given the budget constraints within healthcare IT.

• RSNA is international. As opposed to HIMSS, AHIMA, MGMA, etc., RSNA is populated by vendors from all over the world. As such, the attendees include large contingents of representatives specifically from hospitals in Europe and Asia in addition to North America.
• If you have never attended the show, more than half of the exhibits (if not more) are focused on large pieces of capital diagnostic equipment: MRI, CT scan, monitoring etc. As a result, some of the booths (Siemens, GE, Agfa, Fujifilm etc.) are huge. I’m talking multiple city blocks.
• Unlike HIMSS, where there is an annual influx of new companies with net new technologies, RSNA is similar from an exhibitor perspective year over year. There is still a tremendous number of companies talking about PACs, RIS, and CVIS, although when I spoke with a number of the executives at those booths, the market for standalone imaging systems is stagnant.
• The buzz in the room was primarily centered around image sharing technologies like vendor-neutral archiving, enterprise imaging, cloud-based image storage, multi-site reading interoperability, and other technologies focused on breaking down silos and disparate systems. The focus of these firms is helping hospitals, imaging centers and the like to leverage and get more usability and flexibility out of their existing PACs, RIS, and CVIS systems. Vendors such as Mach7 Technologies, SCImage, Merge, Agfa, Acuo Technologies (now a part of Perceptive Software), Accelerad (aka seemyradiology.com, now a part of Nuance), and others highlighted the groups focused on flexible image interoperability systems.
• There was a good deal of activity as well at the TeraRecon and Vital Images (now part of Toshiba) booths. Both of these vendors have historically been known for their capabilities in 3D and 4D imaging, but both are trying to educate the market on some of their new enterprise imaging capabilities.
• There were other workflow vendors focused on speech recognition and other complimentary diagnostic tools such as MModal with its Fluency product, Nuance with its Powerscribe 360 product set, and Dolbey with its Fusion product, which was Best in KLAS the last couple of years. These booths had good activity too.
• Another well-represented area that should continue to grow is the teleradiology segment. Reading of remote images has been going on for years, but as we focus on providing better quality of care to remote areas and the fact the telemedicine as a whole is on the rise, these companies in my opinion are still a good bet.
• Lastly, there was a new vendor that I thought was very interesting called MedCPU, which recently deployed at the Cleveland Clinic. They have solution that operates behind the scenes of an EMR, RIS, or any other clinical documentation system that can read and comprehend unstructured notes, text, test results, speech (from a Nuance or MModal), and any other clinical information. The solution analyzes this information and cross checks it against compliances guidelines and clinical best practices and identifies variances in real time to alert the clinician of medical errors. They incorporate a combination of natural language processing and other homegrown technologies. After viewing their demo, I think they are a company to watch out for.

All in all, RSNA was well attended this year, but I think that the general consensus is that the large vendors need to figure out how to move the needle while helping CIOs keep costs down and get more out of their existing imaging systems. This will be a challenge for some of the big, publicly traded players, but the future looks bright for the nimble enterprise imaging interoperability companies who are gearing up for Meaningful Use Stages 3 and 4 that require the incorporation of medical images into the EMR.

Mike Silverstein is a managing partner of Direct Consulting Associates of Solon, OH.

Curbside Consult with Dr. Jayne 12/8/14

My favorite fashionista sent me a link other day in advance of this week’s mHealth Summit. Since I spend most of my time worrying about MU, PQRS, VBP, and a host of other acronyms, I wasn’t terribly familiar with the fact that Forbes apparently has a style file. And here I thought they were all about business and investing!

Reading further down her text made me even more curious: “There’s tongue in cheek, and then there’s this….”

“Power Wear: mHealth Summit 2014” starts out innocently enough, providing background on the conference and its attendees. From there, however, the author gets a little silly, stating, “What you wear will visually convey your professional message as well as empower you to fully engage at the conference … my mission is to free you up to concentrate on presentation and participation by making getting dressed easy.”

Seriously? Does she actually think that women who have arrived at the point in their careers where they’re presenting at a national meeting cannot coordinate their own wardrobes?

She goes on to remind us that we need to “appear flattering” and “to opt for clothing that enhances or creates an hourglass shape.” I’m pretty sure I left my corset in the 1890s, where it belonged. When she admonished readers not to be distracted by “a fussy handbag, or fidgeting with your look,” I’m sure my mouth was gaping open. I wonder how many female mHealth professionals even own a fussy handbag, let alone give much consideration to their “look?”

Certainly no one wants to look bad on stage, but most of us prefer to spend our time polishing presentations and ensuring we have time to actually make all the meetings on our schedules rather than fretting about whether our outfits are au courant. Not to mention, serious travelers are more motivated to ensure their entire conference wardrobe fits into a 22-inch roller bag rather than making sure they have multiple handbags with which to accessorize.

She offers three “inspirational style guides” that are (in her words) fashion-forward, professionally-polished, versatile, comfy, and inspirational. Don’t get me wrong, I enjoy a smart suit or a hot shoe. But generally I’m inspired by a person’s words, accomplishments, and how they relate to the audience far more than how they’re dressed.

The second look she pictures reminds me of something out of the Barbie aisle, complete with awkward posture, anatomically-fascinating digital alterations, and optional accessories:

I was torn on thinking whether this piece was really supposed to be serious, so I sent it to some of the most fashion-savvy people I know, all of whom are seasoned conference presenters and attendees. Comments ranged from, “OMG, is this a joke? I’m kind of speechless. And why specifically for mHealth?” to, “After reading the beginning, I was expecting something a little more from the clothing.” One C-level took less exception to the existence of the piece than to the author’s choices: “Seriously, did you look at what she picked out… Good God! But don’t they have similar fashion articles for men?”

Other highlights:

• I am sorry, but I am stunned by this. I would think that this conference would be less Project Runway and a little bit more Davos… the fact that this is probably representative of the wearable market (did Google Glass die yet, because it should), which is ripe with misplaced interest and based on the idea that the sexy dork is a smart one. Sure, I’d love to have years of biometric data in your EHR if I were your patient, but can’t we agree as patient and provider that it would be most valuable if you had all of my previous tests, visits, labs, and data elements in discrete and reportable (and trendable) format inside your EHR first?
• The only trend in healthcare that we should care about is the one that comes from having a true longitudinal and holistic and normalized view of a patient from birth to present. All other trends should be left at the hatters and haberdashers.

My favorite all-around IT guy is married to a physician and summed it up:

Maybe, just maybe, when healthcare leaders start to focus on the meaningful, the trite can be ignored. Providing sartorial suggestions for presenting demonstrates to me that we continue to focus on all that is useless while ignoring the real issues at hand. I am saddened, in a time when female representation at these meetings and panels remains woefully disproportionate to the balance of society at large, let alone employment in healthcare, that there is something important in how a woman is styled that will alter the content of the message, the value of the opinion and/or data, and the attention of the audience.

I am wearing a smart plaid tie over a blue shirt with brown pants, brown belt, brown shoes, and plaid socks with grey in them. No one cares that my socks are poorly chosen and the brown belt and shoes are not the same brown. Nor do people care that I rarely get a close shave. They just don’t. I stand in front of people and present things and they just listen to me and judge me on the content.

My personal advice for presenters is to wear something you’re comfortable in and to make sure that you have somewhere to clip the power pack for your wireless microphone. That in itself effectively rules out the first look, unless you’re traveling with a backstage roadie who is ready to hook it to your bra band or duct tape it to your back under the dress. I saw both of those happening in the green room of the studio where our hospital films its public-access cable show and neither is a technique I’d want to utilize in the 15 minute handoff between speakers at a conference.

I know a good number of HIStalk readers are at the mHealth Summit this week. I’m interested in what you think as well as what you’re seeing in the halls and on the podium. Is the mHealth crowd more fashionable than the HIMSS or Health 2.0 crowds? Is a $177 Tory Burch floral top going to take my presentation from good to great?

Email Dr. Jayne.

Morning Headlines 12/8/14

Alberta moves on integrated health records system

In Canada, the province of Alberta has formed a task force to plan the development of a centralized health information system after the College of Physicians and Surgeons complained that the current system was “woefully inadequate.”

A Response to AMA President Dr. Robert Wah

The Coalition for ICD-10 publishes a harsh reply to AMA president Robert Wah, MD’s outspoken objections to the upcoming transition to ICD-10 codes.

The Woolly Mammoths Of Digital Health Care

Forbes reports on the persistent usability issues that are hindering providers, embarrassing EHR vendors, and frustrating policymakers as the ROI on the nation’s HITECH investment continues to loom just out of reach.

Monday Morning Update 12/8/14

Top News

Alberta, Canada begins its search for a new clinical information system after a auditor’s report found that the $260 million it spent on EHRs resulted in systems that don’t talk to each other, requiring the continued use of faxing to exchange information. Progressive Conservative Member of the Legislative Assembly says, “Do we realize we need to have data exchange standards before we start adding systems? We need systems to talk. It blows my mind.”

Reader Comments

From Not My First Rodeo: “Cottage Health System in Santa Barbara, CA. Going Epic. Recently hired a project director and is moving quickly to hire FTEs from other regional Epic customers.” Somewhat old news, I think, given that Cottage’s bond rating agency mentioned the planned Epic expense in its July ratings report.

From The PACS Designer: “Re: Chartcube. It will enhance your presentations of spreadsheets. Collaborate with colleagues using your iPad to focus on the really important elements of your spreadsheets.”

HIStalk Announcements and Requests

I hereby acknowledge the will of the people in proclaiming Atlanta as the official “Healthcare IT Capital of the US.” Atlanta’s health IT network and civic pride turned out the vote with 45 percent of the 1,600 votes cast (including mine). Congratulations to the “Home of Peach Trees and HIT” (the only peach trees I know there are the 100 or so streets named that, but surely they must grow somewhere among all the concentric asphalt rings). New poll to your right or here: do you look forward to going to work Monday mornings? Vote and then click “Comments” to explain.

It’s a very slow news season and that situation will likely continue over the next few weeks. I could do as the industry rags do and simply pad out this post with endless paragraphs covering non-newsworthy topics, crank out poorly thought out editorials that say nothing new, or pretend that pointless announcements deserve extensive coverage and an easily churned out backstory containing mostly unrelated historical facts. However, I’ve decided (as I always do) that instead I’m going to avoid wasting your time and mine and give you a few minutes (and me a few hours) of your life back. I promise I haven’t omitted anything important and I will continue to be verbose when events warrants. Meanwhile, I’m going to take the rare opportunity to get off the computer and hopefully do something fun.

Last Week’s Most Interesting News

• A new JASON report prepared for the federal government says the health IT systems market is moving in the right direction with regard to interoperability, but that initiatives are not complete because systems sometimes only export entire documents, omit patient information, or provide APIs whose use is contractually limited to customers rather than entrepreneurs.
• HL7 launches the Argonaut Project to address the standards recommendations of the federal government’s JASON group, including HL7’s FHIR (fast healthcare interoperability resources).
• ONC names Jon White, MD from AHRQ as acting deputy national coordinator and acting chief medical officer, taking over for the recently departed Jacob Reider, MD.
• Madison’s alternative weekly newspaper says that Epic has backed down from its plan to extend its non-compete term from one year to two for employees who quit to join consulting firm Vonlay after its acquisition by Huron Consulting Group.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers, executives, and clinicians, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

The Cleveland paper profiles CoverMyMeds, whose CFO predicts it will become a billion-dollar company. The company, with annual revenue of $50 million and growing, doubled its headcount this year to 140 and expects to double it again in 2015 after an undisclosed investment by Francisco Partners. I interviewed co-founder Matt Scantland a couple of months ago.

Sales

Everyday Health chooses Validic to integrate consumer data into its digital health and wellness platform. Validic announces several more new customers, including WebMD and UPMC, that increase its client population from 80 million to 100 million. The company is presenting and exhibiting at the mHealth Summit this week.

Other

A brilliant example of for-profit, non-peer reviewed “journals” that publish articles for a fee: two “predatory” scientific journals accept for publication an article containing indecipherable, randomly generated text as submitted by three authors, all of them characters from “The Simpsons.”

The Coalition for ICD-10 responds to the ICD-10-sarcastic comments of a generally IT-whiny AMA President Robert Wah, MD (who has an informatics background and served as deputy national coordinator of ONC, yet somehow now hates everything about healthcare IT) in saying that seemingly wacky ICD-10 codes have good reasons for their use. Example: “Sucked into a jet engine” might seem eye-rollingly hilarious unless you spend 18-hour days on a Navy ship flight deck trying to avoid doing just that. I have to say that I’ve been hoping someone would give Wah (and the AMA) a good spanking for his ridiculous, self-serving rhetoric  and the group did exactly that:

Dr. Wah complains about the number of codes and the detail in ICD-10 but fails to mention that much of the additional specificity in ICD-10 was at the request of medical specialty societies. Nor does he mention that there are no ICD-9 codes for many critical healthcare issues. There is no code to report and track Ebola. There are inadequate codes for tracking service-related health problems for our veterans. There are no codes to help us research sports-related concussions among young athletes. It’s hard to understand why the AMA is not demanding that this kind of information be available in our national data.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 12/5/14

HL7 Launches Joint Argonaut Project to Advance FHIR

HL7 will work with a large consortium of vendors and health systems to develop a standardized data sharing API and a set of common vocabularies that all EHR vendors could adopt to exchange discrete data and improve interoperability.

Computer-Generated Vs. Physician-Documented History of Present Illness (HPI): Results of a Blinded Comparison

Researchers created a computerized questionnaire that collects clinical data from both patients and providers and then produces a narrative history of present illness. A panel of 48 physicians then blindly evaluated them against physician-documented HPIs, concluding that the computer-generated HPIs were more complete, more useful, more succinct, and better organized.

State says it has repaid $1.3M in overpayments

Massachusetts pays back $1.3 million in Meaningful Use incentive payments after a federal audit found that local hospitals received $2.1 million in overpayments. Representatives from the state Medicaid agency report that the remaining balance will be subtracted from future payments to the overpaid hospitals.

News 12/5/14

Top News

HL7 launches the Argonaut Project to address the standards recommendations of the federal government’s JASON group, including HL7’s FHIR (fast healthcare interoperability resources). Working with HL7 will be athenahealth, Beth Israel Deaconess Medical Center, Cerner, Epic, Intermountain, Mayo, Meditech, McKesson, Partners HealthCare, SMART from Boston Children’s, and The Advisory Board Company. HL7 says the group will create FHIR-based EHR data sharing API specification by the spring of 2015. The big news here: (a) the second JASON report called for a big vendor to propose an open API standard instead of waiting around for the government to do it; (b) FHIR and APIs are a heck of a lot better than today’s document-based interoperability standards and probably better than the customized jungle that the HL7 standard has become; and (c) getting Epic, Cerner, Meditech, and McKesson together at the same table covers nearly all of the hospital EHR market and Epic, particularly, is a key member given its non-participation in CommonWell (and Epic and Cerner already have customers using APIs).

I asked an expert who shall remain unnamed to summarize Project Argonaut:

Project Argonaut is beginning the hard work of not only formalizing the API calling sequence (the easy part and something most vendors already do), but to formalize a set of vocabulary objects – Problems, Allergies, Notes, etc. with controlled vocabularies and predictability. To make FHIR really work, both must be done well. If FHIR succeeds, it will allow third parties to create an “app” and be able to run it in any FHIR-compatible system without the meet and map exercise with each implementation. What we’ll need to do with FHIR is to ensure people don’t get ahead of themselves and customize the “resources,” otherwise we’ll be back in the same boat as HL7 v2. FHIR is at the peak of inflated expectations. It will be great as a minor plug-in where there’s a UI or visualization, but not so great for machine-to-machine communication where one of the endpoints might not always be reliable for high-volume transfers at scale – some of the simpler web service configurations can be horribly inefficient, like making separate grocery store trips for each item on your list. There may be audit and security issues as well.

There is no immediate connection, but over time, CommonWell could add services that are based on the FHIR standard that the Argonauts are trying to speed up. For example, CommonWell today uses XCA to move CDA documents around, but that can be cumbersome if all the doctor wants is to get a list of known allergies from some other site. FHIR makes the later query much easier than using XCA to move a "fake" document that contains only allergies. So, CommonWell will benefit from the success of the Argonaut work (assuming it’s successful!) But otherwise, there is no direct connection, though some of the same people are involved with both.

Reader Comments

From Ken L. Ration: “Re: HIMSS. Our designer got a good laugh from this HIMSS15 promotional graphic. One thought it was an attempt to be edgy, but the general consensus is that it’s a marketing fail.” I think it’s an insightful graphic: those benzene ring-shaped items are probably snowflakes burying HIMSS attendees who would much rather be almost anywhere else — Chicago came in seventh of 11 desired HIMSS cities last time I surveyed, with the clear winners being San Diego, Las Vegas, and Orlando.

From Roy G. Biv: “Re: physician billing services. Do health systems keep using them after implementing Epic? Could you ask your readers if, for instance, the keep using athenahealth’s PM and billing service post-Epic?” Readers have been duly notified – responses are welcome.

From HIT5982: “Re: Medhost. Let 71 people go Wednesday all at once. HR cleaned out their desks while they were being told. I was one of them – I worked in the department division (EDIS, Patient Flow, perioperative) and was told the emphasis will shift to Enterprise (clinicals, financials, patient access, revenue cycle). Departmental sales were down this year.” Reported by two readers. I reached out to the company for a response but didn’t receive one. Nothing says Christmas like being laid off.

I shall digress and pontificate on the topic of layoffs. I’ve seen both sides over the years: (a) I was literally on my way out the door before getting a last-minute reprieve in my one and only vendor job many years ago, where layoffs every quarter were a given as executive bonuses became threatened by poor financial numbers mostly due to their own poor decisions; and (b) I have personally marched at least 20 people out of the hospital IT department through a gauntlet of their peers as I served as judge, jury, and executioner for high-level decisions that I neither made nor agreed with. Both situations were largely created by clueless, spreadsheet-circulating executives who were shockingly indifferent to the havoc they were wreaking on the lives of people and their families. While some of the folks who get axed deserved it and should have been canned a lot sooner, many of them had been given perfectly fine performance evaluations but were singled out for factors beyond their control: changing organizational strategy, their own demographics, higher salaries that they had been voluntarily offered to them, and doing their jobs every day instead of kissing executive butt and backstabbing their co-workers. Readers regularly send me personal stories about being cut loose and I always provide the same response: you’ll be better off in the long term because who wants to work for a company that lays people off? To people all over the industry who have to face the holidays (and their families) with uncertainty, fear, and feelings of personal inadequacy for whatever reason, I am truly sorry. It will get better.

From Pierre Dukane: “Re: slimy companies. This site [URL omitted] charges consultants $300 per quarter to be on the ‘elite’ list for go-live job notifications, using information it gathers from other members and online job postings (duh). The ‘About’ page doesn’t say who runs it and the domain registration information is blocked. I can’t believe people pay for this garbage. Also, an HIT consulting firm’s recruiter is sending emails offering entry into a gift certification drawing if they ‘forward any email you receive from another recruiter or company regarding current opportunities or referral incentives.’ What happened to working the old-fashioned, honest way? No wonder clients and consultants feel so negatively about consulting firms.” It wasn’t hard for me to track down the operator of site you mentioned, which doesn’t seem to be offering much for $1,200 per year. But hey, it’s a free country, and he’ll either get business or he won’t depending on the value he provides. I’ve had both good and bad experiences with recruiters that I’ve either hired or been placed by, but I agree that quite a few questionably motivated people see it as nothing more than making easy money by matching Resume A to Job Posting B. Nearly everything in life can be explained by supply vs. demand.

From Elsa: “Re: BJC’s core clinicals replacement. Vendors were to have been notified Friday. I was shocked that it wasn’t Cerner – my source says it’s Epic. Not sure how they’ll justify the cost when they laid off staff, cut charity care, and froze raises.” Unverified.

From Not Quite: “Re: JASON report. ONC is putting a lot of stock in it, but it’s a fake that is partially plagiarized from Wikipedia. The report lists many references, but fails to list Wikipedia, from which many things were copied. ONC should ask for our money back!” No report should ever reference Wikipedia since it’s not a vetted reference, but hopefully the JASON folks cited their primary references properly, at least where a source contained something that isn’t common knowledge.

HIStalk Announcements and Requests

Voting for the US capital of healthcare IT has been heavy, with Madison leading the pack and Nashville and Boston pulling up as a distant second and third. Voting ends this weekend – my poll is here.

This week on HIStalk Connect: Data scientists with athenahealth are monitoring the onset of the 2014-2015 flu season and note an early uptick in flu-related visits. Google is said to be revamping the internal components of Google Glass in an effort to boost battery life. Personal genome testing startup 23andMe will begin selling genetic tests in Canada and the UK after a year of trying and failing to secure FDA approval for US sales. 

This week on HIStalk Practice: Payers in Colorado build online claims data-sharing tool for physicians. HIPAA compliance at physician practices is found to be woefully lacking. Gila River Health Care goes with NextGen, while Advocate Community Partners selects eClinicalWorks. Practice Fusion VP argues for net neutrality, while Amazon takes advantage of lightning-fast consumer Internet connections. AMA winner Nancy Adams asks, “Interoperability? How about achieving operability first?” Thanks for reading.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

Integrated payments network vendor InstaMed raises $17 million in a private placement, $2 million more than it was seeking.

Sales

Rio Grande Valley Health Alliance (TX) and Lakewood Health System (MN) choose Lightbeam Health Solutions for population health management. I interviewed CEO Pat Cline a few months ago. 

Western New York’s HEALTHeLINK HIE chooses Stella Technology’s clinical data access technology for analytics and reporting.

Children’s Hospitals and Clinics of Minnesota chooses Strata Decision’s StrataJazz for decision support and cost accounting.

Granite Health Network (NH) selects athenahealth’s athenaCoordinator Enterprise Population Manager.

The Medical Center at Bowling Green (KY) chooses ProVation Medical for its cardiac cath lab.

People

CompuGroup Medical US promotes Navid Asgari to VP of service and support for its ambulatory information services division.

Announcements and Implementations

Lehigh Valley Health Network (PA) announces that its physician group will move to Epic.

Levi, Ray & Shoup announces release of a new user interface for Epic users of its VPSX output management solution.

Imprivata announces OneSign 5.0, a new version of its authentication and access management product.

Children’s National Health System (DC) opens an Innovation and Learning Center to house Bear Institute, its partnership with Cerner. The announcement is confusing, but I think it’s just a new physical space to house the existing project, which was announced just over a year ago.

CareSync launches its Chronic Care Management service that allows providers to earn Medicare’s monthly CCM payments.

Perceptive Software launches Perceptive Interact for Google Apps, which allows users to integrate Gmail content into Perceptive Content for review, routing, and collaboration.

Government and Politics

ONC names Jon White, MD from AHRQ as acting deputy national coordinator and acting chief medical officer, taking over for the recently departed Jacob Reider, MD.

Someone tweeted out this fascinating article from March called “Sinkhole of Bureacuracy,” which describes the 600 federal government employees who push paper in the abandoned limestone mine run by Iron Mountain in the middle of nowhere in Pennsylvania at a cost of $56 million per year. Previous federal government automation efforts of the government’s retirement program failed despite spending well over $100 million. A former employee described the manual process as, “I used to chase people for months — literally — for one signature on one piece of paper. You want to talk about an egregious waste of taxpayer money? … On a daily basis, we would get from five to 50 e-mails, asking everybody to take time out of their day to search their desks for case files.” The article says the old mine is legend in the federal government, quoting former CTO Aneesh Chopra as calling it “that crazy cave.”

Massachusetts says it has repaid most of the $2.1 million in Medicaid EHR incentives that were incorrectly given to 19 hospitals that were identified by the HHS OIG. The state blamed requirements that are hard to understand and hospitals that reported incorrect data to the federal government.

Innovation and Research

A small study finds that a computerized symptom questionnaire that was turned into a History of Present Illness narrative using computer algorithms created a better HPI than physicians doing it themselves.

Other

Hospitalists at two Oregon hospitals form a union, hoping to remain as hospital employees rather than being outsourced to a national firm.

A review of a tiny sample of the 100TB (!!) of data hackers took from Sony finds medical information, in the form of doctor letters for medical leaves of absence. The responsible hacker group, possibly from North Korea, has posted some of the information publicly, including salaries, scripts, and video files of unreleased Sony movies. The hackers also released a Word document titled “Passwords” that some idiot Sony executive had used to store all of his computer passwords and credit card information. Sony was burned by hackers in 2011 who stole credit card numbers and took down its PlayStation network for weeks. 

New York police arrest radiologist James Kessler, MD, MPH for copying the information of 97,000 patients of his former employer onto a portable hard drive with intention of starting a competing business.

Singer and cancer survivor Melissa Etheridge, just announced as a keynote speaker for GE Healthcare’s Centricity Live user conference, creates a line of prescription-only “cannabis-infused fine wines” that provide “a delicious full body buzz.”

Sponsor Updates

• An Imprivata video provides an overview of electronic prescribing of controlled substances.
• HCS provided 50 tickets to the Los Angeles screening of the overwhelmingly positively reviewed Glen Campbell documentary “I’ll Be Me” in support of Alzheimer’s awareness. The company will be contributing to the Salvation Army through the holidays on behalf of its clients.
• DataMotion earns accreditation as a Certification Authority and Registration Authority from DirectTrust.org and EHNAC, allowing it to issue and manage digital certificates in addition to its role as an accredited Health Information Service Provider.

EPtalk by Dr. Jayne

ONC will hold its annual meeting February 2-3, 2015. The email announcement caught my eye in mentioning that “the two-day meeting will gather over 1,200 health IT fans,” but on the registration website, it had been toned down to “health IT partners.” The event includes “an exciting panel of ONC’s former National Coordinators,” according to the email. I’m not sure if that’s enough of a draw to convince me to head to Washington in February. If you’re planning to attend, keep us in mind for rumors and newsy tidbits.

GE Healthcare announces its Centricity Live 2015 meeting April 29-May 2, 2015 at the Walt Disney World Dolphin Resort. Keynote speakers include Atul Gawande, Melissa Etheridge, and LeVar Burton. That lineup looks pretty good compared to some I’ve seen. I stayed at the Dolphin a couple of nights before HIMSS and it’s in a minimally mousey part of the Disney compound. Given the recent weather in my neck of the woods, I’m sure by April I’ll have a complete deficiency of Vitamin D, so if anyone wants a sassy traveling companion, let me know.

My good friend Anjali called last week asking for a favor. The annual Christmas Party at her hospital (it’s a faith-based institution, hence the name) was looming. Her husband had to travel and she didn’t want to go alone. She’s run three half marathons with me and has had my back in countless clinical situations, so how could I say no? She works at a hospital across town where I only know a handful of medical staff members, so I was looking forward to a holiday party where I could have a couple of glasses of wine without being interrogated about our EHR.

We were a little late heading out. She had picked up a dose of flu vaccine from the local retail pharmacy and was planning to vaccinate her daughter. The pediatrician’s office was already out of vaccine and the pharmacy won’t vaccinate children under 8 even with a physician’s order, so she decided to get creative. Unfortunately, she’s a surgeon with few pediatric vaccine skills, so I was persuaded to step in.

It’s a sad commentary when you have to work the system to vaccinate your child. Most parents don’t have that option, but I was happy to help. Needless to say, that vaccine won’t be making it into the state immunization registry, but I did email her the Vaccine Information Statement so I don’t run afoul of the feds.

The tables were packed when we arrived. We grabbed the first open space we found. We were next to a husband/wife physician couple – she’s a radiologist on staff and he’s an internal medicine physician elsewhere in town. The odds of a physician conversation (regardless of setting) eventually turning to EHRs and healthcare IT is nearly 100 percent if you talk long enough, and tonight didn’t disappoint.

The radiologist is pretty happy with the hospital’s system. She appreciates being able to view the entire patient chart when there are questions about what an ordering provider hopes to achieve with a diagnostic test. She also enjoys not having to help the radiology staff decipher cryptic physician handwriting.

Anjali told them she preferred handling patient messages from home after her daughter goes to bed rather than having to stay in the office. A couple of other people chimed in and I thought for a brief moment that the EHR love fest might continue in the spirit of holiday togetherness.

The bubble was burst when the internal medicine physician started complaining about his EHR. He complained of the burden of data entry with little return. He said he didn’t understand why there wasn’t any data exchange with other practices or hospitals or why he doesn’t have access to reports on his patients’ health status.

I asked a couple of questions about his practice and his system and was able to deduce that he is actually on my hospital’s platform, through our affiliate subsidy program. Anj picked up on this as well and gave me a little eyebrow raise. She knows I led deployment of our private HIE more than six years ago and that our users regularly exchange data between owned and affiliate practices as well as our multiple hospitals.

She’s also on the same ambulatory EHR although on a different platform, so was able to provide some positive counterpoints to keep him from going too far. I didn’t want to reveal myself as the owner of the platform due to the potential for turning a holiday gathering into a debate, so I excused myself for another glass of wine.

Most of our providers are satisfied with our system and are seeing the benefits of our patient registries, actionable reports, and interoperability. I’m going to need to get to the bottom of why his practice isn’t having a good experience and figure out what we need to do to get them to the same level satisfaction. I’ve reached out to our affiliate program manager so that I can review his implementation documentation and support tickets to try to identify what might have gone awry. I just wish I had heard about it through or formal processes rather than as an aside at a party.

Anj has never seen me in full Administralian mode and told me she was impressed at how I kept my cool while the physician was ripping apart the system I’ve spent the better part of a decade implementing, optimizing, and personally ensuring that practices receive value for their efforts. I must say I haven’t always been unflappable in these situations, but they have become easier over time. I’ve learned to pick my battles and not let situations get out of control.

We did enjoy some seafood and a nice string quartet, as well as good conversation with other physicians.

Have any strategies for enjoying the company holiday party? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 12/4/14

Efforts To Improve Patient Safety Result in 1.3 Million Fewer Patient Harms

US hospitals have reduce medical errors by 17 percent since 2010, with a majority of the improvements coming from reduced adverse drug events, according to an AHRQ report. The improvement is credited with saving an estimated 50,000 lives and $12 billion in healthcare spending.

Jon White, MD, Acting Deputy National Coordinator/Acting Chief Medical Officer

The ONC promotes Jon White, MD to the position of Acting Deputy National Coordinator. White has been with the ONC since 2004, and is also the ONC’s current Chief Medical Officer.

DNA-screening test 23andMe launches in UK after US ban

After being shut down by the FDA in 2013, personal genetic testing provider 23andMe will begin marketing its genetic health assessments in the UK and Canada.

Organizations achieve EMRAM Stage 7

Six hospitals are added to the HIMSS Stage 7 list, including Ontario Shores Center for Mental Health Sciences, the first  hospital from Canada, and first behavioral health hospital, to reach Stage 7.

Readers Write: 10 Talent Trends to Watch in 2015

10 Talent Trends to Watch in 2015
By Anthony Caponi

The entirety of my career has been spent in the healthcare staffing industry. Consequently, I have been at both ends of the spectrum. There were tough times in 2008 and 2009 as the nation’s economic recession spilled into healthcare hiring. Then, as part of the American Recovery and Reinvestment Act of 2009, numerous jobs were created with the promotion of EHR adoption.

The healthcare IT industry is absolutely on the rise. However, we will also see some obstacles, including a talent and skills gap. Below is a list of 10 increasing trends for 2015.

Increasing Mergers and Acquisitions

Healthcare reform is becoming a powerful catalyst for the consolidation and integration trend in the hospital industry. A study conducted by Kaufman Hall found that hospital mergers and acquisitions increased 10 percent in the first quarter of 2014 compared with the same time frame the previous year. Overall, studies indicate a continuation of several trends, including increasing numbers of acquisitions. These mergers and acquisitions that are taking place are resulting in a number of highly qualified CIOs in the job market.

Big Data Employment Boom

The data economy needs dedicated people — 4.4 million of them by 2015 in the IT field alone, according to a Gartner Research analysis. In the U.S., a McKinsey & Company report projects a shortfall of between 140,000 and 190,000 big data professionals with deep analytical skills by 2018. Additionally, the impact of big data on employment goes far deeper than the deep analytics and IT fields. Companies need professionals at all levels that are not necessarily educated in deep analytics but are nevertheless big data-savvy.

New C-Level Positions

The chief data officer (CDO) is a new position coming into play in the healthcare IT industry. Hospitals are using the role to try to "leverage data as a strategic institutional asset … It’s about how to transform data into information, how to transform information into better-informed decisions," according to Seattle Children’s Hospital CDO Eugene Kolker.

Another position that is becoming more popular in the healthcare IT space is the chief nursing information officer (CNIO). According to a Modern Healthcare report, about 30 percent of hospitals and health systems now have a CNIO and that number is expected to grow. CNIOs are helping hospitals implement their EHRs and other healthcare IT projects because of their expertise in how nurses use patient data.

Growing Job Market

The healthcare sector is poised to add 5 million jobs by 2020, according to a report by AMN Healthcare. The increased use of technology for healthcare applications is the primary factor for the growing job market. Healthcare job growth averaged 26,000 positions per month between March and September of this year, jumping significantly in the second quarter and continuing into the third quarter, according to the Altarum Institute’s Center for Sustainable Health Spending.

More Interim Executives

The number of interim executives is growing and the demand for interim talent has become apparent. This trend will become a growing part of the employment movement, especially in healthcare IT-related roles like CIOs and CMIOs. With the expected sizable number of baby boomers retiring, combined with the number of independent delivery networks and hospitals in the U.S., it’s easy to see that the demand will grow. This means that there will likely be a shortage of experienced healthcare executives in 2015, which means demand for interim healthcare executives will only grow over time.

Talent Shortage

As baby boomers retire in record numbers, the healthcare IT industry is feeling the pain of a talent shortage. In an article in InformationWeek.com, Asal Naraghi, director of talent acquisition for healthcare services company Best Doctors, says she “absolutely” sees an IT talent shortage. Tracy Cashman, senior VP and partner in the IT search practice of WinterWyman, also says she sees a genuine talent shortage. "There are more jobs than people who are skilled," she says. While she’s starting to see an uptick in engineering graduates, "we’ve been feeling this since the [dot-com] bubble burst," Cashman says, when college students were worried that all IT jobs would move to India. "And we’re still fighting that," she says.

Universities Offering Healthcare IT Degrees

Cloud computing, big data, mobile technology — three of the biggest trends in IT are changing the way the healthcare industry deals with information and creating a big need for trained healthcare IT professionals. Thus, colleges and universities have started offering healthcare IT as a major, where students learn what it takes to function as a fully capable software developer in any professional environment, but specifically tailor their skills to the rapidly expanding healthcare IT field.

Specialists in Demand

Today’s IT shops don’t just want experience, they want deep experience. “IT organizations are under intense pressure to deliver projects faster than before — and that need for speed necessarily influences IT hiring. The IT generalists, and even some topic generalists, such as infrastructure managers, have found their roles left by the side of the road, as project leaders hire for deep experience in specific niches, such as cloud security, DevOps, and data analysis and architecture.”

McGraw-Hill Education CIO David Wright says, "More and more, the hands-on coders, we’re looking for people who are just really deep in whatever discipline we’re trying to hire." And he isn’t the only one advocating for specialization; Asal Naraghi, Director of Talent Acquisition for healthcare services company Best Doctors, also says, “The trend has gone into more specialized skill sets."

Video Interviewing and Skype More Popular

The use of remote yet face-to-face interactions such as video interviewing and Skype is on the rise. Advanced technology is giving people a way to present themselves with depth and personality to hiring managers and recruiters. In addition, new hires meet the team before they even step in the office.

Interview Process Becoming Lengthier

The interview and hiring process have become more elongated in recent years, a trend that we can expect to see more of in 2015. According to Anne Kreamer, a journalist who specializes in business and work/life balance, “Data compiled for the New York Times by Glassdoor found that an average interview process in 2013 lasted 23 days versus an average of 12 days in 2009. And time-consuming assignments and auditions for candidates … are the new normal.”

Anthony Caponi is vice president of healthcare IT of Direct Consulting Associates of Solon, OH.

HIStalk Interviews Lou Silverman, CEO, Advanced ICU Care

Lou Silverman is chairman and CEO of Advanced ICU Care of St. Louis, MO.

Tell me about yourself and the company.

The company has been doing tele-ICU work for the past seven or eight years with clinical founders. We’ve been growing steadily ever since.

I’ve been at the company for just a little bit under a year. My experience spans healthcare IT, revenue cycle management services, and clinical services. I’ve also had some exposure via being a board member to pharmaceutical companies as well as home care companies and data and analytics companies.

What are the key issues hospitals have with delivering ICU services?

The ICU units happen to be a place where a disproportionate percentage of dollars is focused and spent. ICUs typically have the very sickest of patients for the hospitals.

The staffing in ICUs can be challenging for a number of hospitals. The ICU obviously should be staffed 24x7x365. The gold standard for staffing includes 24×7 intensivist involvement. The supply — and therefore the ability to recruit intensivists — is variable across many hospitals, many markets, and in fact many geographies.

How many hospitals meet that 24×7 intensivist monitoring standard, and of those, how many do it using a remote service?

It’s a relatively small percentage of hospitals that have the gold standard of 24x7x365 bedside intensivists. The number of hospitals that are using tele-ICU services to supplement that is growing fairly nicely, but we are still in the very early stages of adoption of tele-ICU services.

I think it’s fair to say that those hospitals that have elected to adopt tele-ICU services have developed a keen understanding of, and keen appreciation for, the benefits that accrue to a hospital across many different parameters for making that selection. Recruitment of intensivists is difficult. Retention, just by the very nature of the job, can be a little bit difficult. Some markets are far easier to recruit from than others. 

In addition, just getting to uniformity of care, implementation of agreed-upon best practices … there are just many, many elements that hospitals are dealing with in their ICU.

We try to organize our thinking around focusing on outcomes, patient outcomes, implementation, and sustained use of clinical best practices. Doing all of those things in a ROI-appropriate manner.

You can group virtually all issues that hospitals face in the ICU into those one or more of those three areas. A good tele-ICU partner will help address in a compelling way each and all of those key areas.

What is the regional span or the geographical span of the services that you provide or that you could provide? Could it be a global service like radiology nighthawking with appropriate licensure?

Our company specifically is in 20 states today, but that’s just simply a nod to the fact that we’re growing and we’re adding states in a rapid way. The answer to your question from a U.S. perspective is that this is a model that would work in any state.

We focus on having  U.S. board-certified, U.S. board-eligible clinicians working with and for us and with and for our partner hospitals. Historically at least, that has kept the focus of our recruitment on U.S.-based physicians.

It is fair to say that there are some small companies that are starting up in other geographies outside the U.S. and trying to get into the business. Some of those, in fact, also are using U.S. trained and board-certified clinicians to staff their operations. Historically, I’m not aware of any situations where U.S. companies are providing services to hospitals in other geographies. I am certainly aware that tele-ICU services are starting to start up in countries other than the U.S.

How much of the care that’s delivered to ICU patients is driven by formal protocols and accepted evidence? How does the technology take that and turn it into your service?

At a high level, the technology that we are using is driven toward having excellent access to the patients and the relevant patient health data. We have in the technology that we use algorithms that give us advanced alerts when certain patient trends are moving in a negative way. That gives us a way for us to be alerted and for us to also work in partnership with the bedside teams that we collaborate with to ensure a rapid attention to deteriorating patient conditions.

In terms of clinical best practices, that is very much a collaborative approach that we engage in with our partner hospitals. We have developed, over time and over the 60 hospitals that we have under contract, a very good understanding of what clinical best practices are and how they’re best deployed in an ICU. But it’s also fair to say that in some cases, there is perhaps more than one opinion on what the best practice is or the timing for implementing that best practice. 

It is at some level not a “one size fits all” approach that we take. It is much more of a collaborative approach that we take with partner hospitals to establish an agenda of best practices that we want to collaborate and implement together. Once we have agreement on what we’re going to do and in what sequence, we work collaboratively to execute on that plan.

If a hospital has its own local intensivists but needs coverage assistance, can you do that and how is the technology used in that case?

A significant percentage of the hospitals that we partner with do in fact have some level of intensivist staffing. All of them have some level of bedside staffing. We’re not at the bedside. That’s an obvious condition of the partnership.

In terms of collaborating when there are intensivists in place, that is a regular practice for us. We are a 24x7x365 service. We provide is a robust and always-on data capture practice, where we are able to take data across all of the patients that are coming through the ICU. We are able to convert that data into actionable and informative reports that we provide to our clients and collaborate with our clients to understand exactly what’s going on with their patient flow in the ICU. How the ICU patients are faring across a variety of metrics in terms of outcomes and utilization of best practices.

That is a value-added service, even in the context of a collaboration with a hospital that has a certain number of intensivists at the bedside. ICUs historically have been not really robust in terms of the modern data that they’re able to pull on what’s going on within the ICU itself. That’s part of the service that we provide for all of our clients.

The deal that you signed recently with Adventist Health System — are they seeing results yet?

It is still relatively early days. We’ve had a very robust and on-time implementation process across all of the pilot hospitals that we have been working with at Adventist. I’m not prepared to share specific results publicly, but I can tell you that even though it is relatively early days, the returns thus far, both from a quantitative and qualitative perspective, have been extremely positive and extremely well received across all aspects of the partnership.

Do you have any final thoughts?

The whole notion of tele-ICU is a very timely idea. It’s certainly one we’re seeing increased interest as an industry. We’re seeing increased interest in us as a company. 

When you look at trends that are impacting the overall healthcare ecosystem — with people having much more to do than they have time for, budgets are strained, outcomes are a clear increasing focal point — what we do as a tele-ICU provider is very consistent with all of the directional trends that are going on in healthcare, going on in hospitals, going on in the ICU. It is still an emerging market.

Our own company, without making this an advertisement, is the largest player in the space. It’s a very interesting company. The cliché is being in the right place at the right time, but it’s not a cliché for us. We are at that place at that time.