News 10/22/14

Top News

California Republican Darrell Issa, chairman of the House Oversight and Government Reform Committee, plans a hearing Friday to look into the Obama administration’s handling of the Ebola crisis. Newly appointed Ebola response coordinator Ron Klain has declined to testify, likely given that it will be only his third day on the job.

Webinars

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

Acquisitions, Funding, Business, and Stock

Care coordination platform developer CareSync secures $4.25 million in Series A financing led by Founder and CEO Travis Bond, Tullis Health Investors, CDH Solutions, and Clearwell Group. You can read my recent interview with Bond here.

Athenahealth makes plans to expand its brand-new Ponce City Market office in Atlanta. Filings suggest the company could expand by another 40,000 square feet by July 2016.

HealthStream reports Q3 results: revenue up 32 percent, EPS $0.12 vs. $0.08, and announcement of a new patient interview center in Nashville, TN that is expected to create 200 jobs.

TeamHealth Holdings acquires PhysAssist Scribes for an undisclosed sum. PhysAssist will operate as a separate division of TeamHealth under its current leadership.

Announcements and Implementations

National Comprehensive Cancer Network will integrate its chemotherapy order templates into Epic’s Beacon Oncology Information System. The templates will link to NCCN.org, affording end users access to relevant NCCN guidelines.

Cleveland Clinic (OH) and Mayo Clinic (MN) are the latest providers to deploy HealthSpot telemedicine booths. Cleveland Clinic has installed two at Marc’s retail pharmacies in Ohio. Mayo Clinic has placed one at its Austin, MN campus, and anticipates deploying more at private employers next year.

Children’s Specialized Hospital (NJ) and BluePrint Healthcare IT launch the first implementation phase of a new patient-centered medical home model with corresponding software. CSH will use BluePrint’s Care Navigator technology as its main communication and education tool during the process.

Tufts Medical Center and Specialists On Call partner to establish the Tufts Medical Center TeleNeurology program, which will provide community hospitals in Massachusetts with new neurology support options.

Sales

Lahey Health (MA) selects supply chain, performance, advisory, and analytics services from Premier Inc. and Yankee Alliance Supply Chain Solutions.

HealthInfoNet, the State of Maine’s HIE, selects the Symedical system from Clinical Architecture to enhance terminology management and data normalization. HealthInfoNet will also use the system to manage access to mental health- and HIV-related information, which requires additional legal protections in that state.

People

Senator William Frist, MD and David Snow, Jr. (Medco Health Solutions) join TelaDoc’s Board of Directors.

Baptist Health (KY) promotes Polly Bechtold, RN to regional director for clinical IT at its Paducah and Madisonville hospitals. Sharon Freyer, RN will serve as Baptist Health Paducah’s interim CNO.

Jennifer Anderson (Tenet Practice Resources) joins the North Carolina Healthcare Information and Communications Alliance as executive director. She succeeds Holt Anderson, who will retire at the end of this month.

GNS Healthcare names Bill Thornburg vice president of product management, Jim Dutton vice president of product development, and Lance Stewart vice president of payer business development.

Research and Innovation

A study of 142 cardiac patients equipped with C3 Nexus heart rate monitors at Bon Secours St. Francis Medical Center (VA) finds that just 4 percent of those patients were readmitted to the hospital within 90 days. The company is looking to expand its customer base with hospitals and payers in Texas and Arizona.

Clinical Genome Resource launches the Genome Connect patient portal as part of a NIH genetic research initiative. The portal, developed by a team of Geisinger Health System (PA) investigators, serves as a repository for lab data and patient-entered health information to assist providers and researchers in better understanding genetic variants and their impact on health.

A new study finds that participants who used Castlight Health’s Enterprise Healthcare Cloud Software platform to search for healthcare services saw lower costs for laboratory tests and advanced imaging services compared to those participants that did not.

Other

The local paper profiles Resolution Care, which aims to improve in-home palliative care in rural areas via house calls or virtual visits. Michael Fratkin, MD founder of the project and St. Joseph Hospital’s (CA) Palliative Care Program, will launch an Indiegogo campaign next month to raise $100,00 for the project.

Local radio profiles the Kentucky HIE’s progress in rolling out a statewide patient portal developed by NoMoreClipboard. Five facilities are participating in the pilot phase of the myhealthnow portal, which is expected to go statewide by the end of the year.

Kenneth Mandl, MD of Boston Children’s Hospital and Harvard Medical School, points out in a JAMA article that EHRs and workflow aren’t the only problems when it comes to screening for Ebola: “Compounding the problem is that public health, largely absent from the table in defining requirements, remains mostly locked out of the point of care, barely able to exploit the newly deployed health information technology infrastructure. Five years after the enactment of Meaningful Use, public health officials still reach clinicians and hospitals through traditional dispatches and media alerts.”

The mock @CzarOfEbola Twitter account spotlights the frustration many Washington insiders have expressed with the continued leadership of Tom Frieden, MD at the CDC, and appointment of “Ebola Czar” Ron Klain.

The local business paper details the somewhat strange trip a group of Nashville, TN healthcare leaders took to Cuba. Scott Mertie, president of Kraft Healthcare Consulting, noted that, “even though the technology is a little bit behind, they’re still doing advanced medicine. I think in general the population seems very happy with their health care,” adding that may be because they "just don’t know what else is out there."

Sponsor Updates

• Nuance partners with eClinicalWorks to offer cloud-based speech recognition with eClinicalTouch for the iPad, and eClinicalMobile for iPhone and Android.
• Health Catalyst shares “factoids” from its Summit due to a high volume of requests.
• NextGen Healthcare and InterSystems enable Missouri Health Connection to provide on-demand bidirectional data exchange with clients.
• Medicity shares a video of CORHIO’s providers discussing how their HIE has helped improve patient care and streamline workflows.
• Elsevier releases the first multidisciplinary, general medical reference digest of from its new Clinics Collections series.
• Health Catalyst introduces a white paper for a systematic approach to transform healthcare.
• Gartner names the Cache’ data platform from InterSystems a Leader in the Gartner Magic Quadrant for Operational Database Management Systems.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Curbside Consult with Dr. Jayne 10/20/14

One of my friends from residency contacted me last week for advice on converting from one EHR to another. She’s a medical oncologist. Her organization is bucking the single-vendor system trend by allowing its oncology practice to move onto a specialty-specific EHR. They’re planning to use a private HIE to tie it all together for patient care and data integrity.

She wanted to know what kind of skills would be involved in supervising a data extract and migration since she had been asked to be the physician champion.

I started explaining that there are multiple dependencies involved – from how willing the “old” vendor is to participate in an extraction, to what kind of data is moved, to how ready the “new” vendor is to handle a conversion or data insert.

As we talked through demographic conversions, what to do with scanned documents, and various strategies to handle discrete data, it became apparent that no one had been discussing this process with the physicians at her organization.

She told me a little about the vendor they had selected — how great the demos were and how much better they think it’s going to be than their single-vendor platform. We talked about her current workflows and how they might change in the new system.

It sounded like they are heavily dependent on voice recognition technology at present, so I asked how the new vendor proposed to handle that. She wasn’t sure, so I asked if there were questions around that topic in the RFP. I was quite surprised to hear that they had just started working on it.

I asked if she even knew what RFP meant and she didn’t. I told her it was a Request for Proposal and explained that the RFP isn’t just something you send to the vendor for response. Ideally, creation of the RFP involves a thoughtful review of your current state and your desired future state. It’s your way of letting a vendor know what your organization looks like as well as learning what their organization looks like.

She interrupted me part-way through my informatics lecture. “But we’ve already had three demos with them and we really liked it. Why do we need to go through all that?”

I explained that the fact that she has been tagged as the physician champion for this system yet she has no idea whether the system can handle their current preferred method of documentation is a big problem. I brought up other key features that she should be knowledgeable about that would be largely covered in the response to the RFP: MU certification status and track record, eRx capabilities and intermediaries, Direct messaging capability and provider, support, etc. Then I dug into how they should be requesting information on how the vendor plans to support the transition, etc.

Since they’re coming off an existing EHR, those questions should have been included in the RFP rather than being posed to an old friend halfway across the country.

We talked about the requirements analysis that should have been done before they even looked at other systems. Did they actually document how they thought their other system was failing them, or what they wanted to have different? Who was involved in the discussions? Do they know who the decision-makers really are? What is the budget? What will they do if they can’t take their legacy data with them into the new system? Will they keep their current practice management system or transition completely to a new platform? Do they need a vendor who is willing to interface?

It never occurred to her that some EHR vendors will not interface with a third-party practice management system. I explained this is why the RFP process is important and not just to receive the vendor’s response, but to even know what business problems you’re trying to solve. We also talked about how proposals should be obtained from multiple vendors, not just the one you’ve pre-selected. In my organization (which has a strong and highly-regimented RFP process) we’ve had situations where one vendor’s answer to a question lead to additional questions for the other vendors as we hadn’t thought of a particular angle or process.

We also talked about the fact that her organization is a highly visible non-profit that receives a lot of state and federal funding, meaning if they don’t have multiple vendors competing for the contract, that might be a serious problem. Realizing that if they neglected to complete a proper RFP process they were probably cutting corners elsewhere, I had some additional questions for her. Did you check the vendor’s financials? Do you think they’re at risk to be acquired or to have financial difficulties? Do they have a chief medical officer and what are his/her credentials? Who has input into product development? Did you do any reference calls with current clients? Did you do any site visits?

As the call unfolded, she realized that being a physician champion (and thereby putting her stamp of the approval) was going to be a little more involved than she originally thought. I told her I’d send her some reading material and had my assistant drop my dog-eared copy of Jerome Carter’s EHR textbook in the mail. It’s not the current edition, but it will help her prepare for what’s ahead and figure out whether she even wants to be involved given the way her organization is operating.

It never ceases to amaze me that organizations are willing to put themselves at risk by failing to follow basic business processes. Even in her single-specialty situation, there are millions of dollars at stake. Not only the purchase, implementation, conversion, and support fees, but the potential loss of revenue if they don’t get this right.

Does your organization put the cart before the horse? Email me.

Email Dr. Jayne.

Readers Write: What Healthcare Revenue Cycle Leaders Can Learn from Apple Pay

What Healthcare Revenue Cycle Leaders Can Learn from Apple Pay
By Joshua Silver

It often feels like the healthcare industry is just as much about patience as it is about patients. Waiting for final regulations to be approved; waiting to be seen in a doctor’s office; waiting for new EHR systems to be rolled-out; waiting for the final, final, final ICD-10 rollout deadline; just plain waiting.

The waiting game spills over into the consumer technology space too, especially when it comes to mobile payments. Despite the media popularizing the notion of replacing a traditional wallet with a smartphone-based digital wallet nearly a decade ago, mobile payments have yet to become mainstream.

As I watched the recent announcement about Apple Pay, I couldn’t help but think to myself that we might finally be at the tipping point for mobile payments. The payments platform, which Apple bundled into the latest iPhone and iOS 8 operating system, allows consumers to easily pay using their phone in brick-and-mortar retail stores, as well as securely pay for digital goods.

Apple has a proven track record of taking existing consumer technology and repackaging it in such a way that it’s adopted by the masses. When they launched the iPod in 2001, portable MP3 players had already been commercially available for several years, but weren’t widely popular. A few years later, in 2007, when they brought the mobile Web to millions with the iPhone, Apple was building on BlackBerry’s 10-year history in the space. The question remains: can Apple do for mobile payments what it’s done for MP3 players and smartphones?

Additionally, the timing is key as the payments processing industry is poised to transition from magnetic swipe credit cards to “Chip and Signature” EMV-based credit cards. (Visa and MasterCard regulations mandate the switch for nearly all merchants by October 2015.) This macro industry change, coupled with Apple’s long list of banking partners, means that already nearly more than 220,000 stores are equipped to support Apple Pay.

As Apple Pay launches nationwide in October 2014, it’s time for healthcare providers to drop their patience and help their patients by supporting new, consumer-friendly payment technologies. Historically, the healthcare industry has largely taken a “wait and see” approach when new technologies hit the market. However, as healthcare providers face the daunting (and expensive) challenge of getting patients to pay, there is perhaps no other industry that can benefit as much from the recent developments in payment processing technology.

As the options for patient payments continue to diversify and become increasingly complex (nowadays, there is online bill pay, Apple Pay, EMV credit cards, PIN debit cards, eChecks – not to mention the more esoteric options like BitCoin), it’s more important than ever that healthcare providers focus on their core competencies (providing great medical care and a simple billing experience) rather than trying to learn the ins and outs of payment processing. Healthcare providers should look to partner with market-leading vendors who offer comprehensive patient payment platforms. Perhaps surprisingly, it’s rarely the banks.

It’s absolutely critical to use a platform that consolidates all payment types (credit, debit, eChecks — even paper checks) into a single posting report and, if possible, one that will combine all payment types into a single reconciled daily deposit. There is enough complexity in the business office without adding the burden of reconciling additional daily deposits.

With all of the recent news about mega-breaches of cardholder information (Target, Home Depot, JP Morgan Chase, etc.), consumers are beginning to question the status quo of payments, digging deeper into the security of their payment data, and holding the merchants responsible. The last place they expect to find payments innovation is in healthcare. Now is a great time to wow them and get ahead of the market. 

Joshua Silver is VP of product development of Patientco of Atlanta, GA.

Readers Write: Digital Patient Engagement Tools to Achieve “Top Box” Medication-Related HCAHPS Scores

Digital Patient Engagement Tools to Achieve “Top Box” Medication-Related HCAHPS Scores
By David Medvedeff, PharmD, MBA

Improving HCAHPS performance is a never-ending struggle for hospitals, one that has taken on greater urgency as results are linked to CMS’s Hospital Value-Based Purchasing (VBP) program. The HCAHPS Survey is the basis of the “Patient Experience of Care Domain” under VPB, which makes up 30 percent of a facility’s total performance score.

A particularly thorny problem has been improving patient communications regarding medication, which is measured based on HCAHPS responses to three questions:

1. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
2. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
3. When I left the hospital, I clearly understood the purpose for taking each of my medications.

In the most recent published results, 36 percent of reporting hospitals failed to achieve “top box” scores, which reflect the most positive responses to questions related to patient experience with communications about medications. Improvements in patient education and health literacy can go a long way toward boosting these scores, as well as medication adherence post-discharge.

Consider this: a study by the National Assessment of Adult Literacy found that just 12 percent of the more than 19,000 respondents demonstrated proficient health literacy. Another study, published in the Journal of General Internal Medicine, found that 79 percent of patients misinterpreted one or more of the 10 most common prescription label instructions they encountered.

To combat the grim reality of poor health literacy, hospitals must account for all aspects of medication adherence. For example, the CDC highlights the “access to care and patient education material” as two of the largest problems in medication adherence, as well as the “inability to access or difficulty accessing the pharmacy.”

Digital patient engagement solutions address these issues by delivering medication information to patients when and where they most need it. For example, videos outlining proper usage, expected benefits, and potential side effects can be embedded into the hospital’s website. Links to prescription-specific videos can then be sent to patients via text or email for viewing on any computer, tablet, or smartphone. Videos can also be supplemented with text reminders to take or refill prescriptions to further enhance compliance.

It is crucial that video content be comprehensive and current to ensure all pertinent information is included. Content should also be based upon trusted information, such as guidelines from the Food and Drug Administration (FDA) as well as patient packet inserts, medication guides, and consumer medication information.

Ultimately, digital patient engagement solutions remove the barriers that complex text often puts in the way of comprehension and medication adherence. Convenient access via multiple channels also means patients are never without the information they need to successfully and properly administer their medication, improving HCAHPS scores while reducing the risk of medication error and improving care outcomes.

David Medvedeff, PharmD, MBA is CEO of VUCA Health of Lake Mary, FL.

Readers Write: The Elephant in the Room: Provider Validation

The Elephant in the Room: Provider Validation
By Miranda Rochol

I’ve seen and heard a lot of discussion about EHRs and identity proofing – the process of verifying that a provider is who he or she claims to be. Identity proofing has been a hot topic in healthcare for years, starting with the Medicare Modernization Act (MMA) of 2003, when e-prescribing was promoted as a vital part of reducing prescription errors and enhancing patient safety. Prior to that, e-prescribing was a novel concept. 

Today, the majority of office-based physicians (73 percent) send e-prescriptions and nearly all community pharmacies (95 percent) receive them. This wouldn’t have been possible without EHRs or identity proofing. Equally important but less talked about is the critical step of provider validation, which happens before identity proofing.

The concept of provider validation grew in importance when the DEA issued an Interim Final Rule (IFR) and made legal the electronic prescribing of controlled substances (EPCS). Strict regulation of controlled substances now means that validation of DEA numbers is more than just protocol — it’s critical. Because some providers are only authorized to write prescriptions for certain controlled substances, EHRs must ensure that their systems are equipped to validate provider DEA (and other credentials) in real time.

The most logical time to validate a DEA number is when a provider actually writes a prescription for a controlled substance. Since DEA numbers expire or become invalid, a provider’s DEA number should be verified each time he or she writes a prescription. This is the most effective way to ensure compliance with federal regulations and verify that a prescriber is legally authorized to write prescriptions for particular substances.

Failure to validate providers for e-prescribing of controlled substances is serious. EPCS is subject to the same laws that govern written, oral, and faxed prescriptions of controlled substances. Providers who illegally distribute or dispense controlled substances could have their license suspended or revoked and are subject to imprisonment for 5-15 years and fines from $100,000-$2 million.

EHRs should care about this for a number of reasons. The EHR space has become incredibly crowded and competitive. Adoption rates have skyrocketed, but customers have more vendor choices. What’s important to healthcare providers and organizations today are cost, usability, and compliance. Provider validation is a vital part of the compliance equation.

Beyond meeting Meaningful Use requirements, EHR companies must also start thinking strategically about their customers’ long-term needs and how to elevate their position from “vendor of the day” to “services partner of tomorrow.” This is where providing value-added services like provider validation and partnerships with data providers are key.

Lastly, EHRs with provider validation and other functionalities that meet both clinical and compliance needs could attract new fans among hospitals and health systems. Having an EHR that meets both clinical and compliance needs is one way healthcare organizations are attracting physicians, whose adoption of new technologies is integral to improving patient outcomes and public health.

Miranda Rochol is VP of product and strategy for Healthcare Data Solutions (HDS) of Irvine, CA.

Morning Headlines 10/21/14

Tech firms vie for $11 billion military healthcare contract as deadline looms

The DoD has extended its EHR RFP deadline by one week, to October 31. The deadline was already extended by two weeks earlier this month. There are currently four EHR vendors known to be competing for the deal: Epic, Cerner, Allscripts, and VistA via Medsphere.

Healthcare IT Leaders Embrace Federal Interoperability Plans

CHIME and HL7 announce that they will partner to lobby for the inclusion of API-based interoperability standards in Meaningful Use Stage 3.

New Affordable Care Act initiative to support care coordination nationwide

CMS announces the ACO Investment Model, a $114 million initiative aimed at providing rural ACOs upfront funding to help them implement advanced health IT systems.

Morning Headlines 10/20/14

A Letter To Our Community

Texas Health Resources takes out a full page ad in the local paper in part to regain the trust of its community. A separate article mentions that patient volumes have plummeted at THR, with ED wait-times at zero minutes.

athenahealth’s (ATHN) CEO Jonathan Bush on Q3 2014 Results – Earnings Call Transcript

Jonathan Bush leads Athena’s Q3 earnings call, where discussions ranged from improving Epocrates-related earnings to increasing enterprise sales.

Hospital Nurses Forced to Develop Creative Workarounds to Deal with EHR System Flaws; Outdated Technologies and Lack of Interoperability, Reveals Black Book

A new Black Book report surveys 14,000 RNs and finds that 92 percent are dissatisfied with their inpatient EHR systems and that 88 percent blame hospital administrators and CIOs for selecting poor performing EHRs based on price rather than quality of care.

Monday Morning Update 10/20/14

Top News

Texas Health Resources takes out full-page ads in local newspapers to bolster its community image, with CEO Barclay Berdan admitting that “we made mistakes” and adding that Thomas Duncan’s travel history was documented in the EHR but “not communicated effectively among the care team.” 

Meanwhile, the cruise ship passenger that triggered an Ebola scare at sea (for questionable reasons) that resulted in the ship’s return to port has been identified as the lab director of Texas Health Presbyterian Hospital Dallas where Thomas Duncan died. The lab director voluntarily quarantined herself in her ship’s cabin and has since been found to be free of the virus.

In the aftermath of its mistakes (of both clinical and public relations varieties), Texas Health Presbyterian Hospital Dallas  is reported to be a “ghost town” with two-thirds of its 900 beds empty and its average 52-minute ED wait time down to zero. THR spokesperson Dan Varga, MD states that doctors whose offices are near the hospital are having up to 60 percent of their appointments cancelled as patients refuse to get close to hospital property, treating it as though it were Chernobyl instead of the building that previously housed a contagiously sick patient as it does 365 days per year. The economic impact will probably be significant.

Reader Comments

From British Bulldog: “Re: Ascribe. The UK-based company’s CEO and founder, Stephen Critchlow, has resigned, almost a year since Ascribe was acquired by EMIS. Rumour has it that this could spell the end for Ascribe’s Health Application Platform, its flagship software platform.” The company announced Critchlow’s departure to devote “more of his time to his other business interests” on September 29, 2014, while the rest of the statement is unverified.

From Government Mule: “Re: ONC chief medical officer. Jon White from AHRQ took the job according to his LinkedIn profile.” Actually he lists his position as interim CMO (at least in the current version of his profile), which was announced early this month as a part-time commitment while the search is underway.

From GoVols: “Re: [company name omitted]. The CTO resigns, then gets talked out of it by board member. Sales, marketing, and BD team, once 15 strong, is now down to just a few and more layoffs are rumored. No significant sales this year and the fourth sales VP was recently fired. Everyone still here wonders what the BOD is thinking.” I’ve removed company and executive names since no company is going to confirm statements like these, but I’ll keep an eye on what happens there.

From Insidehr: “Re: athenahealth’s Ebola screening tool. Good to hear the athena clients are ready to treat those Ebola patients when they show up for the primary care visit. Sometimes that group would benefit from the concept of less is more.” It’s interesting that everybody is rushing to cobble together electronic tools that perform the most basic function – display a warning if a feverish patient says they’ve been to Africa lately. I think we can assume that even the least-competent nurse in America would go on alert in that case even without an EHR prompt, so its main value isn’t evaluating the patient’s response, it’s reminding someone to ask them the question in the first place, which is also probably not really necessary.

Additionally, the value of crude tools like online questionnaires will be eliminated if the virus starts spreading from people who haven’t traveled but instead were exposed to someone else who has, perhaps unknowingly. It’s like those early HIV/AIDS questions that asked about same-sex contact, blood transfusions, or exposure to prostitutes –  they helped make a few diagnoses in the absence of anything more accurate, but the real accomplishment was developing specific lab tests since patient reports aren’t always reliable, symptoms are vague, and other transmission methods may be involved. A lab person can jump in, but I think the ELISA test works for both HIV and Ebola, the main difference being that a two-day wait time for positive diagnosis is OK for HIV but potentially disastrous for Ebola. When it comes to stopping pandemics, it’s at least equally important to develop diagnostic as well as therapeutic technologies.

HIStalk Announcements and Requests

More than two-thirds of poll respondents don’t like idea of an ONC-run health IT safety center. Reader lgro said in a comment that ONC struggles with the logistics of its current areas of responsibility and worries about another HIPAA-like program that doesn’t add value, while Doug points out that the health IT safety center was proposed as a public-private partnership rather than an ONC-controlled body and may provide value in preventing FDA from stepping in due to lack of progress. New poll to your right or here: should the names and medical details of Ebola patients be divulged publicly?

Last Week’s Most Interesting News

• The American Medical Association sends CMS a blueprint for a redesigned Meaningful use program, adding its criticism of document-based interoperability protocols such as C-CDA.
• Several groups add to the drumbeat urging CMS to slow down the Meaningful Use program and to refocus certification on interoperability, privacy and security, and quality reporting.
• Texas Health Resources executive Daniel Varga, MD says the organization modified its Epic setup and workflow after Ebola patient Thomas Duncan was discharged from one of its EDs, adding little clarity to the original report and subsequent denial that the nurse’s documentation was missed because of an EHR setup problem.
• A paper from the National Bureau of Economic Research says that HITECH was largely ineffective for spurring hospital EHR adoption since most hospitals were already using them.
• HITPC agrees that current document-based interoperability approaches should be replaced by programming APIs provided by vendors of certified EHRs. That would be a dramatic shift, especially if ONC requires such access for EHR certification.
• California HealthCare Foundation releases a report covering health accelerators, find that they are excessive in number, unproven in benefit, and potentially harmful in hyping startups that have a minimal chance of market success.
• Alameda Health System (CA) says a disastrous $77 million Siemens Soarian-NextGen implementation has exhausted its cash and available credit.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CTO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

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

Acquisitions, Funding, Business, and Stock

From the athenahealth earnings call:

• Jonathan Bush says the company is growing, but with growing pains.
• Epocrates is a turnaround in progress and it’s taking longer than the company expected to improve the situation due to major cultural and technical issues.
• Epocrates is moving toward “more of an edutainment relationship where we’re constantly rotating through a set of FDA-approved and clinically appropriate messages for doctors that makes a business act more like a recurring venue business and one-off.”
• The company added 2,800 athenaClinicals physician users, but at a high expense.
• Bush says the challenge of the Enterprise business – which he calls “bipolar” since the company never knows when a big organization will finally sign up – is that internal hospital departments aren’t nearly as interested as the outpatient areas in opening up patient access.
• Bush says it’s hard to sell to academic medical centers: “Nobody gets fired in academic medical. There is no financial mandate. They have got many, many revenue sources, many, many reasons for revenue — the research, the teaching. So that clarity of bottom line is not there. There is somebody in charge of the bottom line who is very clear, but they have grown up an institution that is used to money showing up … an open healthcare network doesn’t help you if you happen to have the highest rates in town … You are not thrill that the doctor and the patient can see the other ones, click on it and rob you of that high-margin encounter … the guys who resist us the most are institutions like Partners, Mass General, where they have historically high rates … and they are terrified of being picked apart.”
• “We are right now in the midst of trying to seed a couple of the major national consulting firms with the idea that its time to change lily pads. That you don’t want to be the last strategic consultant that advise the board of directors to plump down $0.5 billion on a closed system. The problem is there’s a lot of revenue that goes to those firms that way and so we have been working it.”
• Bush expresses frustration in working with (and ultimately bypassing) hospital CIOs, declaring, “Typically the CIO has worked very hard to build board-level access and a great huge budget surrounding the idea of his own data center and his own servers and his own programmers. He is sort of craft brewing milky beer and doesn’t want anybody to compare him with the pros from Dover.”

Above is the one-year share price chart for ATHN (blue) vs. the Nasdaq (green).

People

University of Virginia Health System hires Michael Williams, MD (North Shore-LIJ Health System) as its first CMIO.

HealthMEDX names Chris Dollar (Henry Schein) as COO.

Government and Politics

A HIMSS response to NIST’s cybersecurity RFI says healthcare providers are too focused on HIPAA compliance and should evaluate their overall security instead, adding that NIST should publish a target state for providers to measure themselves against.

Former National Coordinator David Blumenthal, MD says that Texas Health Resources, in first stating but then denying that an EHR flaw caused it to discharged Ebola patient Thomas Duncan, is part of an “inglorious pattern in human behavior” that causes providers to seek scapegoats when something goes wrong. He also says EHRs are the lightning rod for provider challenges because they use them constantly in daily work while other problems seem to be “distant thunder,” but he adds that users are justifiably frustrated with EHR usability and interoperability.

Other

I don’t automatically believe reports from Black Book Rankings, especially when they don’t itemize their methodology, but their survey of 14,000 RNs who use hospital EHRs claims the following results that I don’t doubt a bit:

1. Hospital nurse EHR dissatisfaction stands at 92 percent.
2. EHR workflow disruption reduces job satisfaction, according to 84 percent of respondents.
3. Nine of 10 nurses say CIO and their executive peers choose EHRs based on price or Meaningful Use performance rather than their usefulness to nurses.
4. Nine of 10 nurses say the EHR interferes with nurse-patient interaction and 94 percent say it hasn’t helped nurses communicate with other clinicians.
5. Three-quarters say the EHR has failed to improve the quality of patient communication.
6. More than two-thirds of RN respondents label their IT departments as “incompetent” in their EHR knowledge.
7. A hospital’s EHR is one of the top three criteria for choosing a workplace according to 79 percent of respondents, with top-rated systems being Cerner, McKesson, NextGen, and Epic. The lowest satisfaction scores were for Meditech, Allscripts, eClinicalWorks, and HCARE. This statement alone raises a red flag given that eCW doesn’t offer an inpatient EHR, HCARE is (I believe) HCA’s implementation of Meditech, NextGen’s EHR is used mostly by very small hospitals and isn’t likely to have had enough respondents to be judged on inpatient use alone, and McKesson’s users weren’t broken out among Horizon, Paragon, and its other products. The survey’s biggest flaw is not breaking out practice site – ED, ICU, surgery, ambulatory, general med-surg nursing, etc., all of which use broadly (and often incorrectly) labeled “EHR” systems differently.

An interesting article by Clinovations SVP Steve Merahn, MD says that “unstructured” is a bad term when referring to data because it contains the built-in bias that all data should be structured, when in fact the only reason “structuring” data into convenient pigeonholes is necessary is because our ability to analyze information is otherwise limited. He draws a parallel to earlier observations about Internet content vs. data, which is similar to EHR-contained checkbox results vs. useful clinical information:

• Content has a voice. It is written to communicate ideas, make a point, convince. It is personal.
• Content has ownership. Someone created the note from their perspective of authorship as defined by their levels of authority and responsibility.
• Content is intended for a human audience, for human senses to process.
• Content has context. Even the most objective content contains lexical, syntactic, and semantic clues about where the reader should focus their attention — what was important and what was not.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 10/17/14

Examining The US Public Health Response To the Ebola Outbreak

Dr. Daniel Varga, the chief clinical officer for Texas Health Resources testifies before the House Subcommittee on Oversight and Investigations regarding THR’s handling of Thomas Duncan, the hospital’s initial Ebola patient, and the subsequent spread of the disease to two of the hospital’s nurses.

athenahealth, Inc. Reports Third Quarter Fiscal Year 2014 Results

athenahealth reports Q3 results: revenue was up 26 percent to $190 million, but the company posted an overall net loss of $1.6 million. Adjusted EPS $0.27 vs. $0.29. Epocrates-related sales dropped 27 percent during the quarter, bringing in $9.8 million.

Coalition letter requesting changes to meaningful use for greater systems interoperability

Premier, the American Academy of Family Physicians, AMA, MGMA, and several other organizations and health systems send a letter to CMS urging it to slow the pace of Meaningful Use and refocus it to make gains on interoperability, security, and quality reporting.

News 10/17/14

Top News

Dan Varga, MD, chief clinical officer of Texas Health Resources, testifies to a House subcommittee inquiring into its handling of Ebola patient Thomas Duncan that THR has changed its screening procedures to ask travel-related questions first thing in the ED and to make the patient’s travel history available to all caregivers. THR modified its Epic configuration to (a) make the Ebola screening tool more visible; (b) to ask more Ebola-related screening questions; and (c) to display pop-up instructions if any of the screening questions are answered positively. The wording of his statement suggests (in my interpretation, anyway) that the original problem wasn’t because the ED doctor couldn’t see the patient’s nurse-captured travel history, but that the questions weren’t asked at the proper time.

Due to a high volume of Greenway PrimeSUITE customers using the new cloud-based reporting / dashboard solution through our PrimeDATACLOUD, we’ve seen dashboard service disruptions that have impacted a small number of our customers. To meet customer requirements for Q3 attestation, the cross-function Greenway Meaningful Use Service Team worked with customers and supplied them with the information needed to attest for the Q3 90-day attestation period. To prepare for a higher volume of customers planning to attest in Q4 and in 2015, we’re currently making enhancements and performance improvements to the PrimeDATACLOUD environment. This maintenance window is expected to last until the end of October. During the maintenance period, we’re making the MU Dashboards available on a regular basis to all customers using the system, enabling them to track their progress towards attestation goals. In addition, we continue to on-board customers who need to attest for Q4 as well as 2015. The Greenway MU Service team continues to engage directly with all affected customers to provide updates as well as help guide them through the MU process. Greenway Health is committed to ensuring that all eligible providers using our solutions who are planning for MU attestation have the required information in time.

 

HIStalk Announcements and Requests

This week on HIStalk Practice: athenahealth creates an Ebola risk assessment algorithm for its EHR. Palmetto Primary Care Physicians taps eGroup to help it install IT in South Carolina’s first gigabit community. ONC adds a dozen primary care physicians and administrators to its Health IT Fellows Program. Ability Network acquires MD On-Line Inc. See our Must-See Exhibitors Guide for MGMA 2014. Thanks for reading.

This week on HIStalk Connect: Dr. Travis explores the potential ROI that can be generated from implementing online self-scheduling tools for patients. Patient engagement startup Welltok raises $25 million of a planned $37 million Series D. The NIH announces $32 million in grant awards that will be used to further big data research in healthcare.

Welcome to new HIStalk Platinum Sponsor FormFast, the leading provider of process automation solutions for hospitals (electronic forms and signatures, workflow, and content management) that integrate with existing systems to add functionality and streamline processes. FormFast has been providing electronic workflow solutions since 1992 with 1,000 hospital customers that are gaining efficiency, improving task coordination, reducing supply costs, and eliminating errors (webcasts and case studies are here). Thanks to FormFast for supporting HIStalk.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CTO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock

Revenue cycle solutions vendor Ability Network will acquire competitor MD On-Line.

Athenahealth reports Q3 results: revenue up 26 percent, adjusted EPS $0.27 vs. $0.29, meeting expectations for both. The company’s $293 million Epocrates acquisition from January 2013 continues to drag down the bottom line as the unit’s quarterly revenue dropped 27 percent to less than $10 million.

Analytics vendor Viewics raises $8 million in funding.

Telepharmary kiosk vendor MedAvail completes $30 million in Series C funding.

Consumer rewards-based wellness platform vendor Welltok raises $25 million of a planned $37 million funding round.

Sales

Marin General Hospital (CA) chooses MModal for clinical documentation software and services.

People

James R. Boldt, chairman and CEO of Computer Task Group, died unexpectedly on October 13 at 62. He led CTG into the healthcare IT provider services market after taking the role in 2001.

Just-resigned GE Healthcare CEO John Dineen is named fund advisor to private equity operator Clayton, Dubilier & Rice.

Paul LaVerdiere (Iron Mountain) joins ESD as regional VP.

Announcements and Implementations

Elsevier launches Mosby’s Home Health Care, which provides content for home health nurses. The company also announces that it will provide free access to its ClinicalKey reference site to healthcare and disaster aid workers battling the Ebola outbreak in Liberia, Nigeria, Sierra Leone, and Guinea

Regional Medical Imaging (MI) goes live with Merge Notifi for patient appointment reminders.

Predixion Software releases Predixion Insight 4.0.

Evangelical Community Hospital (PA) goes live with Nursenav Oncology’s patient navigation workflow system. The company offers patient tracking, assessments, reporting, and a patient portal.

HIPAA compliance platform vendor Catalyze puts its 25 model HIPAA policies for “a modern cloud healthcare company” online as open source.

DrFirst announces October 28 availability of its electronic prior authorization service Patient Advisor ePA+SM, which will integrate multiple sources starting with CoverMyMeds.

Government and Politics

A paper from the National Bureau of Economic Research says that HITECH was largely ineffective for spurring hospital EHR adoption, having fast-forwarded usage by only two years at a cost to taxpayers of $48 million per new EHR-using hospital (as opposed to the majority of hospitals that earned HITECH payouts for just using what they already owned). I wasn’t willing to pay $5 to read the full paper, especially since it’s a draft version, but I suspect I would have issues with its methodology even though its conclusions seem reasonable. Paying hospitals  (and doctors, which the report didn’t cover) to keep using systems they had already purchased was of questionable taxpayer value, but then again much of the $787 billion ARRA program was equally iffy from a value perspective.

Organizations including the AMA, MGMA, and Premier urge HHS to refocus Meaningful Use certification on interoperability, quality reporting, and privacy and security. The groups also want HHS to slow the Meaningful Use program down and to encourage innovation and the development of new clinically-focused healthcare technology.  

The Treasury Department is trying to fix an HHS-created technical mistake that allows employers to offer employee health insurance that doesn’t cover hospitalization.

Technology

Apple announces that OS X 10.10, also known as Yosemite, is available as a free upgrade to MacBook users.  

Sponsor Updates

• HCS is sponsoring and exhibiting at the LeadingAge Annual Meeting in Nashville October 19-22.
• SCI Solutions launches a company blog with an introductory post by CEO Joel French.
• HIMSS Analytics says in its latest “Essentials of the US Hospital IT Market” that computer-assisted coding applications will experience increased hospital growth.
• Vishal Agrawal, MD, president of Harris Healthcare Solutions, will participate as a panelist on “innovations in Access and Population Health” during the Scottsdale Institute 2014 Fall Forum.
• Clinovations interviews Will Hodges regarding service line management vs. physician employment.
• BlueTree Network challenges Vonlay-Huron to a food drive challenge to see who can raise the most meals or funds for meals from November 5 through December 3.
• Levi, Ray & Shoup will participate in the 2014 SAP TechEd && d-Code event in Las Vegas October 21-23.
• Imprivata reports that 100 European organizations have confirmed rapid adoption of virtual desktop infrastructure for single sign-on.
• NoteSwift announces availability for Allscripts TouchWorks EHR.
• NTT Data is named to the Winner’s Circle in the 2014 SAP Services Blueprint Report.
• The Advisory Board Company discusses the threat of Ebola to healthcare workers in a recent blog.
• Lifepoint Informatics unveils its patient access portal this week at G2 Lab Institute 2014.
• HTMS, an Emdeon Company, launches Coverage Scout to assist in calculating health plan rates and federal subsidies.
• Ingenious Med announces that three members of its mobile development team took first place in the Mobility Live Hack-Back Invitational.
• The keynote address of eClinicalWorks CEO Girish Navani will be streamed live from the 2014 National Conference on October 17.
• Louis Stokes VA Medical Center (OH), Orange City Area Health System, (IA) and Mercy Hospital Fairfield (OH) are live with Extension Engage to manage clinical alarms, alerts, and patient-centric text messaging.

EPtalk by Dr. Jayne

My apologies for not mentioning eClinicalWorks in my recent shout-out of fall conferences. Their National Users Conference kicks off October 17 in Orlando. From the pictures of last year’s event, it looks to be a lot of fun. If you’re attending, we love a good party, so do tell how it’s going and share your photos.

I received a fair amount of reader response (and a handful of vendor solicitations) after this week’s Curbside Consult on transitioning to mandatory e-learning as part of EHR implementation. We already went live, so I’m not looking for a vendor (although you can bet I’m going to file your contact information away in case our system tanks and we need a replacement). Others wrote about their own experiences. The general consensus is that short segments with focused content are best and that unless mandated, user adoption can be less than stellar. E-learning seems to be most popular for workflows that aren’t overly complex but require more than a PDF to explain. So far we haven’t had any major glitches and people are logging on and completing the curriculum, so I’ll remain cautiously optimistic.

The most intriguing healthcare IT tool I’ve seen recently is called The NNT. For readers who are not statisticians, NNT is the “number needed to treat” and represents the number of patients who would have to use a treatment for one person to benefit. If the NNT is low, that means you don’t have to treat a broad population to deliver benefit. If it’s high, the likelihood of the patient in front of you benefiting is low. In addition to providing NNT data, the website also uses a color-coded header bar to indicate treatments that make sense and those that don’t. Thanks to Wired for profiling the site.

It’s not exactly healthcare IT, but it does involve health care and IT giants. Several colleagues asked my opinion of Facebook and Apple offering egg-freezing as part of their benefits plans. Having cared for many women during their pregnancies, I can tell you that freezing eggs and using them later doesn’t change the other risks that pregnant women face when they’re older. Regardless of their motives, I’m glad it’s available for people who need it for medical reasons, such as young women undergoing cancer treatments. On the other hand, I’m still waiting for my own company to cover services many people take for granted, so I’m a little jealous.

A shout-out to Dr. Travis and his recent mention of startup Thync, which aims to develop a device that can aid in shifting the wearer’s mood. Since it is worn on the head and uses ultrasound waves to trigger brain changes, I’m not sure I’d be a fan. For mood-altering wearables, I prefer the sparkly kind.

What kind of wearables alter your mood? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 10/16/14

Subsidy program for EHRs ineffective, draft report argues

A draft report from the National Bureau of Economic Research analyzes pre-ARRA EHR adoption trends and concludes that ARRA incentive payments only expedited EHR adoption by two-years. The report also says that ARRA incentive payments cost taxpayers an average of $48 million per implementation.

ID System Reduces NICU Errors

Montefiore Medical Center (NY) tests a new positive patient identification step in its CPOE workflow that help neonatologists ensure they are placing orders in the correct chart when caring for babies in the NICU that have not yet been given a name. Adding this step reduced wrong-patient orders by more than 50 percent in the unit.

MIT and MGH form strategic partnership to address major challenges in clinical medicine

A new partnership between MIT and MGH will form research teams focused on improving the prevention, diagnosis, and treatment of a variety of diseases.

CIO Unplugged 10/15/14

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

The Hands of God

“Will I die?”

My nurse checked my vitals on the evening prior to my operation, a surgery to correct a birth defect. Even at eight years old, I was acutely aware of the possibility of going asleep and not waking up.

I’ll never forget what happened after I voiced my fear. Sitting on my bed, the nurse drew me close and wrapped her arms around me. “Little boys don’t die,” she whispered. Nurse Beata’s verbal medicine soothed my anxiety. I woke the next morning confident and excited about getting a new ear.

Nurse Practitioner Pinkerton shed a tear of joy and gave my wife a hug when Julie showed delight upon hearing that we were indeed going to have a baby. As the primary caregiver at the student medical clinic at Colorado State University, Nurse Pinkerton shared that students usually expressed sorrow over an unwanted pregnancy. Julie was the first student that year to be happily pregnant. I was especially pleased that Brandon’s due date was after graduation.

A few years after our son was born, we had a daughter, Talitha. She pent the first eight days of her life the NICU. Our precious baby, her life in the balance, was loved on by nurses’ caring hands.

About a year ago, Tali and I dropped in on them to say hello and let them see the fruit of their labor. They studied the strong woman that frail baby transformed into. Tali had a chance to say thank you to the nurses who had watched over her like angels two decades prior.

Early in my healthcare career, I worked with nurses in the OR. Oh, the things I witnessed! So hard to express in words. The love. Compassion. Humility. The hours and dedication. The passion and the tears. The smiles. The joy. The healing. I hated leaving that environment and culture, but my calling lay elsewhere.

As I became involved with technology, I remembered the nurses. I consistently position nurses on my team and I’m proud of all of them, especially those who have become CIOs. At last count, roughly 25 percent of my teams have been certified clinicians of one sort or another. They understand workflow and the culture. You match this education and experience with technology and boom! I exhort my fellow IT leaders to embrace nurses.

OK, not all of my nurse experiences were positive. My only bad nurse encounter happened when I was 15. While riding my bike to school, I was struck broadside by a truck that pushed my face and body into the asphalt for about five yards. Much of the skin on my face was roughed up.

An ambulance rushed to the ER, and the triage nurse gawked at me and winced. That was not a good signal for an insecure teenager in shock. But to his credit, he did take good care of me and stopped wincing after painstakingly pulling every bit of gravel out of my face. I forgave him.

My point? I’m thankful for nurses. They don’t win Emmys or Heismans. Fearful patients chew them out, yet they extend mercy. They sooth your worries. They help facilitate healing. They make health information technology successful.

One last thing, something we rarely acknowledge. They put their lives and health at risk for us.

They are the hands of God.

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

Readers Write: Harnessing Data to Support Population Health Management and the Evolution of Next-Gen Population Health Management

Harnessing Data to Support Population Health Management and the Evolution of Next-Gen Population Health Management
By Larry Schor

Accountable healthcare delivery is in the midst of a three-stage evolution as organizations increasingly turn to the promise of health IT and data to improve patient care and the bottom line.

First-generation accountable care is all about meeting process quality measures and closing gaps in care. At this stage, provider compensation is loosely tied to compliance with standards of care and protocols for specific common conditions, such as immunizations or screenings for diabetes and glaucoma. However, during this phase, financial rewards predominantly come in the form of bonuses for achieving quality measures with little or no downside financial risk.

As the industry currently evolves from first-generation toward middle-generation accountable care, new complexities are emerging. As such, healthcare organizations must manage clinical risk and begin assuming limited financial risk for identified patient populations.

Because both upside bonuses and limited downside financial risks exist at this stage, it is imperative that patients are clinically well controlled. Clinical data, therefore, becomes increasingly important for understanding risk. The historic reliance on claims data will no longer suffice. It is at this second stage of maturity that next-gen population health management becomes a critical strategy for managing population health because it effectively blends clinical and financial data.

Once healthcare organizations achieve next-gen population health management, mature accountable care — which is characterized by high-performing networks operating under full global risk arrangements — can be realized. This advanced care delivery model focuses on optimization and lowest total cost of care, achieved through high patient engagement as the result of personalized outreach and full next-gen population health management. The benefits of this stage of maturity will be realized through more comprehensive and precise analytics to personalize patient care, especially for those with chronic conditions.

While national initiatives are encouraging the forward momentum of accountable care, a bird’s eye view of the industry reveals that most healthcare organizations are in the very early stages of this cultural shift. Despite evolving reimbursement models that are gradually incentivizing quality outcomes and efficiency, organizations still must invest in the necessary infrastructure and embrace new workflows.

Electronic health record implementation provides one example. To date, even the most sophisticated EHRs usually are implemented as little more than electronic versions of existing processes and workflows. What is needed instead are more comprehensive and precise analytics to segment patients and personalize patient care.

Traditional analytics match demographic and claims data against quality measures, but engage all patients with similar conditions in the same manner. All patients identified with Type 2 diabetes, for instance, might be offered the same form of educational outreach. While EHRs today offer transactional clinical decision support at the point of care—some even are even adding managed care modules—they lack the capability to support the data-driven workflow of a distributed care coordination team. They are not designed to ensure top-of-license performance by all participants in the cycle of care, whether they are charged with managing a patient’s financial, clinical, or social welfare.

With new analytics, however, healthcare organizations can begin to offer a more tailored approach to care based on reviewing more comprehensive claims, clinical, and psychosocial data. As such, future success with population health management requires a data management infrastructure designed to capture an exploding volume and variety of data in real-time, much of it outside the claims stream.

Going forward, the strongest organizations will be those that most effectively harness, integrate, and analyze multiple types of data to inform the care of patient populations at the point of care. For example, claim clickstream data may reveal what treatments patients were provided in the past, but not necessarily whether they worked. Psychosocial data—such as whether a patient drives or has adequate social support—can have a massive impact on the success or failure of care, but is often embedded within provider documentation. Pharmacy, lab, and real-time clinical biometric data from devices such as wireless glucometers and scales is essential to effective care management.

Simply put, a real-time, 360-degree view of the patient, plan of care, evidence-based guidelines and psychosocial data results in more targeted, effective population health management, which in turn leads to better, more accountable care.

Effectively improving population health and the bottom line will require that data be translated into structured content readily available for analysis. Healthcare organizations today must take advantage of technology that allows storage and maintenance of data at its finest-grain level. It is no longer adequate to extract data, drop it into a data warehouse, and run pre-defined reports. This solution simply isn’t agile enough to answer new questions or handle increasing data volumes.

Instead, data must be conditioned, as data hygiene is extremely important for effectively using data out of the chute. Moreover, natural language processing also is becoming increasingly valuable for extracting actionable data from physician notes.

Cloud-based storage strategies, however, have proven most effective for supporting greater volumes of new data. Cloud environments offer an on-demand infrastructure capable of finding the right signals through the data noise that is expanding as the velocity, volume, and variety of data increases. Overall, healthcare organizations must employ technologies capable of clearly identifying relevant data and revealing that data at the point of care in a way that is quickly and easily consumable by providers.

Information is becoming a driver of consumer and clinical value in healthcare. In the near future, the use of data to enable effective population health management will align healthcare organizations with the cost and care quality goals so vital under accountable care reimbursement models. The most successful healthcare organizations, therefore, will be those that find new ways to use technology to leverage a wide range of patient data to improve both the bottom line and patient care.

Larry Schor is SVP of Medecision.

Readers Write: Are You a “Check the Box” Executive?

Are You a “Check the Box” Executive?
By Dana Sellers

Over the Labor Day weekend, CMS released an update for Stage 2 Meaningful Use that provides some relief to providers struggling to fully implement the 2014 requirements. That’s great, but here’s the problem: Meaningful Use is not just an exercise to check some boxes off.

It’s more than implementing CPOE. It’s more than getting your physicians to use a problem list. It’s more than the incentive dollars. It’s about getting value beyond the implementation.

If your organization attested in 2012, you have been continuously collecting discrete standardized and coded data for close to two years. You’ve done the heavy lifting and you’re continuing to do so for Stage 2. Now you have a foundation that provides a common data platform across the organization with standardized vocabularies, regardless of different EHRs or other operational systems.

While you may be awash with all kinds of data, Meaningful Use provides specific clinical data that you can focus on. You have a means to ensure that all parts of the organization can begin to measure the same things the same way.

In a recent project, we turned our new cadre of Quintiles researchers and biostatisticians loose on a bunch of clinical data. We imposed one important ground rule: we limited the data to things that were already being collected for Meaningful Use. We asked if they could find anything interesting. In a matter of weeks, they discovered significant findings that relate directly to outcomes and cost.

Here’s the cool part. Every organization that has attested for Meaningful Use has the data needed to do the same kind of study.

Are you looking at Meaningful Use as a check-the-box exercise, or are you looking to drive real value? Have you considered the possibilities of using your current data foundation in order to improve workflow and processes?

For example, changing how the patient intake process occurs, not only for better collection of data, but also for safety and care coordination. Can you move beyond monitoring clinical process measures to conducting analytics that will drive insights for better care and outcomes?

It takes the organization thinking about Meaningful Use as a foundation for value. It requires change.

• Break down organizational silos. No single department owns the challenges facing organizations around quality, cost, and performance. Yet multiple departments and stakeholders often try to answer the same types of questions, resulting in inefficient processes as well as conflicting answers. Create cross-departmental, multi-disciplinary teams to address these challenges.
• Get data governance in place. Information transformation requires that data is consistent, accurate, and timely. This foundational data is a start, but still requires an organizational structure and process to provide direction and decision-making to create common definitions and apply common standards across multiple stakeholders and departments.
• Start with the foundation. There is tremendous value in the foundational MU data. Begin to explore beyond the standard Meaningful Use process objectives. Use this foundation to evaluate how well standards are applied. Explore for other clinical insights like impacts of the use of evidence-based orders on specific disease-based populations in this data set.

Meaningful Use is not an IT project or task to cross off a project list. It is a foundation for an information journey to value.

Dana Sellers is CEO of Encore, A Quintiles Company of Houston, TX.

Readers Write: What to Ask When Deciding to Take the CMS 68 Percent Settlement Offer

What to Ask When Deciding to Take the CMS 68 Percent Settlement Offer
By Bill Malm

The October 31 deadline for providers to decide whether or not to take the 68 percent settlement offer from CMS is quickly approaching. This settlement enables any provider to withdraw their pending inpatient appeals in exchange for a timely partial payment which equals 68 percent of the net allowable amount. CMS is offering this settlement in order to reduce the volume of inpatient status claims currently pending in the appeals process and to alleviate the administrative burden to both providers and Medicare.

Many healthcare organizations have already submitted their request to take this agreement, but if your hospital is still weighing the pros and cons of doing so, some key factors for consideration include the following.

• Does your hospital have significant dollars at risk or a high volume of outstanding appeals? Hospitals with a large number of appeals and/or a significant amount of revenue tied up in the appeals process may benefit from seeing the appeals through the ALJ process. Interest payments alone could outweigh any reason to settle.
• Was your hospital’s appeal strategy based on an internal review process that appealed only strong cases, writing off weaker cases? Hospitals that had a denial review strategy and chose to appeal only those cases with a reasonable likelihood of success may not want to agree to a 32 percent reduction in payment and forfeit the Limitation on Recoupment 935 interest. On the other hand, hospitals that appealed cases indiscriminately are promised 68 percent of the net payable amount. In the end, this may result in a higher payment for these organizations.
• What was your hospital’s recoupment strategy? Is the expected interest on a successful appeal financially substantive or marginal? If your facility allowed immediate recoupment of overpayments following receipt of Demand Letters, then your claims are not subject to 935 interest. Conversely, 935 interest is owed when claims were involuntarily recouped and you prevail at the ALJ level. For claims that wait years for an ALJ hearing, this payment could be substantial.
• How badly do you need your money? This may seem like a silly question, but keep in mind that strong appeals and long wait times will likely result in payments with greater than 100 percent value, but it may be a very long time before you see that money. Can you afford to wait? Hospitals that accept the settlement can expect reimbursement within 60 days of a fully executed agreement.
• What is the cost associated with pursuing your appeals? Hospitals with high costs associated with the pursuit of appeals may want to consider the settlement.  Those costs might include consultants, attorneys, and expert witnesses. The cost of internal personnel time and resources should also be considered.

Deciding whether or not to take this settlement depends on a variety of circumstances. The final decision should be based on a position of financial strength and a strategic choice rather than a short-term stopgap out of necessity.

Bill Malm is senior manager of revenue integrity communications at Craneware.

Morning Headlines 10/15/14

AMA Provides Blueprint to Improve the Meaningful Use Program

The AMA publishes a wish list of Meaningful Use Stage 3 criteria as part of a letter to CMS. Within the list, AMA calls for more flexibility on threshold measurements, reduced penalties for those that fail to meet criteria, and improved interoperability standards.

Joint HIT Committee Meeting

The ONC’s HITPC workgroup will present its conclusions after analyzing the 2013 JASON report that was highly critical of the interoperability plan being pursued in the US. The group will propose an API-based interoperability approach as a path forward.

Highmark-UPMC split raises health records concerns

Pennsylvania state representative Dan Frankel questions whether UPMC, which uses Cerner, will be able to send patient records to other health systems once it severs ties with Highmark Insurance and those patients move on to new care providers.

News 10/15/14

Top News

The AMA issues a Meaningful Use blueprint that calls for CMS to:

• Waive penalties for providers that hit a 50 percent threshold.
• Pay incentives for meeting a 75 percent threshold.
• Make three unpopular measures optional: View/Download/Transmit, Transitions of Care, and Secure Messaging (or as an alternative, set thresholds at less than 100 percent).
• Eliminate thresholds and menu vs. core requirements.
• Add Stage 3 measures that are more appropriate for specialists.
• Continue hardship exceptions for anesthesiologists, pathologists, and radiologists given their tiny attestation numbers and their use of systems provided by hospitals that don’t care all that much whether they can attest or not. AMA also wants a hospitalist exemption for those who treat large numbers of observation patients since they don’t qualify as hospital-based EPs in that setting.
• Leave the measures in place that HITPC suggested removing, but allow providers to qualify by meeting any 10 measures.
• Loosen the hardship exception requirements by expanding the definition of “unforeseen circumstances” and exempt hospitalists and physicians who are eligible for Social Security by the end of 2015.
• Revamp EHR certification to cover only interoperability, quality reporting, and privacy and security.
• Eliminate the requirement that only licensed clinicians can enter orders.
• Create standards for electronically passing data between EHRs and registries in a standard format, eliminating the need for middleware.
• Focus Stage 3 standards on coordination of care and new payment models rather than on data collection.

The AMA’s document also calls out C-CDA as causing interoperability problems, saying that ONC mandates its use in Stage 2 even though it has had “very little real world testing, nor was it balloted or approved for standardization by HL7” and therefore is still a draft standard with “wild variation in technology versioning.”  It urges that ONC not repeat the same process of jumping on untested standards starting with Stage 3.

Reader Comments

From Media Horse: “Re: Abraham Vergese, MD’s comments about EHRs interfering with patient care. He was the keynote speaker at athenahealth’s user conference a few years ago. It was a good speech about preserving the patient-doctor relationship, but it’s interesting that he spoke for a company that’s in essence a billing company with an attached EHR. I’m not suggesting that he’s a hypocrite, but I’m sure he was paid well.”

From Number Six: “Re: Health Data Warehousing Association conference in Portland, ME last week. I was impressed by the all-volunteer organization’s conference and the low registration fee of under $500 for 2.5 days. It was held in MaineHealth’s really nice conference center and had about 170 attendees. No vendors, just data people giving concrete details of what they’re working on in their institutions. Utah presented how they incorporate PROs into Epic and Altrius had a talk on predictive modeling, which was then covered in a ‘Sharing’ session on Day 2 since it was obvious that their specs could be implemented at other places. I highly recommend the conference HIStalk readers. Next year’s meeting is in Grand Rapids.”

From Always Be Closing (Offices): “Re: CompuGroup Medical. Closing the Boston office and terminated the sales VP and several sales reps.” Unverified, but the report is from a non-anonymous insider.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CEO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock

Lifestyle healthcare technology vendor Alphaeon Corp. acquires Utah-based TouchMD for $22 million. TouchMD’s apps allow plastic surgery and OB-GYN practices to educate patients on their services to “increase consultation closings at the time of service and added procedures beyond the consultation, resulting in increased practice revenue.”

Sales

Beaver Dam Community Hospitals (WI) will deploy eClinicalWorks across its eight locations.

People

Andrew Gelman, JD will step down as SVP of corporate development for PDR Network to run a family business, but says he will keep his hand in healthcare with occasional consulting.

Facebook CEO Mark Zuckerberg and his physician wife donate $25 million to the CDC for Ebola control.

University of Arkansas for Medical Sciences promotes Rhonda Jorden to vice chancellor for IT and CIO.

ONC names Lucia Savage, JD (UnitedHealthcare) as chief privacy officer, replacing Joy Pritts, who resigned in July.

Announcements and Implementations

Mobile Heartbeat will integrate EMR and waveform data from AirStrip’s One platform into its care team smartphone app.

Eskenazi Health (IN) will use technology from Indianapolis-based Diagnotes to alert its brain center coordinators when patients are admitted, discharged, or transferred from hospitals as reported to the state HIE.

Personal health records management app vendor Hello Doctor claims it has “gained access to an API” that gives it “access to 52 percent of clinics and hospitals in the US.” That sounds suspicious since there’s no single API out there that covers multiple vendors, leading me to believe that perhaps they’ve connected to Epic in some manner and are using the “52 percent” statement incorrectly to refer to organizations rather than patients.  

Allscripts will offer Shareable Ink’s documentation solution for surgical and clinical documentation for Sunrise.

Government and Politics

Rep. Renee Ellmers, RN (R-NC) issues a statement saying she’s pleased that CMS extended the Meaningful Use hardship exception after admitting that its submissions website wasn’t working correctly, but repeats her request (made via her proposed Flex-IT Act) that CMS reduce its 2015 Meaningful Use Stage 2 reporting period from 365 days to 90 days.

Beth Israel Deaconess Medical CenterCenter John Halamka, MD says the White House should choose someone from DC rather than Silicon Valley in replacing departed US CIO Steven VanRoekel:

I always support the federal government, but bold new ideas get lost in the complexity of procurement, contract management, and getting stakeholders to agree. Navigating the US government is difficult and complicated, and an outsider from Google or Facebook is likely to be eaten alive. Only an insider can navigate the process while offering new ideas and approaches.

HITPC’s JASON Report Task Force will deliver its conclusions today (Wednesday), proposing that current interoperability approaches should be replaced with an API-driven model starting with Meaningful Use Stage 3. It disagrees with the JASON report’s conclusions that such an approach requires new clinical and financial systems, that the market has failed in its failure to advance interoperability, or that a newly mandated software architecture is required. The task force advocates that ONC create a public interoperability API and encourage its use via the Meaningful Use program. 

ONC names 12 providers as health IT fellows. 

Executives of California’s health insurance exchange are questioned about its contracting practices as a state senator claims the organization practiced cronyism in awarding dozens of no-bid contracts, some of them to a company whose owner has close ties to Covered California’s executive director.

The chief of staff of New York City’s medical examiner’s office quits following a $10.9 million no-bid, sole-source contract award to a ICRA Sapphire, whose software has cause bodies to be mishandled or lost. The city has been paying for the system using Homeland Security grants, having awarded what one lawyer called a “lifetime contract with constantly increasing costs and poor results” and hiring the India-based company’s rep as the ME office’s CIO. The previous CIO and his girlfriend were arrested for embezzling $9 million in FEMA grants intended for tracking the remains of 9/11 victims. The just-resigned chief of staff had been promoted to the position even after getting caught stealing an airplane’s exit handle from the 9/11 debris to take home as a coffee table souvenir.

Technology

Philips Healthcare begins Netherlands hospital trials of a wearable COPD monitoring sensor that collects information on physical activity, respiratory indicators, and sleep disturbances.

A reader called my attention to Xenex, whose xenon-powered pulsed UV devices (“Germ-Zapping Robots”) can disinfect hospital rooms in a few minutes, a timely topic given Ebola. Two of the company’s executives hold doctorates from the Bloomberg School of Public Health at Johns Hopkins University, while the other two were involved with Rackspace Hosting.

Google is testing a search feature that would allow people who are Googling medical symptoms to click a “talk with a doctor now” link.

Breathometer integrates its $100 Breeze personal breathalyzer with Apple’s HealthKit.

Other

The Brookings Institution presumably publishes intelligently written and authoritative articles on occasion, but this lame piece called “Could Better Electronic Health Records Have Prevented the First American Ebola Case?” isn’t one of them (maybe Farzad was the only person there who knew anything about healthcare IT). Its insight is zero, its valid points are few, and its flaws are many:

• It doesn’t answer the question its sensationalistic headline asks.
• It is based on a preliminary report that an EHR setup decision caused Texas Health Presbyterian Hospital Dallas to discharge the Ebola patient from its ED, which turned out not to be the case according to the hospital.
• It gets the hospital name wrong even though it’s right there on the page to which the article links.
• It wanders all over the place about EHR privacy, cost, and “voluminous files,” then meanders into healthcare policy issues, health IT competition, and a proclamation that an undefined “many”are skeptical about EHR value and the government should therefore fund outcomes research (which is already underway).

Anna McCollister-Slipp, the co-founder of an analytics company and Tricorder Xprize judge who also has Type 1 diabetes says she’s tired of waiting for digital health to flourish, pointing out that:

• Even hospitals that took Meaningful Use money won’t allow patient-sourced data to be imported into their EHRs.
• Most of the health apps were designed for people who are already healthy.
• Her academic medical center does not offer online EHR access, doesn’t allow electronic communication with its physicians, and won’t provide her endocrinologist with the software that would allow him to load her glucose monitoring data to his computer.
• None of her doctors use electronic scheduling, none offer online lab results retrieval, and only one accepts electronic refill requests.

A Pennsylvania legislator questions UPMC (PA) about its ability to send records of Highmark insurance patients to new providers when they lose access to UPMC’s hospitals on January 1. UPMC CIO Steven Shapiro says they can transfer records electronically within 24 hours, but Highmark claims UPMC will be sending faxed documents instead. UPMC uses Cerner among its variety of systems, while Highmark-owned Allegheny Health Network is moving to Epic.

Reuters covers the growing telemedicine market in China, which the government is supporting to overcome the rural-urban medical expertise gap. A report says doctors in China spend 13 hours per week online, with 80 percent of them using mobile phones.

CDC and ONC will present a webinar on Thursday, October 16 at 1:00 – 2:30 p.m. Eastern to encourage providers and EHR vendors to work together to develop Ebola screening tools. CDC’s Ebola team will present its detection algorithms and travel history / medical signs checklists.

NBC medical correspondent Nancy Snyderman, MD admits that some of her crew members broke a voluntary Ebola quarantine in going out for takeout food after returning from Liberia, where the group had been in contact with an Ebola-infected freelancer. New Jersey health officials reacted to her admission by making the quarantine mandatory.  She declined to say whether she herself was one of those involved as several locals who spotted her indicated.

Sponsor Updates

• Predixion Software joins the Salesforce Analytics Cloud ecosystem.
• Greenway Health’s SuccessEHS is prevalidated by NCQA to receive 27 points in auto credit toward PCMH 2011 scoring.
• Frost & Sullivan names Validic to its 2014 Best Practices Award for Customer Value Leadership.
• First Databank’s collaborative research paper is selected as a finalist in the Best Paper Competition by the American College of Clinical Pharmacy.
• The Jacksonville Daily News discusses the history of military healthcare IT solutions and calls RelayHealth a “pearl.”

Contacts

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

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