Monday Morning Update 11/24/14

Top News

Beth Israel Deaconess Medical Center (MA) will pay $100,000 to settle a state complaint over the 2012 theft of a laptop that contained the health information of 4,000 employees and patients. The attorney general said the hospital broke the law in failing to encrypt the device. CIO John Halamka says the hospital has since started encrypting all devices and requires employees to verify annually that their personal devices are encrypted.

Reader Comments

From Sam Lawrence: “Re: CommonWell. I read through their website to understand what exactly they offer and was unsuccessful. Tons of reference to ‘services’ and appears to be written entirely in vague marketing-speak. What can the two endpoints exchange? CCDAs? Discrete data? If so, what data? Can it be viewed and pulled directly into the EHR at either end? Do users have to query for data or is it passively making connections behind the scenes? Maybe this is coming, but instead of some fluff quotes, I’d like to understand what the provider actually gets and how it’s helpful.” Their website has specific use cases and refers to documents that members receive, so I assume it’s really just non-members who are still in the dark. CommonWell gets a pass for their hastily prepared HIMSS13 publicity rush, but for a group that talks a lot about transparency and openness, they aren’t very good at either when it comes to explaining their business model, technology, and the status of their offering to the industry as a whole (they’re kind of like Epic in that regard, in fact). The latest announcement looked like a committee-edited PR fluff piece. I suppose that’s inevitable when you ask several EHR vendors to collectively agree on anything. Loftily stated benefit to mankind notwithstanding, I fully expect that McKesson and Cerner expect to make money or gain competitive advantage from their participation, so I would just like them to say so.

From Donald: “Re: health IT consulting. We’re seeing a huge downturn. Rates are down a bit and opportunities are way down. Every consultant and recruiter I’ve talked to says the same thing.”

From Mr. Ron Anejo: “Re: health IT consulting. The market is dead. Very few large implementations remain, providers aren’t chasing MU $, and uncertainty surrounding possible repeal of the ACA has Medicare heavy hospitals and health systems freezing spending. In speaking with many consultants, they’re terrified because recruiters are no longer calling them 10 times a day with offers and aren’t sure how long they will be without work. Supply (consultants) definitely outweighs demand for services right now — consulting firms should be able to drive down pay rates and hospitals should push for lower rates.”

From Deborah Kohn: “Re: ICD-10 phase-in. I contacted Sue Bowman, AHIMA’s Senior Director, Coding Policy and Compliance (Public Policy & Governmental Relations), who confirmed and articulated what I suspected. Per Sue: It’s not just a matter of accepting both code sets – someone has to process the codes, be able to analyze and compare data, etc. With different providers on different code sets, it would be a nightmare. And there is also the matter of coordination of benefits. Our healthcare delivery and reimbursement systems are too inter-connected to allow different entities to use different code sets for the same date of service.” CMS is abound with botched, expensive IT projects (Healthcare.gov being just the most visible one), so I wouldn’t be optimistic that the checks will keep flowing without interruption. Here’s a free tip for mainstream reporters looking for a big story: start sleuthing around in the spring to see how confident CMS’s contractors and project people are about their ICD-10 readiness and how thoroughly they’ve tested. I bet they, like providers, just moved on to something else while waiting out the year-long delay.

From Jello Biafra: “Re: CareTech Solutions. Has it been sold to Mr. Madhava Reddy?” Weekend confirmation is hard to get, so I’ll stick with facts: (a) the Federal Trade Commission approved on November 20 the acquisition of CareTech Solutions, Inc. by Madhava Reddy; (b) Madhava Reddy is president and CEO of IT/BPO outsourcer HTC Global Services; and (c) both companies are located in Troy, MI.

From Dan: “Re: Dr. Oz. Invites fans to send him questions via Twitter, getting gems such as ‘I just got my flu shot — when can I expect to develop autism?’" America’s favorite daytime TV huckster doctor should have known better to take to the Twitterverse given the flack he takes for touting bizarre miracle drugs and refusing to have his children vaccinated. My favorite questions asked of him: (a) “What has been your most profitable lie for money so far?”; (b) “Is snake oil gluten free?”; and (c) “Why have you not been censured or fired from Columbia Surgery for conduct unbecoming a physician, scientist, and gentleman?”

From The PACS Designer: “Re: Office 365 sharing. The Garage Series for Office 365 ProPlus highlights a nice upgrade called shared computer activation, which can enhance productivity for multiple users of any computer.” It uses Remote Desktop Services to allow multiple users to connect to the same remote computer simultaneously to run Office 365 ProPlus programs like Word or Excel. It was announced using hospital nurses as an example.

HIStalk Announcements and Requests

Most poll respondents left their most recent jobs because of problems management could have resolved, with 50 percent saying they didn’t like management, were overworked, or lacked opportunity. A surprising 9 percent said they were fired from their last position. New poll to your right or here for hospital or practice people: how much IT consulting will you use in 2015 vs. 2014? Vote and then click Comments to explain – I’m curious about what seems to be a consulting downturn and I’d like to learn more.

Some interesting comments from last week’s poll:

• Laid off. Other hand-picked layoffs included people who had worn out their welcome at the company after on-the-job injury, bereavement, and of course, cancer.
• Competition was eating our lunch nationally, and their response was to constantly cut staff and raise prices; classic short-term thinking.
• The software company where I worked for many, many years sent me to India to train developers. After I returned, the company decided they didn’t need the experienced local staff and our jobs were outsourced to India.
• I left, not because I was unhappy or underpaid at my last job, but because I saw an large challenge in my new job… this new job came a’-calling and the offer was intriguing. Essentially the same money, but in a warmer climate. The job though was to start a program from scratch, accelerate it as quickly as possible. I wanted to see if I could do it.
• When I turned in my notice, management went after me. They contacted Epic to look into if I might be trying to go into consulting. Epic found I was. My management told them to blackball me in an attempt to get me to stay. The job which I was to start in a few weeks disappeared. The site and recruiter were told by Epic that they could not do business with me since I was leaving an active installation, which was untrue.
• Individuals in management roles tended to be those who stuck with the company the longest, rather than individuals who were talented or forward-thinking. There was no official training that management received, as far as we knew, so most managers didn’t know how to grow their team members or keep them at the company (most managers had no idea how to handle HR issues either, like what to do when an employee told them they wanted to quit).

I was frustrated at not being able to see a journal article because it’s behind the paywall of a for-profit journal publisher. My conclusion: journals should continue providing a service in vetting and editing submitted research articles, but perhaps the authors should pay a submission fee and let everybody read the resulting article for free. That would serve several purposes: (a) it would reduce the number of crap articles that are accepted only because the journal is desperate for content; (b) journals could stop accepting ads if they haven’t already, or they could all start running ads as long as the editorial process is separate; and (c) human knowledge would be diffused to everyone, not just high-paying subscribers. That’s especially true of articles written from government-sponsored research or by government employees: why should I as a taxpayer have to pay to see them? It’s the author that gets bragging rights and personal benefit, so let them pay. I’d also like to see an impartial panel of experts grade the methodology, originality, and applicability of each article, which might shame sloppy authors or journals into not wasting reader time.

Listening: new from Gerard Way, the former singer of My Chemical Romance. Not bad, although MCR was a lot better.

Last Week’s Most Interesting News

• CVS Health announces plans to open a 100-employee technology development center in Boston that will create consumer-engaging technologies and work with health-related startups.
• EHealth Initiative’s “2020 Roadmap” calls for the federal government to refocus Meaningful Use on interoperability, get EHR vendors to offer API access to their systems, and align federal agency interoperability efforts.
• Cleveland Clinic creates Adeo, a for-profit company and website that will sell software developed by it and academic medical centers in the Healthcare Innovation Alliance.
• Emdeon announces that it will acquire consumer engagement tools vendor Change Healthcare for $135 million.
• A Salesforce blog post describes how Johns Hopkins Healthcare is using its platform to manage high-risk patients, seemingly confirming a big healthcare push by the company.
• UPMC takes a $9 million gain by selling a procurement systems software company it created to a private equity firm.

Webinars

Webinar recordings recently added to YouTube:

Improving Trial Accrual by Engaging the Digital Healthcare Consumer. 

Cerner Takeover of Siemens, Are You Ready? Vince and Frank have hit over 1,000 YouTube views in four days, giving them a good shot at surpassing Dim-Sum’s all-time record.

Government and Politics

Karen DeSalvo tweeted out this farewell photo with Jacob Reider in a nice gesture. They have something in common: both are doctors who used to work full time for ONC.

Technology

US News profiles Health Heritage, developed by NorthShore University HealthSystem (boy, do I hate that multiply conjoined words name created by marketers run amok – why create a dumb name that 99.9 percent of your customers couldn’t spell in a bar bet?). It’s a genomic decision support system that combines family history to information from Epic, developed by the founder of Apache Medical Systems. Of 3,000 people who signed up and downloaded their NorthShore information, 13 percent were flagged as being high risk for cancer.

Other

An Advisory Board survey lists the reasons doctors are worried about retail clinics:

• They will siphon off the profitable and more easily managed simple cases.
• Patients don’t understand the value of provider continuity and will seek convenient access instead.
• Retail clinics will move up the food chain in offering ever-expanding services that threaten the medical group model.

My reaction as a patient:

• If a practice can’t survive without cranking through expensive but mindless sore throat and fever encounters that trigger an automatic (and often clinically inappropriate) antibiotic prescription, then we have too many practices.
• Providers haven’t in most cases demonstrated the value of continuity to their patients, treating each encounter like an impromptu hooker visit where the patient describes what they have and what they want in 10 furtive minutes of bartering and eventual consummation of a clumsy balance of compassionate care and bare-knuckle capitalism.
• If retail clinics can threaten the overpriced, underperforming, and often patient-indifferent healthcare system and that system refuses to change, then I’ll happily go to Walgreens or CVS where I get treated like paying customer and can park for free close to the door. I feel perfectly safe as long as the provider (whether it’s a PA, NP, or telemedicine doc) knows when to turf me off to experts when they’re in over their head.

It’s really odd to me that retail clinics made a big splash, were seemingly on the verge of extinction, and now are seen as a big threat to entrenched providers (the “odd” part being why it took so long).

Florida’s Blue Cross Blue Shield company installs a HealthSpot telehealth kiosk in its Miami center to allow members to access doctors from Miami Children’s Hospital. HealthSpot even did a nice job Photoshopping MCH’s logos onto stock photos of its device.

In Canada, a Montreal newspaper’s editorial says Quebec’s EHR project is “an abysmal failure,” adding that its health minister agreed in an interview. The project was supposed to cost $500 million US and be finished by 2010, but is now targeting a $1.4 billion cost and 2016 completion date. The editorial blames the variety of EHRs that were approved (nine for practices, four for hospitals) that can’t exchange information.

Weird News Andy says this article on the privacy-invading possibilities of 90-minute DNA criminal profiling creates should also have addressed potential medical uses, such as finding genetic disorders that mimic MS or identifying people with genetic sensitivity to warfarin or chloroquine.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/21/14

Emdeon to Acquire Change Healthcare

Emdeon announces that it will acquire Change Healthcare for $135 million. Change Healthcare markets a benefits management system focused on helping employees make the most of their health benefits,

Fiscal Year 2014 Top Management and Performance Challenges Identified By the Office Of Inspector General

The Inspector General of HHS publishes a list of the top 10 challenges it is facing. The list touches on a number of health IT initiatives, including: validating spending for federal and state health insurance exchange markets, and monitoring the EHR Incentive Program for fraud.

Can we predict the unpredictable?

Researchers at the University of Windsor unveil a forecasting algorithm that can monitor EEG waveforms and predict oncoming seizures in epileptic patients 17 minutes ahead of time.

Merge Healthcare to Introduce Merge One for Ambulatory Radiology at RSNA 2014

Merge unveils a new solution, called Merge One, which is designed to support ambulatory imaging centers. Its provides a RIS, PACS, financial system, universal viewer, cloud archive, document management, and business analytics.

News 11/21/14

Top News

Emdeon will acquire Change Healthcare for $135 million. The company offers consumer messaging, lookup, and education tools to improve engagement.

Reader Comments

From Former McKesson: “Re: McKesson reorg. McKesson Technology Solutions has another big reorg, the third in three years, this time in the MCCA business unit. MTS has lots three good GMs in the past 12 months and middle managers are fleeing.” Unverified. An attached internal email from Jeff Felton, president of McKesson Connected Care and Analytics, says that several RelayHealth business lines have been combined into McKesson Connectivity & Analytics under Ken Tarkoff and that several reporting changes have been made.

From Judge Smails: “Re: country club brawl, with a healthcare IT twist.” Police responding to a 911 call break up a fistfight at the tony Boston-area Weston Golf Club, started when the club’s president ordered jeans-wearing guests to leave the premises because of their dress code violations. The club president who apologized and then resigned was Tom Ferry, president and CEO of hospital software vendor Curaspan. I interviewed him a couple of years ago. I’m siding with him: people everywhere (restaurants, cruises, meetings, etc.) are offended at the idea that clearly stated dress-related rules might inconveniently apply to them and being loudly obnoxious usually gets them a quiet exemption.

From Mike Kovner: “Re: Medicare ACO Shared Savings Program results. CMS has posted the Performance Year 1 final financial reconciliation and quality performance results for all MSSP ACOs with 2012 and 2013 agreement start dates. Kudos to the 52 ACOs that produced real savings and met the threshold for clinical quality measures. Memorial Herman ACO was the big winner with a $28M earned Shared Savings payment, followed by Palm Beach ACO with $19M. Tough break for the six ACOs that produced savings but did not meet the quality threshold, leaving real money on the table.” Mike sent over a detailed worksheet that I’m sure he would be willing to share.

From Ohio MD: “Re: ICD-10. We’re a busy orthopaedic EP. Both 5010 claims and HCFA 1500 can handle both code sets, so why not allow a phase-in over several years? There’s no way to do end-to-end testing since you can send a claim to CMS, but you don’t get payment, and no other payers allow testing as far as I know. Plus getting signed up for CMS testing is an absolute nightmare, especially for small providers.” Readers are welcome to weigh in: is a hard compliance date for ICD-10 necessary? CMS has had plenty of time to prepare with the one-year delay, so why can’t it start accepting either version now?

From Sinking Ship: “Re: [consulting firm name omitted]. Earlier this week rumors were spreading that the company has over 50 percent of its consulting staff on the bench due to poor performance by the sales teams.” Unverified and likely not possible to verify, so I left the large company’s name out. Maybe the sales team is underperforming, but I believe we may be seeing a downturn in the healthcare IT consulting business in general due to fewer go-lives and government meddling with ICD-10 dates and Meaningful Use tweaks. That could be my own incorrect perception from talking to a couple of folks. If you’re on the front lines, tell me what you think.

HIStalk Announcements and Requests

This week on HIStalk Practice: Greenway, CVS, and Quirk open new facilities. CMS Compare websites come under GAO’s fire. Pediatrician Sapna Mukherjee, MD discusses her use of HIT at her concierge practice. Healthcare.gov sees fewer glitches than several state-run exchanges. Seacoast Orthopedics & Sports Medicine physicians achieve MUS2. ONC welcomes several new staff members. Thanks for reading.

This week on HIStalk Connect: Harvard public health researchers launch a heart health calculator that evaluates lifestyle choices rather than blood pressure and cholesterol levels.  Walgreens rolls out on demand lab tests across its 8,200 facilities. Cue, a digital health startup making smartphone-based lab analyzers, raises a $7.5 million Series A.

Acquisitions, Funding, Business, and Stock

Valence Health receives a $15 million growth equity investment, raising its total to $45 million.

A questionable Fortune article called “Digital healthcare investments soaring again. Here’s why.” spends most of its pointless meandering talking up Castlight Health, which is hardly the poster child for why digital investments should be soaring. All of those sharp investors who jumped all over Castlight right after “the most overpriced IPO of the century” have seen their investments shed 72 percent of their value in just seven months (blue) vs. the Nasdaq’s gain of nearly 11 percent (red) over the same period as the company continues to lose big money. Castlight is still mysteriously worth $1 billion, or 28 times annual sales.

Sales

Providence Health & Services chooses NantHealth’s Clinical Operating System and eviti|Advisor for genomic analysis and evidence-based cancer treatments.

Providence Anesthesiology Associates (NC) chooses TigerText secure messaging.

WellSpan Health (PA) selects the Visage 7 Enterprise Imaging Platform.

People

 
EHR scribe provider Essia Health names Anita Pramoda (TangramCare) to its board and William Moore (4medica) as CFO.

Dave Morgan (Vista Consulting Group) joins Greenway Health as CFO. He apparently replaces Laurens Albada, but I’m not quite sure since the company’s leadership page lists Morgan but Albada still has a leadership profile that lists him as CFO. I haven’t seen any announcements either way, so I’m going with Dave.

Announcements and Implementations

CommonWell Health Alliance announces (in a poorly written press release that makes it impossible to figure out what they’re actually announcing) that is offering its services to a broader market, that RelayHealth is its technology provider, and that Aprima and CareCloud have signed up as members.

Greenway Health will open a technology development center in Cobb County, GA in early 2015 that will create 150 jobs.

Revenue cycle and coding products vendor VitalWare launches VitalABN, a medical necessity validation tool that automates the Advance Beneficiary Notice of Noncoverage process.

MModal announces that its Fluency for Image Reporting can notify radiologists of documentation deficiencies in real time.

Johns Hopkins Medicine and Premier will collaborate on educational, clinical, and analytics projects.

A Salesforce blog post suggests that its rumored healthcare push is underway as it describes how Johns Hopkins Healthcare is using the company’s platform in an engagement program to keep high-risk patients out of the ED and to coordinate the schedules of home care workers.

GE Healthcare, a 50-50 joint venture partner in Caradigm along with Microsoft, will resell Caradigm’s single sign-on and context management solutions to integrate anatomic pathology information systems.

Merge Healthcare launches Merge One,  a cloud-based, transaction-priced solution for ambulatory radiology sites that includes PACS, RIS, financials, universal viewer, cloud archive, document management, and analytics.

Government and Politics

Newly discovered emails from former CMS COO Michelle Snyder say her boss, CMS Administrator Marilyn Tavenner, used threats and tantrums to insist that Healthcare.gov be launched on time no matter what. Snyder retired weeks after the failed launch. Meanwhile, the House Committee on Science, Space, and Technology gets its subpoena-powered audience with former US CTO Todd Park on Healthcare.gov. Republican members hammered away, while the ranking Democrat member apologized to Park for making him a  target for Affordable Care Act venting and said it will make it harder for Park to carry out his current job of recruiting wealthy technical entrepreneurs to federal government work once they see how he was treated.

The GAO says the consumer transparency tools created by CMS aren’t user friendly and fall short on cost and quality information. HHS agrees.

Another GAO report finds that the VA violates its own policy in failing to push out critical OS patches to desktops and laptops within 30 days.

CMS forms the Office of Enterprise Data and Analytics and names Niall Brennan as its chief data officer.

HHS’s OIG lists the agency’s top challenges for FY 2014, one of which calls for HHS to make sure that Meaningful Use policies align with its goals and reflect “the changing health IT landscape,” adding that HHS should provide guidance on adoption, Meaningful Use, and interoperability and that HHS, CMS, and ONC stay focused on privacy, security, and fraud prevention.

Vermont cuts ties with economist Jonathan Gruber over his unflattering comments about lack of transparency in passing the Affordable Care Act. The state is ending Gruber’s economic modeling contract in which he bills his time at $500 per hour and that of programmers at $100 per hour. He and his associates collected more than $6 million in federal and state grants and contracts and he’s still working on an NIH project that will pay him $2 million.

Innovation and Research

Two University of Windsor researchers say their newly patented predictive software can monitor EEG waveforms and give someone with epilepsy a 17-minute advance warning that they’re about to have a seizure, although they studied only 21 patients. They also recognize that while it would be nice to let an epileptic know they need to pull their car over or surf one last wave before hitting the beach, it won’t do much good unless someone develops a portable, continuous EEG monitor (waterproof, in my second example).

 
 
Finalists in Harvard’s Health Acceleration Challenge are Twine Health (personalized treatment plans),  Boston Children’s Hospital’s I-PASS (care team communication), Bloodbuy (a Priceline-like bidding system for hospitals to buy blood products), and Medalogix (predictive identification of patients as candidates for palliative care).

Technology

The city of Cleveland will reportedly announce Friday that the Euclid Avenue area, home to several health-related organizations and vendors and locally branded the “Health-Tech Corridor,” will get 100-gigabit fiber optic broadband connectivity courtesy of a federal grant that will pay for it.

Apple publishes WatchKit tools and guidelines to help developers move their iPhone apps to Apple Watch.

A Santa Barbara, CA group that treats homeless people from temporary clinics it sets up in public parks uses a self-developed mobile EMR running Microsoft Access on $200 Chromebooks and a Wi-Fi hotspot. Its author says, “I do not have nearly as many coding options to control both the styling and the function as I would if I had coded the platform from scratch. What we gained was security, instant accessibility of all past charts for a patient, legibility, more detailed records, more accurate reporting, and much more.”

Other

Botsford Hospital (MI), which recently merged with Beaumont Health System and Oakwood Healthcare to create  $3.8 billion system, will replace McKesson Paragon with Epic, which is used by the other members of the new system.

Colorado RHIO announces that its Regional Extension Center will no longer offer free services now that its ONC grant has run out. The REC will be replaced with a fee-based services division. I would opine that dwindling Meaningful Use activity makes it even more unlikely (if that’s possible) that providers will spend their own money on its services.

A Truven Health Analytics-NPR poll finds that 75 percent of Americans see an EHR-using doctor, 68 percent are OK with having their de-identified health information shared with researchers, but only 22 percent would let their doctor or insurance company review their credit card transactions or social media information even if it might improve their health. More than half the respondents claim they have reviewed their information as kept by their provider.

EClinicalWorks CEO Girish Navani writes an Entrepreneur article called “The Case for Never Selling Your Company,” saying that eCW “is, and always will be, a privately-held company. I have no interest in selling it, regardless of any offer I may get. In addition, we don’t use investor cash or spend money we don’t have.” He says selling a company often changes its founding principles, threatens its longevity, and takes away the independence of its leaders.

Sponsor Updates

• Wellcentive SVP Mason Beard and CTO Kirk Elder accepted a finalist plaque for the Intel Innovation Award at the 2014 Health IT Leadership Summit in Atlanta on Thursday.
• T-System is providing free flu T Sheets that include the latest CDC guidelines to all providers
• NextGen Healthcare earns top ranking among healthcare IT vendors providing outsourced billing / RCM.

EPtalk by Dr. Jayne

I received a fair amount of reader feedback about this week’s Curbside Consult on proposed measures for Meaningful Use Stage 3.

From Ski Dude: “I enjoyed your article on MU Stage 3. Ever so true, as an IT consultant and patient I find the overly inquisitive requirements to be a burden. I have a customer, a primary care physician group with approximately 120 providers, that has a spread sheet for all the metrics they need to capture and for whom they have to report them. It is a 17 x 160 cell grid. I’m sure it’s costing these providers way more than they’ll gain in incentives or lose in reimbursements just trying to collect all the data and deliver it to the 17 data consumers.” I’m right there with you on that. Back before MU, we had approximately 20 metrics that we were tracking for providers as part of our internal Clinical Score Card. Every one of them was evidence-based and had a direct impact on patients: influenza vaccination, colorectal cancer screening, diabetes screening / glucose control / foot exams, etc. that had a real return on investment, either financial or in reduced patient morbidity and mortality.

Now we’re tracking hundreds of measures, some of which have not been directly proven to benefit patients. I wonder what our Institutional Review Board would think about the fact that our entire patient population (not to mention all of our staff) is part of an unapproved research project involving human subjects?

I’ve been asked to judge a local science fair this year. Looking at the packet of rules and regulations, what MU is doing to the healthcare community wouldn’t even pass muster for the seventh grade.

I received a couple of replies that surprised me, generally stating that the proposed measures didn’t go far enough to allow providers to make significant advances in MU3. Various suggestions included: tying the payments to actual data scores (not merely reporting the data); requiring HIE exchange on each and every patient visit; and requiring interfaces with data reported by patient mobile devices and apps.

If MU wasn’t already on its deathbed, I’m sure including those factors will push it into full arrest. It’s not that many of us disagree with these ideas, but including them in MU3 without significant financial support and adequate time to plan, code, test, and implement the features just makes them untenable. Not to mention that there is little evidence that wholesale implementation of these features (especially if it’s at the expense of tried and true population health work) may not have significant demonstrable benefit.

I also received one comment that made me smile.

From Thoughtful, Albeit Weird: “Great Column on MU3. It made me think of this: When you brought your car in for repairs, you would have to provide information to the counter person on how you had driven your car and when. What about the other cars in the house? Did you have an accident in the past couple of years? Parking or speeding tickets? What kind of gas do you use? When your mechanic is working on your car, would they have to check the brake, power steering, coolant, and other fluids and document the findings? Tire pressure? Document the state of the belts and hoses? What was the brand of brake shoes they installed? Why did they use that brand and not a different one? When they replaced the brake fluid, did they document that the old fluid was properly drained and that no water was in the line? Did they scan the brake fluid they installed? Did the software automatically check it was of the approved type for the car? If they did have to document these things the cost of every visit would have to go up because of the time involved in documenting these items (not to mention the purchase of the system they use to do the documentation) which leads to fewer customers seen per day. Instead, they use a sheet of paper with checkboxes that they give you (probably so they don’t get sued if something happens to your car). The government is setting the map for the marketplace instead of letting the market do it. I do not favor that approach.”

There are so many comparisons you can make here. At the hair salon, did my stylist counsel me on the risks and benefits of adding highlights and lowlights to my hair? Did he warn me that my elderly grandmother would think reddish lowlights to be tacky? Did he suspect that my wanting to change my color was a potential sign of emotional distress? Did he arrange follow up evaluation on exactly WHY I wanted a different color? Did he caution me that being a blonde might not actually mean that I would have more fun? Did he scan the bar code, document the lot number, and record other information about the chemicals in case there is a recall? Did he conduct a time-out prior to actually applying the color to make sure he had mixed the right combination and to ensure I was fully aware of what I was getting myself into?

Of course I’m just being sassy, but if you look at most industries that we depend on or use regularly, if they were being run like healthcare IT (not to mention healthcare in general) it would be like living in a dystopian sci-fi movie.

How do we stop the madness? Or should I change fields and start designing that hair stylist tracking software? 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 11/20/14

CMS creates new chief data officer post

CMS names Niall Brennan, former acting director of CMS’ Offices of Enterprise Management, as its first Chief Data Officer. Brennan will oversee the newly created Office of Enterprise Data and Analytics.

Former Obama adviser Zeke Emanuel says digital health coupled with payment reform will vindicate ACA

Zeke Emanuel, a former healthcare advisor to President Obama, refutes the recent “stupidity of American voters” comments of MIT economist Jonathan Gruber, as well as his claim of being central to the drafting of the ACA. Emanuel says that Gruber was an outside consultant with limited influence on the legislation, that the ACA has already slowed healthcare spending, and that as value-based payment reform takes hold, VCs will respond by funding startups focused on expanding at-home and office-based care delivery.

New coalition hopes for no further ICD-10 delays

A group of 15 healthcare organizations that includes providers, insurers, vendors, and professional membership groups like CHIME and AHIMA, sent a letter to congress requesting that the October 1, 2015 ICD-10 implementation date be upheld this year.

Survey Reveals Private Option Impact on Hospitals

The Arkansas Hospital Association publishes a survey measuring the effect of implementing a state-level plan for expanding health insurance to low-income residents. The survey included responses from 80 percent of all Arkansas hospitals, and measured a 56.6 percent decrease in uncompensated care losses associated with uninsured patients. The decrease was attributed to a 46.5 decrease in uninsured inpatient visits, and a 35.5 percent decrease in uninsured emergency department visits.

Advisory Panel: ONC’s Leadership Exodus

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: What is your reaction to ONC’s recent leadership exodus?

Back at the ranch, my team and I are implementing healthcare information technologies and give little thought to ONC’s entrances and exits. Cynically, I guess their departing leaders are chasing new money and will move to lobbying consulting.

From my perspective, I don’t see us in a post-MU world yet. Maybe that’s because we are so focused on still getting all the Stage 2 requirements to work, but I don’t think we’ve moved into a stable time yet.

I think it’s normal turnover when the top person leaves. That’s not to say that ONC is not undergoing an identity crisis. They need to re-invent themselves and I would think people at that level would enjoy that type of challenge. But they’re bureaucrats and I’m not, so I could be off. 

ONC is in free-fall. The confusing series of announcements about Karen  DeSalvo’s departure that isn’t a departure is symptomatic of a larger problem. There doesn’t seem to be a plan. Turnover in government agencies at this level is pretty normal, but there usually isn’t a shortage of people ready to fill the gaps. Not so this time.

My reaction is not of surprise at all. You have a very unpopular administration right now that is like a sinking ship. When non-politicals get involved, they don’t need to have their reputations tarnished by what is happening in Washington in general. The public may never get the truth behind the exodus, but it certainly looks like people that just want out of DC.

I am not surprised. CMS leadership (if we can use that term) lacks real-world understanding. When Ebola rose as an issue, it would have been a wonderful excuse to suspend programs like MU2 under the guise of a national emergency. Instead, they took Karen out of the leadership position at ONC and reversed themselves soon afterward when the heat got too hot from the IT and Informatics community, among others. Of course, she now has two jobs and won’t be able to do either as well as they need to be done. This is not normal turnover. I think folks are looking at MU and realizing that with the incentive money essentially gone, everything from here on out will be very difficult. Like all human beings, the ONC staff are doing the calculations – work hard for little reward or find something else to do.

I think this is a bit of “it’s harder to get all these (implementer) cats to cross the finish line then we wanted to believe” combined with the natural life-cycle of a run fast and free organization tied to stuffy CMS, and this has started to shut down the ask-for-forgiveness freedom that the recent leaders needed to stay interested.

Not surprised and neither (turnover or identify crisis). I think it’s indicative of our current state, both in healthcare and the world. Few make long-term commitments or have a vision that lasts longer than three years. We want to make changes to fix the perceived problem right now and pad our resume but we aren’t willing to live with the consequences of our choices. We’ve lost any ability to do anything other than complete a few tasks and then take off for the next organization with the hopes of increasing our paycheck and retirement portfolio. Jaded? Yes. But you asked.

I think these sort of non-career appointments have a high turnover rate. Most of the ONC heads have left after two years or so. I think this is a very difficult job. they have to be on their toes watching what they say 24×7. As for Karen D, I think she saw this as a perfect excuse to leave when the going is going to get very difficult, not that battling Ebola will be any easier. As for Jacob R, I think he was upset that he didn’t first get selected to be the National Coordinator before Karen D and then more recently get selected as at least the interim coordinator to replace her. I know I would have quit for that reason.

Not surprised – matter of time and I suspect the timing was perfect for her. I also think this is a symptom of a significant identity crisis and I think the overall program is in jeopardy. The ONC turnstile is likely indicative of what it’s like to try reconcile vision, policy, and politics with the realities of an immature technology market with providers trying to figure out how to be successful in an uncertain world. This might be a revised definition of insanity. In summary, I don’t blame her as the job has involved into something that cannot be achieved under the current construct (and I thought CIOs had it tough these days).

I think the changes occurring in ONC are higher than normal for government agencies. It could be the post-MU blues, but I think it is also the drain from pushing for HIT progress through tedious, laborious regulations which don’t always hit the mark.

Not surprised. Didn’t see any major strategic announcement following Dr. DeSalvo’s assignment except a change in the org chart, which didn’t amount to much. Her heart has always been in helping people with health issues and not working for an agency distanced from the patients.

This is an example of the government doing an about face and the government as well as ONC know they are doomed. They have no value to the healthcare system at this time with virtually zero leadership effect.

Looks pretty much akin to the death throws of a wounded skunk … it ain’t pretty and someone is bound to get sprayed.

As to Karen and Jacob’s departures, I was not surprise. Karen presented Grand Rounds here the week prior to her recent announcement and it was clear that she has much to offer this country. While the ONC role is an important one, many of us were so impressed with her candor, her transparency, her passion, and her commitment (in her own words) “to the poorest of the poor, and the sickest of the sick” that I believe she had to move into a more visible role. I’m not sure what’s next for her, but I genuinely believe we will see her move around, in a good way, for the years ahead. I hope she stays involved in ONC for a while (as the press releases seem to indicate). I hope HHS will work hard to seize this opportunity to reconsider some of the ways ONC could play are more collegial role, like the one Karen was creating,  promoting collaboration toward the ultimate roadmap that Karen was assembling.

Ugh. I hope the interoperability focus/Jason report doesn’t get lost (why did she?)

My feeling is that the personal movement shows that there is no plan. The government seems to be making it up as goes with no end game, which leads to staff unrest. The number of healthcare enterprises abandoning even trying to meet MU measures shows that the program should be reworked to focus on interoperability instead of focusing on the care delivery process.

They did what they thought would “revolutionize” healthcare and perhaps realized the root causes of our systemic issues are different than what they thought. We now have EHRs and MU measures but you could argue that’s made a ton of money for vendors but had little impact on quality of care. In government work, it’s not surprising when g-men and g-women go take private jobs at some of the same corporations they had dealings with.

I am concerned about the change in leadership. This new leader is the fourth in the last three years. That does not spell stability to regardless what CMS/ONC says about their stable team.

Readers Write: HIE Encounter Notification Solutions and Meaningful Use

HIE Encounter Notification Solutions and Meaningful Use
By Rob Horst

I joined esteemed colleagues from Johns Hopkins Community Physicians (JHCP) in presenting an HIStalk webinar on November 12 titled “3 Ways to Improve Care Transitions Using an HIE Encounter Notification Service.” Some of the attendee questions during and after the webinar required more insight into how ENS helps Eligible Hospitals (EHs) meet Meaningful Use Stage 2 (MU2) and the Transitions of Care (TOC) Measure.

In the way of background, EHs and critical access hospitals (CAHs) that transition or refer a patient to another setting of care are required to provide a summary of care record for more than 50 percent of transitions of care and referrals. This MU2 measure has proven challenging for many organizations to achieve. The method of getting a summary of care record to the right destination and then calculating the number of summary of care records that are actually received is imprecise.

On September 22, CMS issued FAQ 10660, clarifying that a third-party organization that plays a role in determining the next provider of care and that ultimately delivers the summary of care document can count in the measure’s numerator for EHs.

Part of the challenge of meeting the TOC measure is that EHs/CAHs and providers must clearly identify the intended recipient of the transition or referral and verify that the summary of care was received by the intended recipient via one of the allowed transport methods. ENS has a unique capability that can help EHs/CAHs meet the TOC measure.

ENS is capable of sending a C-CDA summary record using the same logic that it uses to send EHs/CAHs encounter notifications to subscribers. Using the patient demographic information in the header of the C-CDA, ENS is able to match the patient with the subscriber’s patient panel and send the document with the same accuracy and predictability that it does with encounter notifications. Once the C-CDA is sent to the subscriber, ENS logs the acknowledgement of when it was accessed and is able to provide a report back to the C-CDA sender with the critical metric needed to calculate the numerator for this measure.

We received these questions during and after the webinar that might provide clarity for those considering their options.

How does ENS help EHs/CAHs satisfy the TOC requirement?

EHs/CAHs, primary care physicians, and specialists submit panels (patient rosters) to ENS. When a patient is discharged from the EH/CAH, the EH/CAH generates a C-CDA from their Certified Electronic Health Record Technology (CEHRT) and sends the C-CDA to ENS via one of the allowed transport methods. ENS uses the patient data in the C-CDA header and the patient rosters to identify the correct PCP or specialist and automatically send a summary of care document to the receiving provider.

How does ENS help provide relevant metrics for the EH/CAH to use in its numerator calculation?

ENS will provide a report to the EH/CAH that includes data elements such as the patient identifiers, receiving subscribers, and time of receipt of the C-CDA. These data elements can be used in calculating the numerator.

Does ENS have to be CEHRT?

No. ENS is not the technology that is creating and transmitting the C-CDA and therefore does not need to be CEHRT.

Rob Horst is a principal with Audacious Inquiry of Baltimore, MD.

Readers Write: Leveraging Technology for Communicable Disease Care

Leveraging Technology for Communicable Disease Care
By Paul J. Caracciolo

The Ebola crisis has been another wake-up call for healthcare providers to get prepared for national and global medical emergencies. Experts agree that it is only a matter of time before the world experiences another pandemic, such as the flu of 1918 that killed many of millions worldwide.

The recent outbreak of Ebola in West Africa and subsequent spread to the US has caused providers to re-examine how they handle sick (and potentially infected) patients, but we don’t have to use Ebola as the example. The seasonal flu still has a significant impact on health and many deaths occur each year. This past year has also seen the rise of enterovirus D68, sickening many hundreds of children across the country, resulting in several deaths.

The proper care of patients with communicable disease is a concern. We want to ensure that patients receive appropriate care, but at the same time, we need to take precautions around the containment and spread of disease. Recently, CNN News reported statistics that approximately 4.5 percent of reported Ebola cases in West Africa are infected caregivers. In the case of Ebola, disease management is further complicated considering the 21-day incubation period, with possible imposed isolation and continuous monitoring of potentially infected patients during this time.

Solutions can be implemented now that could make a huge difference in not only increasing the quality of patient care, but also protecting caregivers from prolonged or unnecessary exposure to sick patients.

Telehealth / telemedicine. It would be beneficial to have this capability in sick patient rooms to control access. This would allow remote consults with disease specialists, primary care providers, ancillaries, or whoever needs direct access to these patients and their caregivers. This solution could be expanded to include two-way audio and video with nursing staff and HD video conferencing between the patient and their families. Or in the case of isolation for potential infection, patients could communicate with their loved ones, employers, benefits providers, or anyone else on the outside.

Virtual patient observation. This solution includes video equipment, network integration with nurse call, and intelligent software that can be configured to be sensitive to patient movement. A monitoring console can be presented at a nurse station computer or accessed mobile from tablets. Several patients can be monitored from one station, or select rooms can be monitored. Coupled with two-way voice communication, this can be a powerful tool.

Alert and alarm management, workflow enhancement. This middleware that can capture relevant patient data from monitoring devices and lab results and then present this data to caregivers on mobile devices. Staying with the theme of patient and caregiver safety and more efficient workflows, this technology can streamline communications. Alarms from biomedical equipment in a patient’s room can be triaged by the configured system, thus preventing alarm fatigue for caregivers and focusing attention on critical alarms. Additionally, these applications can use push notification technology to send out critical lab test results, with related information, to the mobile devices of clinicians Secure text messaging, typically another feature, can streamline communications and record the information and send it to the EMR to complete the care record and maintain compliance.

Care team collaboration applications. Having the ability to share patient related data is key to keeping care teams on the same page. Access to the EMR may not be feasible for all caregivers involved. The ability to share documents, notes, lab results, and images (and imaging) among care team members wherever they may be is powerful. Even caregivers who are suspected of being infected (and in isolation) could still be part of a productive care team with these applications. Cloud applications could be used on demand and are easily scalable to fit emergency scenarios.

Hospitals can take action now to be better prepared to deal with outbreaks. Although many hospitals may not have formal isolation rooms, they may want to designate and prepare certain rooms that could be used in a more formal manner if needed in emergencies. For instance, specific nurse wards, floors, or group of rooms could be outfitted with these technologies. In time of emergency, the emergency protocol would kick in, with technology in place and workforce trained. These technologies can also be used on demand for triage or isolation tents, with portable versions of telemedicine and virtual patient observation solutions.

Paul J. Caracciolo is chief healthcare officer of Nexus – A Dimension Data Company of Valencia, CA.

HIStalk Interviews Joe Torti, CEO, ESD

Joe Torti is founder and CEO of ESD of Toledo, OH. 

Tell me about yourself and the company.

I started in healthcare IT in 1983 when I got out of graduate school. I worked in healthcare IT for a few years and left the industry. In 1990, I was talking to some people that I worked with for a couple of years and they said, "There’s a need for this."

I felt entrepreneurial at that time and I went for it. I was an HBOC project manager on a few jobs working for myself. Then I slowly started hiring people as I talked to people I knew or met more people in the industry. I started building up the practice one consultant at a time.

The company just announced some layoffs and a restructuring, which is something most companies aren’t as forthright about. What challenges led to that decision and what have you learned from it?

We had increased our sales force to get more exposure to the market. As the forecast got closer and closer, we realized that the market for our products and the consulting industry in general was down. A good majority of the clients that we dealt with that were ripping and replacing systems had already done it.

A major portion of our business is still go-live and staff augmentation, which have slowed down significantly throughout the industry. One of our contracts, a very large one, just moved from April to the end of the year. We did not see that in our sales forecast and our salespeople were not seeing a lot of traction in the market for the next three to six months. That’s what drove our right-sizing, if you want to use an industry phrase. 

We have not closed. We’ve sized for the market we see over the next three to six months. We have kept key people in key positions to move forward in the market that we see.

How has the business changed in the past two years?

Two years ago, everybody was trying to get Meaningful Use dollars. They were putting in systems. The staff augmentation on these projects was huge. The activation part of the business was huge.

Since a lot of the organizations have made the decision, they’ve moved ahead a lot of what we thought was going to be first half 2015 work. They dropped ICD-10 work, spent the money on other projects, and now they’re back to spending it on ICD-10 because they’re trying to get that done.

The market will be very strong again over  the next two to three years. Even though a lot of hospitals have made the call on switching or upgrading, a lot of them are still making that decision.

Where do you see the opportunities going forward?

There will be activation work in the next  18 months, but optimization is the opportunity. Clients have said, “We put in a model system or a vanilla system and now we need to make it work for us better.”

We are uniquely qualified in that area because of our clinical focus. Many of our consultants are clinical, with very good knowledge of multiple installations of certain software . They can come back to a client and help them optimize it based on best practices from around the country.

How will you take the company forward?

Our COO, Kelly Myles, is an RN. We’ve always marched to her saying, "Whatever we do affects the patient eventually." That’s been our guiding force. 

We provide good consultants who are focused on doing the best job so that the patients have the best experience with whatever organization they’re in.

Do you have any final thoughts?

Our business has been successful because of the value of the consultants that we have built relationships with. That part of our business remains unchanged. We’ve spent many years developing those relationships and working with the same consultants over the years. We know their expertise very well.  They’ve worked for ESD on many projects. 

We have multiple clients that we’ve been working with since 2005 or even 2003. They still have confidence in us, every one of them.

Moving forward, we will provide the same level of quality to our clients. We will keep those relationships intact. Our changes will allow us to be there for the consultants and for our clients.

Morning Headlines 11/19/14

John Glaser to join Cerner upon acquisition close

Cerner reports that Siemens CEO John Glaser will join Cerner as a senior vice president following the acquisition. Glaser will focus on driving technology and product strategies, interoperability, and government policy development.

Fitch Affirms Duke University Health System (NC) Revs at ‘AA’; Outlook Stable

Duke University Health System retains its AA bond rating despite a $65 million reserve adjustment tied to billing issues following its Epic go-live.

Armed Robbery Of Doctor Puts Brigham and Women’s Patient Info At Risk

Brigham and Women’s Hospital (MA) is notifying 1,000 patients of a potential PHI breach after an armed gunman steals a physicians computer and then ties him to a tree and demands his username and password.

HSE sets up internal audit into awarding of hospital contract

In Ireland, federal auditors are investigating a public hospital group that signed a sole-bidder contract for a clinical IT system after a local reporter discovered that the CEO of hospitals had previously consulted for the private firm that won the business.

News 11/19/14

Top News

HIMSS, IHE, and the EHR/HIE Interoperability Workgroup (created and led by the New York eHealth Collaborative) announce their combined efforts to streamline connectivity between EHRs and HIEs. IWG, formed in 2011 to improve that connectivity, will use ICSA Labs to test and certify products beginning in early 2015. It will continue its focus on standards and certification of query-based exchange and the use of Direct. The organization includes several HIEs and a large number of EHR vendors, including Cerner, Epic, and McKesson. 

Webinars

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

Vince Ciotti and Frank Poggio delivered an HIStalk webinar Tuesday that held my rapt attention all the way through: “Cerner Takeover of Siemens, Are You Ready?” These guys have 90 years of healthcare IT expertise between them, including living through more than a dozen acquisitions as insiders, and both of them are cynical, snarky, and highly knowledgeable. Both also contribute regularly to HIStalk. Thanks to them for doing a great job. We had something like 280 attendees online and I’m sure the YouTube video recording will get a bunch of views — the record is held by Dim-Sum’s DHMSM 101 DoD one, which has been viewed 1,300 times in addition to the views it got directly from HIStalk and during the live session.

Acquisitions, Funding, Business, and Stock

Analytics technology vendor MedeAnalytics acquires OnFocus Healthcare, which sells performance management systems.  

Online wellness coaching vendor Fruit Street Health offers free shares in the company to those who lost their investment in CEO Laurence Girard’s previous failed venture. I wouldn’t bet my money on those shares either since it charges $300 per month for four weekly video calls with a fitness coach and dietitian, at least not before reviewing this site whose entire mission is “to protect investors from Laurence Girard” that claims he has said repeatedly that Prevently was a Ponzi scheme and that he’s not disclosing several other failed ventures.

CVS Health will open a 100-employee technology development center in Boston for “building customer-centric experiences in healthcare” and to connect with health-related startups. The company — which operates drugstores, pharmacy benefits management, specialty pharmacies, and MinuteClinic retail clinics — will also open three drugstores that will be used for live testing of new digital technologies. Its Digital Health group is headquartered in Woonsocket, RI, where it recently opened a Digital Experience Center.

Kaiser Permanente will open retail clinics inside four California Target stores. Insurance competitor Blue Shield of Competitor says it will contract to have its members covered in the KP locations, which will also accept Medicare and Medi-Cal in offering services for minor illness, checkups, and chronic disease monitoring.  

UPMC sells its 51 percent interest in the procurement systems vendor it created — Prodigo Solutions — to a private equity firm, realizing a $9 million gain.

Zipnosis, which offers consumers a $25 televisit using an automated interview and clinician review, receives an undisclosed seed round investment.

North Bridge Growth Equity secures a majority stake in Atlanta-based Ingenious Med.

Sales

Chicago-area FQHC Mile Square Health Center chooses Forward Health Group’s PopulationManager and The Guideline Advantage.

Memorial Healthcare (MI) and King’s Daughters Medical Centers (MS) engage Iatric Systems to perform EHR-neutral integration with Apple Health.

Orlando Health (FL) chooses Ingenious Med’s charge capture system.

Ob Hospitalist Group (SC) chooses PatientKeeper Charge Capture for its physicians that provide services to 75 hospitals.

Arnot Health (NY) selects eClinicalWorks for EHR and health exchange for its 160 providers.

Virtual Radiologic chooses SyTrue’s natural language processing systems to extract information from its radiology reports, with plans to use the company’s Semantic Search to present teleradiologists with exams similar to the one being reviewed to drive clinical performance and efficiency.

St. Elizabeth Healthcare (KY) selects Strata Decision’s StrataJazz for cost accounting, budgeting, capital planning, and financial planning.

Rio Grande Valley HIE and University of Texas Health Science Center choose Wellcentive’s population health management solutions to help manage the care of people with diabetes.

People

CTG promotes Ted Reynolds to SVP with responsibility over CTG Health Solutions.

George Evans (Singing River Health System) joins Sagacious Consultants as principal consultant.

The HCI Group names John McDaniel (NetApp) as VP of innovation and technology solutions.

AMC Health hires Bruce Matter (GE Healthcare) as SVP of sales and client development.

Afik Gal, MD, MBA (PwC Consulting) joins QPID Health as VP of product innovation.

Siemens Health Services CEO John Glaser will join Cerner after its acquisition of SHS is complete. He says, “I’ll join as a senior vice president, focused on driving technology and product strategies, interoperability, and government policy development.” Leaders of acquired companies don’t usually last long, so we’ll see. As Vince and Frank said in Tuesday’s webinar, Siemens customers should get any promises in writing from Cerner, not from Siemens.

Cal INDEX HIE hires Greg LeClaire (Aetna) as CFO; John Lee (Oracle) as CTO;  and Doug Hart (ConvergeHealth) as VP of marketing and corporate communications. Also hired but with no photo available anywhere I could find on the web: Andrea Leeb, RN, Esq. (LA Care Health Plan) as chief privacy officer. I’m amazed at technology people who don’t keep their LinkedIn profile current or who don’t include a photo of reasonable quality. Mistake #1 (second only to not including a photo at all): shrinking down the head shot to horrible quality, missing the point that LinkedIn thumbnails it automatically while still displaying the full-sized original when clicked. Mistake #2: using an informal snapshot that adds distracting features such as the shoulders of other people from the cropped group photo or a Hawaiian lei. Of course this advice comes from someone whose own profile doesn’t have a photo, but I have an excuse: LinkedIn shut mine down until I removed the “Caddyshack” image of Carl Spackler.

Announcements and Implementations

Faith Community Hospital (TX) successfully attests for Meaningful Use Stage 2 shortly after choosing and implementing the RazorInsights EHR and using its Meaningful Use Dashboard.

Memorial Healthcare System (FL) is sending referral information from its ED to Henderson Behavioral Health (FL) to integrate medical and behavioral services. The health system sends HL7 C-CDAs from Epic to Henderson’s Netsmart CareRecord EHR that include completed labs, demographics, medical summary, meds list, and vital signs.

The Greenville, SC paper profiles ChartSpan Medical Technologies, which has developed a new PHR app for iOS.

Government and Politics

A Federal Trade Commission investigation into website privacy certification company TRUSTe results in a $200,000 settlement. TRUSTe didn’t perform some of the the annual website privacy audits it promised. It also failed to require certified sites to display an updated seal indicating TRUSTe’s conversion to a for-profit company in 2008. 

Michigan’s top-earning doctors in CMS’s Open Payments database of drug and device company payments explain their income as follow, a good example of just how complicated the issues are around medical payments:

• A diagnostic radiologist who was paid $688,000 by a medical device manufacturer says he doesn’t use the needle biopsy and software he developed because he no longer does biopsies. He says he supports Open Payments to expose doctors who are paid to use products on their patients.
• A GP who was listed as earning $571,000 from a drug company is actually the medical director of a clinic that was paid for conducting three studies. The doctor does research work only and is paid a salary by the clinic, while the drug company payments were made to the clinic itself and he received nothing.
• A plastic surgeon who earned $341,000 in drug company money for training doctors to use an Allergan breast implant says he doesn’t promote the product and loses money when consulting for up to $5,000 per day since that’s a tenth of what he would make otherwise.
• A University of Michigan Medical School orthopedic surgeon who was paid $201,000 in royalties for a knee replacement device says he follows his employer’s conflict of interest guidelines and doesn’t receive royalties when the device is used by anyone within UM.
• An orthopedic surgeon who made $196,000 from device companies says he holds 55 patents and he tells patients if he’ll get paid for using a particular one.

Innovation and Research

A study finds that use of EMR-triggered, telephone-based prescription refill reminders for heart-related drugs was associated with very slightly improved medication compliance and outcomes.

A small, short-term study finds that smartphone-based weight loss apps (specifically MyFitnessPal) don’t really help users lose weight.

A Penn Medicine study finds that ambulatory clinic doctors prescribed generic drugs as a higher percentage when the EHR was modified to require an extra click to show the brand name item.

The Washington Post profiles the Swasthya Slate, an inexpensive device that connects to Android-powered phones and tablets to perform 33 diagnostic tests. The device has been tested in India, where it excelled at detecting preeclampsia, increasing the rate of needed testing, and reducing administrative time for healthcare workers from 54 percent of their day to 8 percent. They expect the cost of the device to be around $150 at full production and see potential for its use with telemedicine.  

Walgreens will offer inexpensive, minimally painful blood tests from startup Theranos, with the service already launched in the Phoenix area.

Technology

Statistical software vendor SAS co-founder and CEO Jim Goodnight, PhD, a North Carolina programmer turned multi-billionaire,  tells a banking technology magazine that the data warehouse is not obsolete:

Fraud, customer intelligence, compliance — if you have the right set of data all together, you can use that set of data, you don’t have to keep go looking for data every time you need something. That’s one thing Hadoop provides. It’s a great place to store data. Also, you’re buying these 1.2 terabyte disks at about $300 apiece, you can hang 20 of these on a server and it’s local, so you can read the data straight on the machine … We’re seeing a shift away from that kind of hardware [IBM mainframes] to commodity. People are dropping AIX boxes and going to Linux x86 boxes and Intel chips. The chipsets are incredible. Dell has a machine we really like, it’s called an R920 and it has four slots, you could put four chips each with 16 cores, you end up with a server with 64 processors, you can put three terabytes of memory in that machine, and it’s about $100,000.

Other

Brigham and Women’s Hospital (MA) announces that the information of 1,000 patients was exposed in September when a robber held up a doctor at gunpoint, tied him to a tree, and forced him to give up his cell phone and laptop passwords. 

The bonds of Duke University Health System (NC) remain at an ‘AA’ rating despite a $65 million reserve adjustment due to a collections slowdown caused by its Epic implementation and problems with new IT systems at both North Carolina Medicaid and Blue Cross Blue Shield of North Carolina.

In Ireland, the health service is reviewing why a five-hospital group invited only one vendor to respond to a clinical information system RFP. Auditors also want to know whether the former CEO of the hospital group disclosed that he previously worked as a consultant for the company, Northgate Public Services.

The provider folks behind “Just Epic Salary” make their survey results available for free Excel download. Some of the highest average salaries were for permanent hire physicians ($348,000), permanent hire management ($243,000), and contracted application management ($187,000), although even with 753 responses some of the categories had a small sample size.

Sponsor Updates

• CIO Review names secure communications vendor PerfectServe as one of the “20 Most Promising Healthcare Tech Solutions Providers in 2014.”
• Versus Technology announces that Amerinet members will receive discounts on its RTLS products.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/18/14

International Classification of Diseases, 10th Revision (ICD-10) Testing -Acknowledgement Testing with Providers

CMS kicks off its first ICD-10 testing week, during which providers will be able to submit ICD-10 claims, and CMS will respond with an acknowledgement or a rejection.  Additional testing weeks will be held in March and June 2015.

Some New Frustrations as Health Exchange Opens

As the 2014/2015 health insurance enrollment period opens, sporadic but largely non-disruptive technical problems continue to plague both state and federal exchange websites. However, 23,000 people submitted complete applications in the first eight hours after Healthcare.gov opened on Saturday morning.

Strategic partnership between IWG, HIMSS and IHE focuses on EHR-HIE connectivity

HIMSS, the EHR/HIE Interoperability Workgroup, and Integrating the Healthcare Enterprise have formed a strategic partnership that will work to expedite the creation of national data exchange standards, and will develop EHR and HIE certification programs to independently validate vendor interoperability.

Curbside Consult with Dr. Jayne 11/17/14

Color me less than thrilled that the Institute of Medicine is now asking for EHRs to capture additional social and behavioral data as part of Meaningful Use Stage 3. That’s assuming that Meaningful Use is still viable now that the money is nearly gone and more than half of ONC’s senior leadership has left in recent months. Practice administrators have been dazed and confused trying to figure out if they are better off trying to apply for hardship exceptions, take advantage of the flexibility rule, or throw in the towel altogether.

I recently met a practice administrator who swore up and down her providers were attesting for Stage 2, even though they hadn’t yet installed a patient portal and didn’t have a Direct interface. Then again, she also thought that Patient-Centered Medical Home was some kind of design/construction initiative rather than a practice transformation activity, so I shouldn’t have been surprised.

I understand that the Institute of Medicine sees EHRs as a great place to mine data for research, but patients are already weary of having their privacy invaded. Anyone remember the Florida legislation to control whether providers could ask about firearms in the home? My vendor actually had to code in a setting where a practice could hide the firearms questions to avoid running afoul of the law.

Although we’re pushing patients to be more engaged and it’s nice to work with them when they are, at least in my world the majority of patients don’t care about engagement. They just want to be treated and get back to work, their kids, or whatever else was going on in their lives before they got sick. They’re not interested in proactively managing their health when they’re living paycheck to paycheck and think that even questions about alcohol and tobacco use (which are clearly linked to major health outcomes with most people understanding their significance) are over the line.

When we had to start asking about race and ethnicity, we spent on average two to three minutes per patient explaining why we needed that information and helping patients figure out how to answer the question. Many patients thought they were interchangeable, so we were at the front desk educating them on the vagaries of demographic data rather than collecting their co-pay and speeding them back to see the doctor. At least those particular pieces of demographic information don’t change over the life of the patient, so you only have to ask them once.

Now the academic crowd is going to push us to ask about factors that could change at every visit, including depression, education, intimate partner violence, financial resource strain, physical activity, social connections/isolation, and stress. I can tell you without gathering data or an exhaustive chart review that most of my patients would require discussion of the last four.

As a good primary care physician, I should be asking about these things anyway, but I want to ask about them at an appropriate time during an appropriate visit, after I have built a relationship with the patient. I don’t want them turned into screeners that my staff has to administer to every single patient so we can avoid being penalized.

Will providers be judged on the percentage of patients who follow advice to manage these issues, like we’re currently judged on the number of patients we can convince to go for colonoscopies or mammograms? That’s not what I signed up for as a physician. I should do my best to encourage my patients, but didn’t I spend a lot of time in medical ethics learning about patient autonomy and how the paternalistic model of healthcare delivery has to go? We’re just asking for more cherry-picking by providers as they dismiss non-compliant patients from their panels to improve their numbers.

Most patients don’t understand that their data is already being used for research by health plans and other payers without their specific understanding or consent. Sure, it’s probably in the fine print somewhere and it’s either aggregated or de-identified, but if you asked them whether they understand where their data goes or what it’s used for, they would say no. When people think their information might be used in a way they don’t want it to be used (or to be out of their control), they’re going to lie.

Mr. H’s recent poll showed that nearly half of HIStalk readers have withheld medical information from a provider due to privacy concerns. I’m one of them, I admit. Parents are lying on the California home language survey  because they don’t want their children labeled as “English learners” for fear they will miss out on other educational opportunities. The old medical school adage of “take the amount of alcohol the patient says he uses and double it” reminds us this is not a new phenomenon.

How about let’s actually get people to use the EHRs they already have and use them well rather than pushing more minutiae on overburdened end users? A friend of mine has an EHR with a great onboard reporting tool, yet hasn’t leveraged it at all for actual clinical care. They’re so busy trying to get their patient portal enrollment numbers up and micromanaging the rest of their “all or none” Meaningful Use metrics that they’ve lost their ability to do cancer prevention outreach, immunization campaigns, or other interventions that have been actually proven to save money as well as improve people’s lives. And that, dear readers, is a shame.

What do you think should be in Meaningful Use Stage 3? Email me.

Email Dr. Jayne.

Morning Headlines 11/17/14

eHealth Initiative 2020 Roadmap

The eHealth Initiative publishes a HIT roadmap that focuses on improving interoperability and data access, while maintaining a focus on business and clinical adoption motivators.

Health IT Enabled Quality Improvement: A Vision to Achieve Better Health and Health Care

ONC publishes its own 10-year plan for advancing health IT capabilities. The plan focuses on advancing clinical decision support and laying the groundwork for standards-based interoperability.

£200 million eHospital system at Addenbrooke’s Hospital in Cambridge under spotlight after incident in operating theatre

In England, executives at Addenbrooke’s Hospital are denying widespread problems with its recently finished $200 million Epic install, despite concerns voiced by its OR staff and technical issues with its blood transfusion analyzer interface.

Did Jonathan Gruber earn ‘almost $400,000′ from the Obama administration?

The Washington Post analyzes the financial compensation that MIT economist Jonathan Gruber, the “architect of Obamacare,” received for helping the administration draft the ACA. The media has been focusing on Gruber recently after a video of him surfaced in which he claims that the ACA was intentionally written to hide its true cost, in what was a successful effort to exploit “ the lack of economic understanding of the American voter.”

Monday Morning Update 11/17/14

Top News

EHealth Initiative releases its “2020 Roadmap” as a preliminary private sector alternative to the federal government’s Meaningful Use agenda, obviously sensing as others have that ONC’s rapidly decreasing influence will leave a power void in the industry. Some of its points, all of which are aimed at the federal government:

• Reward providers for outcomes (quite a few of the proposed activities involved incentive payments, with no suggestion that the federal handouts be curtailed).
• Focus federal policy on interoperability.
• Simplify quality measurement programs and standardize measures for quality, cost, patient satisfaction, and value.
• Hold the October 2015 ICD-10 date firm.
• Push Meaningful Use Stage 3 back.
• Focus federal policy on the minimum necessary data requirements to manage the health of individuals and populations.
• Encourage HISPs to publish their provider address directories.
• Encourage the use of APIs to support core functions.
• Put more emphasis on Direct-based capabilities, including awareness.
• Encourage the use of REST and FHIR.
• Shift EHR certification to measure what the market wants, including interoperability, safety, and security.
• Consider post-acute and behavioral health providers in interoperability programs.
• Help define the elements of a nationwide interoperability ecosystem, help overcome privacy and security barriers, and use government purchasing and regulatory clout to advance interoperability.
• Align federal interoperability efforts across the DoD, VA, NIH, FDA, and CDC.
• Improve patient and data matching capabilities.
• Study the costs and benefits of letting patients control the use of their own information.
• Create a data breach policy guidebook and a trust framework.

HIStalk Announcements and Requests

Nearly half of the respondents to my poll have withheld information from a provider because of medical records privacy concerns. New poll to your right or here: why did you leave your last job? You can elaborate further after voting by clicking the poll’s comment link. I especially like stories involving management incompetence since I’ve seen plenty of that.

Last Week’s Most Interesting News

• The Institute of Medicine recommends adding 17 new mandatory patient social history data collection items, such as financial resources and social connections, to EHRs via the Meaningful Use program to give researchers more insight into social determinants of health.
• UCSF School of Medicine Professor Bob Wachter, MD adds his voice to those calling for ONC to either be refocused on interoperability or shut down.
• The UK’s Department of Health issues a broad and bold patient-focused health IT plan covering the next several years.
• Reuters reports that the Federal Trade Commission is reviewing how Apple’s HealthKit manages and shares user health information, adding that Apple is considering hiring a health privacy expert.

Webinars

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

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

Recent webinar videos on YouTube:

Keeping it Clean: How Data Profiling Leads to Trusted Data

3 Ways to Improve Care Transitions Using an HIE Encounter Notification Service

Acquisitions, Funding, Business, and Stock

Siemens says it will keep its healthcare unit, ending speculation that it wanted to sell that business as it did its healthcare IT and hearing aid divisions.

Cleveland Clinic creates a company and website to distribute its self-developed software and technology developed by the academic medical centers in its Healthcare Innovation Alliance.

Sales

Mercy chooses Emmi Solutions to provide patient information tools.

People

UnitedHealth Group announces executive changes that include adding to the duties of its Optum division CEO Larry Renfro, who was named vice chairman of UnitedHealth Group in charge of strategic and key client relationships. His responsibilities include OptumInsight, which is the software and consulting part of the business.

Ross Martin, MD, MHA tweeted out this picture from Sunday’s Fun Run at the AMIA annual meeting in Washington, DC.  In the photo are Ross (AMIA), Danny Sands,MD (BIDMC),  Tom Payne, MD (UW Medicine), and Bill Hersh, MD (OHSU).

Also from the AMIA conference: John Glaser of Siemens receives the William W. Stead Award for Thought Leadership in Informatics.

Announcements and Implementations

ONC released its 10-year plan Thursday. While it captured at a high level some of the same ideas expressed in eHealth Initiative’s “Roadmap 2020” report, it was less prescriptive and more self-congratulatory. I didn’t find much interesting in it other than its intention to define common data elements and to create a feedback loop between EHR-collected information and published quality information. The UK’s Department of Health digital strategic plan was a lot more interesting and patient focused than either of these in my mind.

Baystate Health (MA) opens the TechSpring healthcare IT incubator where it will work with vendors such as Premier and Cerner, funded by a $5.5 million grant from the Massachusetts Live Sciences Center.

Vanderbilt University will move Vanderbilt University Medical Center into a financially separate organization that can “act nimbly and more independently in a rapidly changing healthcare environment.”

Healthcare IT companies making the Boston Globe’s “Top Places to Work” list include Kronos, athenahealth, Philips,  NaviNet, Imprivata, and Park Place International.

Wolters Kluwer Health launches the Consumer Education Center, which allows providers to create their own consumer health information website using the company’s medication handouts, drug interaction checker, and drug identification tool.

Government and Politics

A Securities and Exchange Commission investigation finds that CMS employees apparently tipped off investment firms that Medicare was about to increase provider payments 19 months ago, sending insurance company shares soaring two days before the decision was announced publicly. Investigators found that at least 456 CMS employees knew about the increase beforehand and believe that 44 investment funds made trades based on the information insiders provided. An internal CMS email says CMS struck a deal to raise Medicare Advantage payments in order to  get Marilyn Tavenner confirmed as CMS administrator.

Meanwhile, a Washington Post investigation finds that HHS paid MIT economist Jonathan Gruber $400,000 to help design the Affordable Care Act even as the White House cited him as an unbiased expert who supported its plan. HHS paid him another $2 million to review Medicare’s prescription drug program. Gruber is best known for his comments from several recently discovered videos, including, “If you have a law that makes explicit that healthy people pay in and sick people get money, it wouldn’t have passed. Lack of transparency is a huge political advantage and basically call it the stupidity of the American voter or whatever … This bill was written in a tortured way to make sure the CBO did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies.” Gruber help design the Massachusetts reforms that inspired the ACA, of which yet another video captures him saying, “The dirty secret in Massachusetts is the feds pay for our bill … Ted Kennedy … and smart people in Massachusetts had basically figured out a way to sort of rip off the feds for about $400 million a year.” The New York Times says at least CBO was clear on providing guidance on how to write the ACA legislation “in order to not move trillions of dollars of healthcare expenditures onto the federal budget.”

Technology

Reuters reports that early Google Glass developers and users appear to be losing interest in the product, which is still in beta with no announced rollout date. Of 16 Glass app developers, nine abandoned their projects because of poor business or device limitations, while three that were working on consumer apps refocused on businesses. Several key Glass developers have left Google and a funding consortium of high-profile VCs appears to have shut down.

Other

A Wharton School African forum called “Can Technology Enable Healthcare for All?” finds that simple technologies could improve poor conditions, such as giving expectant mothers cell phones and tracking vaccines with barcodes. A speaker said that Kenya Airways quickly deployed technology and protocols to limit the spread of Ebola, with a result of “Ebola is actually more feared in New York than Nairobi.”

The Columbus, MS paper describes the iPad-powered EHR created by local dentist Patrick Singley, DMD (on the left in the photo above) for his medical mission trips to underdeveloped countries. He has formed a non-profit organization and is offering the system to other groups.

In the UK, Cambridge-affiliated Addenbrooke’s Hospital says rumors of widespread problems with its $300 million Epic IT system are false, but admits a patient’s on-screen OR record was missing information and that surgeries have been postponed due to problems with blood transfusion analyzer interfaces.

“Remote Area Medical,” a film covering the non-profit volunteer medical relief corps of the same name, opens in New York on November 28 and nationwide December 5. It focuses on a single three-day clinic held at the Bristol Motor Speedway in Tennessee. Remote Area Medical was founded by former “The Wild Kingdom” host Stan Brock in 1985 to provide free medical clinics. Most of its work is in its home state of Tennessee, which is apparently the only state that allows volunteer doctors licensed in other states to practice.

Boston Magazine runs a feature on the completely solar powered 1966 Volkswagen Bus of Daniel Theobald, co-founder and CTO of patient check-in system vendor Vecna Technologies. He chose that particular vehicle to convert because it’s a “big open box” for experimentation and it was large enough to hold his wife and their seven children. 

Sing along with Weird News Andy: “I am stuck on the MRI ‘cause the MRI’s stuck on me.” Two hospital employees in India are injured when one of them brings a patient’s oxygen tank into an MRI room, pinning both employees to the giant magnet for four hours as staff tried to turn it off.  The hospital blames GE Healthcare for what it says was a malfunctioning switch.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/14/14

Capturing Social and Behavioral Domains and Measures In Electronic Health Records

The Institute of Medicine calls on ONC to mandate the inclusion of far more comprehensive social and behavioral health assessments as part of the MU Stage 3 requirements.

Personalised Health and Care 2020: Using Data and Technology to Transform Outcomes for Patients and Citizens

In England, the Department of Health publishes a “framework for action” that outlines its  ambitious digital transformation plans spanning the next five years.

Saving Patient Ryan — Can Advanced Electronic Medical Records Make Patient Care Safer?

Researchers at Carnegie Mellon University compare pre and post-implementation data sets and measure a 27 percent reduction in patient safety events following the deployment of an advanced electronic medical record.

Former Shelby County Hospital CFO Guilty in EHR Incentive Case

The former CFO of Shelby Regional Medical Center (OK) pleads guilty in federal court to charges that he attested for Meaningful Use and collected $785,000 in incentive payments while the hospital was still almost entirely on paper. He faces up to five years in prison.

Meaningful Use. Born, 2009, Died, 2014?

UCSF School of Medicine Professor Bob Wachter, MD recall the history of the Meaningful Use program from inception to its current state, concluding that the ONC does not have the leadership to right the ship, and that the program should be scaled back and focused solely on interoperability, or altogether scrapped so that vendors can go back to developing features that customers are interested in.

News 11/14/14

Top News

The Institute of Medicine urges ONC and CMS to add additional social and behavioral health measures to EHR certification and Meaningful use criteria to allow researchers and health systems to uncover determinants of health. The unshaded items on the list above, involving 17 patient questions, would be new for most providers.

Reader Comments

 

From Flatus Maximus: “Re: ONC’s data matching project. I can’t believe that ONC thinks that these two (or anyone, for that matter) can solve this problem in two years given the huge legal an policy issues. I don’t think ONC understands that this is a socio-technical problem that requires more than a technology fix.” ONC and HIMSS bring in two people to solve the patient identity matching problem via HHS’s “Innovators in Residence” program that temporarily hires technologists to fix specific problems. Hired were Catherine Costa, RN (marketing director at PatientPoint) and Adam Culbertson (NIH biomedical informatics fellow). Political reality takes the obvious answer off the table: a unique consumer ID with biometric verification.

HIStalk Announcements and Requests

This week on HIStalk Practice: The Massachusetts eHealth Institute offers grants to spur EHR adoption among behavioral health and long-term care providers. New York inches closer to becoming the largest HIE in the nation. SCHIEx and GaHIN launch one of the first state-to-state HIE connections. Billings Clinic implements vein scanners. Envision Medical Group selects new Aprima RCM services. Florida Heart & Vascular’s IT Administrator details the tough time they’ve had with EHRs.

This week on HIStalk Connect: The Nokia Health Sensor XPRIZE competition concludes, with DMI Diagnostics taking the $525,000 grand prize. Samsung opens its SAMI health data SDK service to developers and showcases its new open design Simband prototype. Two Singularity University grads raise $12 million to launch a machine learning-backed population health platform. Ginger.io announces a handful of new research partnerships that will test its behavioral health app within a variety of remote patient monitoring initiatives.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Australian telecommunications company Telstra’s health division acquires 2 percent of New Zealand-based Orion Health prior to Orion’s upcoming IPO that values the company at $725 million.

MMRGlobal, which makes a lot of its money licensing (via nuisance vendor infringement lawsuits) its PHR and other medically related technology, took in nearly $2 million in the most recent quarter, up 1,584 percent over last year. I interviewed CEO Bob Lorsch last year and asked him some pointed questions about the company’s business model – you can decide what you think about it.

Xerox invests in telemedicine kiosk vendor HealthSpot and will provide it with cloud hosting, system integration, and claims processing services.

The Portland, OR business paper highlights the $150 million venture fund of Providence Health & Services, which is looking for healthcare startups in telehealth, wearables, clinical applications, and e-commerce that seek up to $5 million. The fund is finishing due diligence on four unnamed companies. The fund’s partner explains, “The point isn’t just financial. Our chief investment officer could buy bonds. Our goal to make products and services that help our community, our patients, our members and providers.”

IBM invests an unspecified amount from its Watson investment fund in genetic testing company Pathway Genomics, which will develop a Watson-powered mobile app that will answer a consumer’s health questions by analyzing information from their wearables, genetic markers, and electronic health records.

Sales

Baylor Scott & White Health selects McKesson’s Performance Analytics, Analytics Explorer, and Pay-for-Performance for financial analytics.

City of Health and Science University of Turin, Italy chooses InterSystems TrakCare.

Wellmark Blue Cross and Blue Shield (IA) will implement employer reporting from MedeAnalytics.

Presbyterian Medical Services (NM) selects the analytics platform of Lightbeam Health Solutions.

Christus Health signs a five-year extension with Strata Decision Technology.

NantHealth licenses Streamline Health’s Looking Glass analytics to track populations and compare clinical effectiveness.

MaineGeneral Health (the combined words represent their conceptual mistake, not my typographic one) renews its Allscripts Sunrise and TouchWorks agreements and adds FollowMyHealth.

People

 

Nordic Consulting CEO and co-founder Mark Bakken will leave the company to start a venture capital fund in which he and Nordic will invest.

Ed Kopetsky, CIO of Lucile Packard Children’s Hospital Stanford (CA), receives the Distinguished Achievement Award of his alma mater, University of Wisconsin-Madison and its College of Engineering.

Allina Health announces that CEO Ken Paulus will retire at the end of the year, with President and Chief Clinical Officer Penny Wheeler, MD replacing him. She’s done quite a bit of work with their Epic and data warehouse systems.

Announcements and Implementations

Named to Deloitte’s “2014 Technology Fast 500” are DrFirst, Etransmedia, Imprivata, InstaMed, Kareo, Liaison Technologies, Qlik, VMware, and ZeOmega.

Silver Hill Hospital (CT) implements QPID Health’s Cohort App to product HBIPS behavioral health quality metrics and will work with the company to deliver a behavioral health portal.

Billings Clinic (MT) goes live on patient identification via palm vein scanning using technology from PatientSecure that is integrated with its Cerner system.  

The medical school of Mount Sinai (NY) enrolls its first patient in a televideo-powered prostate cancer clinical trial, working with real-time patient management solutions vendor AMC Health.  

The state HIEs of Georgia and South Carolina connect to each other with the help of technology partners Truven Health Analytics and CareEvolution.

Healthgrades launches a new version of its doctor search site that uses claims data to show users the level of experience a doctor has with a given procedure or diagnosis.

Intel-GE Care Innovations announces Health Harmony, a remote patient monitoring platform that aggregates information for clinician review and helps them collect the new $40 per month Medicare payment for chronic care management. The joint venture was started in January 2011. Only one executive remains of its original 10-member management team.

Novant Health (NC) joins the federal eHealth Exchange, adding that so far this year it has shared 148,000 patient records via Epic’s interoperability as well as a total shared record count of 38 million this year.

Government and Politics

UCSF School of Medicine Professor Bob Wachter, MD says the “accidental” Meaningful Use program has achieved its goals of putting stimulus dollars on the street and increasing EHR use, but says that Meaningful Use Stage 2 is an indication that ONC should be put out to pasture once it has handed out its remaining incentive money. He says it’s time to declare victory, move Meaningful Use toward encouraging API-driven interoperability, and let quality and clinical demands rather than government checklists drive the technology market.

CMS releases three free ICD-10 education resources that offer CME and nurse CE credits.

In the UK, the Department of Health’s National Information Board creates a wide-ranging, technology-focused policy draft covering digital health over the next several years. Highlights:

• EHRs are used by 96 percent of doctors, but only 4 percent of them allow patients to see their information. All will be required to offer patient access by April 2015.
• Technology has had minimal impact on the patient experience.
• Interoperability is a big problem, as hospital systems are “impenetrable” and little electronic information exists for nursing home and hospice patients.
• Hospitals and practices don’t integrate their services with mental health and social care.
• Digital services should be the default delivery channel, with services such as appointment booking and prescription refill requests combined into a single information platform (an extension of NHS Choices) that requires citizens to verify their identity through the Government Digital Services IDA program.
• Health-related apps and devices should be nationally accredited and service marked to encourage their adoption
• Specifications will be published by April 1, 2015 for accessing NHS’s core systems, such as Spine and e-referrals.
• NHS England will pilot technology in which patients will hold their electronic records and a personal budget.
• A national pilot will give consumers a PHR that they control that is also available in real time to clinicians, which will also include their end-of-life preferences.
• NHS will seek universal adoption of its healthcare ID number, which was introduced in April 2014 as the primary identifier in clinical correspondence.
• NHS will propose that clinical systems adopt clinical structure standards developed by the Academy of Royal Medical Colleges.
• The entire health system will adopt SNOMED CT clinical terminology by April 2020, while additional work with semantic web technologies will be undertaken.
• NHS England will develop a standard for adopting the GS1 identification standard of patients, products, and places as well as RFID tagging.
• NHS will reduce the number of organizations that collect patient information for purposes other than clinical care, moving by 2020 to process that requires patients to consent to having their data shared.
• The Department of Health has created the role of National Data Guardian for health, which will lead efforts inform patients where their data has been used and the benefits they received as a result. Named to the role is Dame Fiona Caldicott, chair of the Oxford University Hospitals NHS Trust and a psychiatrist whose government-created committee reviewed the protection and use of patient information in 1997.
• Technology made available under the General Practice Systems of Choice will be more selectively targeted to encourage integrated services, SaaS-based systems for new providers of primary care services, and innovative systems for non-hospital services.
• IT investment will shift to investments that support older citizens, those with chronic conditions, and those being cared for informally.
• NHS England will decide with the GPSoC contract ends in April 2018 whether it should continue or whether PCP payments should be increased to let them buy whatever systems they want as long as they meet data standards.

Also in England, the $6 billion fund created to reduce ED visits and readmissions of elderly patients is declared a “shambles” by auditors who say it probably won’t save NHS even one-third of the original $1.5 billion estimate.

A Reuters report says that the Federal Trade Commission has been meeting with Apple for several months to make sure the health information contained in HealthKit and Apple’s upcoming smart watch will be managed appropriately and not shared with third parties as was found to be the case with health and fitness apps from other companies. Sources say Apple is considering hiring a health privacy czar.

Innovation and Research

A study of Pennsylvania’s mandatory hospital patient safety reporting database finds that “advanced EMRs lead to a 27 percent decline in patient safety events.” I was predisposed to not liking the article because its overly cute title asks a question rather than states a conclusion (“Saving Patient Ryan – Can Advanced Medical Records Make Patient Care Safer?”) and its regurgitative academic meandering goes on for 40 painful pages. However, I originally assumed the authors didn’t look at individual hospital performance pre- and post-EHR, but I asked an expert in statistics to wade through the endless graphs and methods to tell me and he says they did, which is admirable. That still leaves a few weak links – underreporting of errors, failing to distinguish between how individual EHRs were implemented, and non-EHR confounders that make proving causation difficult – but overall it seems to be pretty solid as long as you trust the HIMSS Analytics database, which was built for selling data to vendors for marketing rather than research.

Other

India-based hospital chain Narayana Health, best known for performing high-volume and low-cost heart surgeries, opens Health City Cayman Islands in a joint venture with Ascension Health. It expects the 108-bed hospital, its first outside of India, to expand to 2,000 beds as it capitalizes on a location near (but not in) the US for medical tourism. The hospital chain prices its services in flat rate bundles and sends the patient a single, all-inclusive bill. The Cayman Islands hospital has a sophisticated EHR, its clinicians use Google Glass and smart watches to review information and communicate with patients as they round, and (most interesting to me) every patient gets a mobile tablet that is updated with their most current information. The chain is also a big user of telemedicine, where India-based command center doctors monitor patients all over the world. Health Catalyst created the video above that includes a profile of Narayana Health’s founder, philanthropist and cardiac surgeon Devi Shetty, called “the Henry Ford of heart surgery” by the Wall Street Journal. He also designed a comprehensive health insurance plan for poor farmers in India that costs 20 cents per month.

An interesting survey finds that Americans are increasingly worried about their electronic privacy, yet continue using the services they distrust (social media, text messaging, email, and cell phones) because they don’t see an alternative. They’re also willing to give up privacy in return for getting something free, such as providing personal information to use a website.

Texas Health Resources apologizes, creates a memorial fund, and pays an undisclosed settlement to the family of deceased patient Thomas Duncan for discharging him from its ED without making an Ebola diagnosis. Meanwhile, Duncan’s fiancée signs a book deal.

The former CFO of Shelby Regional Medical Center (TX) pleads guilty to falsifying the hospital’s Meaningful Use attestation in November 2012, earning it a $785,655 CMS payment. He faces up to five years in federal prison. The CFO, who rose from the position of maintenance worker, claimed the hospital used EHRs when in fact it remained mostly paper-based and entered minimal EHR information after discharge. He attested using the Social Security number of another employee who refused to put his own name on the form. The for-profit hospital, since closed, was one of six owned by Tariq Mahmood, MD, who was involved in the scheme and was found guilty in July 2014 of healthcare fraud, identity theft, and conspiracy. He threatened to fire coders who declined to falsify diagnosis codes and hand-wrote his own additions to patient records to maximize billing. The six hospitals were paid $18 million in HITECH money despite ongoing allegations of fraud from former administrators going back to 2008. CMS didn’t even know Mahmood owned multiple hospitals.

Spartanburg Regional Healthcare System (SC) celebrated Veterans Day by honoring 240 of its employees, volunteers, and contractors who are veterans. VP/CIO Harold Moore (second from left) was among the executives serving lunch. It looks like barbeque given the squirt bottles of what could be the mustard-based South Carolina style sauce that isn’t my favorite, but the picture wasn’t clear enough for definitive zooming.

Niko Skievaski polls some of his fellow Epic alumni to determine why they left the company, with results that aren’t too surprising since they are similar in most places: lack of work-life balance, technicians with poor people skills who are promoted into management, and lack of company appreciation. Meanwhile, copies of Niko’s “MU2 Illustrated” art book have arrived from the publisher and are ready to ship. His projects are often fun, marginally commercial, and reflective of his youthful optimism, so Lorre contributed some art and I wrote the book’s foreword. We’ll probably have a virtual launch party or something just for fun and maybe invite him to sign books at our microscopic HIMSS booth.

Weird News Andy gestated this story that makes his heart go pitter-patter. Doctors at a Florida hospital perform CPR for three hours trying to resuscitate a woman who had an amniotic fluid embolism (which has a fatality rate of at least 25 percent, up to 90 percent in some studies) during an otherwise successful C-section. The team called the family into the room to say goodbye after 45 minutes of a flat-line ECG, but just as they were pronouncing her, she spontaneously revived. The baby is fine and the mom is not only alive, but miraculously free of brain damage.

Sponsor Updates

• MediQuant’s employees launch a fundraiser to help build a school in Sierra Leone, with a goal of $5,000. A fundraiser will be held tonight (Friday) in Broadview Heights, OH and donations are being accepted. Company President Tony Paparella spent two years as a Peace Corps volunteer in Sierra Leone and will personally match the funds raised. Tony also plays harmonica in the company band The DeCommissioners and their “Legacy System Blues.”
• First Databank informatics pharmacists Joan Kapusnik-Uner, PharmD and George Robinson, RPh will present sessions on pharmacy informatics and drug terminology standards at AMIA’s Annual Symposium November 15-19 in Washington, DC.
• TeraMedica will debut Evercore 6.0, the latest version of its vendor-neutral archive, at RSNA.

EPtalk by Dr. Jayne

I’ve subscribed to multiple CMS mailing lists in an attempt to stay current as an Eligible Provider. It’s to the point, however, that it’s a rare day when I don’t hear from CMS when I open my inbox. This morning’s offering gave me chuckle, however, as CMS is “pleased to announce that the 2012 Electronic Prescribing (eRX) Incentive Program Supplemental Incentive Payments are now available.”

Originally I thought it was a typo, but yes, now that it’s November 2014, you can get your money for 2012. I hope no one switched jobs because payments are going as a lump sum to the taxpayer ID associated with the claims. I’m not sure why it takes 20+ months to figure out the payments, so feel free to clue me in.

I spent a couple of days earlier in the week at Ebola response training. Our hospital asked for physician volunteers and I was assigned to be one of the clinical documentation liaisons. Essentially my job would be to scribe documentation as the care team treats patients. We’ve not been designated as a primary response site, but are training anyway, which is probably a good thing.

It’s a bit of a strange feeling though to have your EHR skills valued above your clinical skills. Experiencing what our scribes deal with on a daily basis was also an eye-opener. I’m putting some thoughts together on how to improve their documentation protocols and workflows.

There are still exhibitor openings available at the mHealth Summit’s Consumer Engagement and Wearables Pavilion. Even better, if you need a sassy spokesdoctor to show off your wearables, I might know where to find a couple. You could also pick our brains on what primary care physicians really think about wearables and how we do or do not want to handle the volumes of data that can be produced as patients quantify themselves.

I’m a big fan of my Garmin, but I’m pretty sure my doc just wants to know that I run at least five days a week as opposed to knowing what route I chose and what my lap split times were. My EHR vendor is starting to integrate personal tracker data and what we’re seeing come in is far more than we would ever want to see.

It’s possible that being at some vendor events last week has given me trade show fever. Although I wasn’t initially looking forward to the upcoming HIMSS conference — the keynote lineup certainly didn’t help — I found myself today dusting off last year’s Social Schedule Pocket Guide so I can keep my eye out for noteworthy happenings and interesting events.

For anyone making his or her first trip to the big show, HIMSS is offering a series of “HIMSS15 Unveiled” webinars for attendees to learn about the event’s education, exhibition, and networking opportunities. Learning objectives for the webinars promise to “identify the latest initiatives designed to enhance the attendee experience.” I’m hoping those initiatives involve mid-afternoon martinis and massage therapists at the end of every exhibitor aisle.

The holidays are approaching and I’m already dreading the dinner table conversations. In addition to the usual topics of Medicare and Social Security, we also have the recent elections as a potential discussion thread. To make things even better, the Supreme Court has agreed to hear King vs.Burwell, which addresses insurance premium subsidies under the Affordable Care Act. Thinking about those combinations almost makes me wistful for my favorite holiday table topic: health conditions of people that aren’t at the table.

Are you starting to plan for HIMSS? Have any suggestions for the holiday table? Email me.

Contacts

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

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Morning Headlines 11/13/14

New VA chief may fire 1,000 staffers over healthcare scandal

Veterans Affairs Secretary Robert McDonald unveils a restructuring plan within the VA that he says will be the largest in the organizations history. As part of the shuffle, McDonald confirmed that 35 staffers will lose their jobs immediately as a result of the recent scheduling scandal, and that nearly 1,000 others are being pursued for “violating our values.”

Health Information Technology: An Untapped Resource to Help Keep Patients Insured

Researchers with Oregon Health and Science University publish a study in the Annals of Family Medicine that concludes that EHRs and health information exchanges are untapped resources that could be used as tools to support clinic-based efforts to help eligible patients maintain insurance coverage.

AMA backs interstate compact to streamline medical licensure

The American Medical Association calls on more states to adopt the recently finalized interstate provider licensure compact drafted by the Federation of State Medical Boards. The compact was written to help reduce barriers to telehealth programs, but only 10 states have adopted it so far.