Morning Headlines 9/26/14

Intermountain Healthcare Partners with Cerner to Provide Clinical Governance for Leidos Partnership for Defense Health

Intermountain Healthcare joins Cerner, Accenture, and Leidos on their joint-bid to win the DoD EHR deal, making Cerner the only vendor with a prominent health system listed as a contributing member.

Premier, Inc., eHealth Initiative survey suggests many ACOs lack mobile applications and face high costs

A survey of 62 ACOs find that 95 percent are experiencing significant problems integrating data across disparate systems, and that 90 percent cite cost and ROI of health IT solutions as a barrier to adoption.

Workgroup for Electronic Data Interchange ICD-10 Survey Results

A survey of 514 providers, vendors, and payers finds that while some progress has been made in preparation for the ICD-10 transition, most organizations have slowed, or completely halted, preparation efforts.

MEDITECH: Form 10-K Annual Report

After an 11-month delay in financial reporting due to revenue recognition issues, MEDITECH files its 2013 year end results: revenue fell three percent to $579 million, while net income rose slightly to $133 million.

DoD EHR Update from Dim-Sum 9/26/14

Between 2000 and 2003, Harvard Business School published a case study on Toyota industrial engineering processes in a hospital. Toyota collaborated with Beth Israel and LEAN Healthcare was born – now that was a great and interesting collaborative. Well defined and the results were quantifiable!

Collaboratives can add value; even ones that may not sound great at first could prove to define and refine standards, improve care, and actually enable better quality controls for care. If you like collaborative approaches, take a look at what has been done between Deloitte and Northern New England Accountable Care Collaborative (NNEACC). The solution is called Insight. After mentioning that new collaborative, I cannot help but remember a strange and poorly constructed one. How can anyone forget the ill-fated relationship between Philips and Epic that ended in 2006?

I can think of one specific collaborative that has promised the world and delivered almost nothing (see NwHIN). However, after a cursory read of the DHMSM Team Leidos article about a collaborative effort linking Cerner’s mega client Intermountain Health on governance structure, I began to think of what other collaboratives I would want to accentuate and/or at least commoditize so that I might differentiate my team to compete for the DHMSM opportunity. IBM will certainly throw in an Epic-esque client that has provided the groundwork for improvements across the Epic stable of solutions. I even think CSC and Allscripts might find their favorite client pet co-development.  I think I like Collaboratives.

One has to wonder, what was the primary edict for the collaborative, and what measurable outcomes have been reported – indicating value? To what extent have the monies invested into the collaborative been shown to improve profitability or improve PQRS results? I am not against collaboratives so much as I have a real desire to understand how some of them were stood up and made financially viable, why some dissolved, and most evolved with grand entrances into the market only to die a death of irrelevance. I think I like Collaboratives.

I for one like the New York eHealth Collaborative and the Massachusetts eHealth Collaborative, and not just because they have the word collaborative in their name. I think they are practical entities that leveraged historical regional extension centers, where money was initially provided by public funds and, through attrition and maturation of models and adoption challenges, the collaboration actually had to collaborate. They had to collaborate to survive. These collaboratives had to figure out smart ways to make their collaborative viable. Their challenge, unlike Intermountain Health (for Cerner) or Kaiser (for Epic), is that they had to work with disparate and competing entities, clinicians that were not incented by what their crosstown rivals did. The collaborative’s cross regions that did not in and of themselves support huge populations, and yet they wanted to know how their colleagues worked in other parts of the state, in rural, suburban, and urban environments.

Sounds remotely like the military HIT that we have grown to appreciate and fear. I like those collaboratives because they have to work together even though they are in a “coopetition” mode. (They were built to compete, to differentiate their medical specialty, and yet they know that cooperation has to occur for a peaceful co-existence and patient-first mentality. Thus the term “coopetition.”)

Honestly, I wish Team Leidos, Accenture, and Cerner would chat up their HealtheIntent population health tool, and what can be done to improve care coordination, quantify targeted chronic-disease management, improve appropriate care measurements, lower readmissions, and provide dynamic quality measures that actually act as a catalyst for patient engagement. Maybe Team Leidos could express its thoughts on how to turn prescriptive, descriptive, and predictive analytics into actionable analytics – impacting care and quality of life? Why not share its philosophical thoughts on data liquidity and how that could be the conduit for improved EHR and research data mining? Take the time to share their approach to research – we know IBM will reference Judith’s Cogito – so compete.

Maybe I am being harsh. I guess I am all too aware of how collaboration in the federal government has not always worked out very well. The best example of a collaboration was between the VA and DoD to share – or rather to transition – the EHR for a service member en route between active duty into veteran’s care. The best analogy: “Imagine spending the day as a cub scout during a camp out, eating gummy bears, enjoying hot dogs roasted over an open flame and masticating pounds of beef jerky on the three-hour canoe trip!” That was the planning for the debacle between DoD health and VA health – now imagine being stuck in the tent all night with those boys – that is pretty much the result of DoD/VA EHR interoperability – a smelly tent!  Not sure if there is a lesson in that story, but after reading it aloud, I smiled.

The good news is that at least DHMSM competing teams are looking to grab practical experience and applying it to the DoD HIT environment. Any collaboration with organizations that embrace HIT standards is a great thing. Any collaboration that shows that the HIT development vendor actually possesses a veracious understanding of governance structure – bully for them. Any collaboration that can accentuate the divine path to full-on proactive adoption, well then … that is Heaven. I like the move, and expect to see a lot more collaborating.

Inasmuch as I like the collaboration with Intermountain Health, I really would like to hear more about lessons learned from Accenture’s effort in Singapore. Cerner should express lessons learned from its NHS efforts. After all, Cerner had to work with Fujitsu (sort of the equivalent of our service integrators in and about the Beltway). Fujitsu is a less-than-stellar example of HIT consulting talent that was appointed by the NHS to implement, integrate, and manage the regional program. Maybe a white paper on nexus process and data touch points that could improve continuity of care with an eye on improving outcomes and lowering readmissions would be helpful and germane.

DHMSM is about transition and data liquidity. The DoD will not get excited with the commercial version of efforts to move from fee-for-service to value-based care. However, the DoD will perk up and pay attention to care coordination – so focus on the client and similar client experience and their deficits, lessons learned, and what new approaches improved adoption and workflow. One should remember that the DoD has stated on several occasions – mostly during Hill meetings – that the DoD does want to be more innovative like Kaiser (code for Epic). Cerner probably sees Intermountain Health as its Kaiser, so why not leverage that as a collaborative? I just hope Cerner can provide the depth of white papers and analysis of pre- versus post-Cerner in Utah and a lesser extent Idaho. That would be good news for the DoD.

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.

News 9/26/14

Top News

Intermountain Healthcare (UT) joins Cerner and Leidos in their bid for the DoD’s new EHR system. Intermountain will provide clinical governance of solutions and workflow to be proposed for the $11 billion Defense Healthcare Management Modernization Initiative (DHMSM). Intermountain is in the process of implementing Cerner’s EHR and revenue cycle solutions across its 22 hospitals and 185 clinics. The move is no doubt yet another feather in the cap of Cerner President Zane Burke, interviewed this week in the local paper: “It’s a really interesting time. We have a lot of work left in front of us, but I love the position we’re in and the clients that we have on the journey with us. It’ll be a lot of fun.”

Dim-Sum, HIStalk’s intrepid DHMSM insider, shares always entertaining and thought-provoking insight into the Intermountain “collaborative.” A snippet:

“After a cursory read of the DHMSM Team Leidos article about a collaborative effort linking Cerner’s mega client Intermountain Health on governance structure, I thought of what other collaboratives I would want to accentuate and/or at least commoditize so that I might differentiate my team to compete for the DHMSM opportunity. IBM will certainly throw in an Epic-esque client that has provided the groundwork for improvements across the Epic stable of solutions. I even think CSC and Allscripts might find their favorite client pet co-development. I think I like collaboratives.”

Reader Comments

From Chris Jaeger, MD: “Re: Sutter Health’s HIE discussions with Orion Health. As Sutter Health’s CMIO and executive sponsor of its HIE efforts, I can state without a doubt that the following post is false:
From Deal Breaker: “Re: Sutter Health. Stops discussion with Orion Health after its HIE project goes on for nine months. …”
Our collaborative relationship with Orion and related HIE efforts have never stopped – to the contrary, we continue to make great progress while also actively planning the next phases of establishing robust data exchange with those that share in the care of our patients.”

HIStalk Announcements and Requests

This week on HIStalk Practice: Athenahealth looks for the next great startup. TekLinks partners with Greenway. Doximity goes live in Utah. Physician practices in Texas take home quality improvement award for use of HIT. Physicians feel slighted by CMS thanks to attestation "glitch." Healthcare.gov costs more than originally thought. Physician executives have options when it comes to standing desks. Thanks for reading.

This week on HIStalk Connect: Dr. Travis analyzes the non-traditional roles that cloud-based computing has found in healthcare thus far, and speculates on its future. Researchers in Paris are working with 3-D video cameras to create virtual reality-based surgical training aids. Virtual visit provider Teladoc raises a $50 million Series C.

Acquisitions, Funding, Business, and Stock

Allscripts and Citra Health Solutions (formerly Orange/MZI) announce a partnership to make their services available to each other’s customers. Citra, which provides consulting services and technologies for providers and payers, unveiled its new name and branding at the Allscripts user group meeting last month.

ZirMed acquires predictive analytics vendor MethodCare and announces plans for a Chicago-based Healthcare Analytics Center of Excellence led by MethodCare staff. Moving forward, MethodCare will operate under the ZirMed name.

Conifer Health Solutions agrees to acquire physician practice business solutions vendor SPi Healthcare for $235 million. SPi CEO John O’Donnell will join Conifer’s senior management team, reporting to President and CEO Stephen Mooney. The transaction is expected to close in Q4 2014.

Sales

North Philadelphia Health System (PA) selects Medhost’s inpatient EHR for implementation at St. Joseph’s Hospital and Girard Medical Center.

Beaufort Memorial Hospital (SC) selects the Access Passport online forms solution to take its paper-based accounts payable, human resources, and administrative documentation processes digital.

Announcements and Implementations

Community Hospital (NE) goes live on a patient portal from Relay Health.

Children’s Healthcare of Atlanta joins the Georgia Health Information Network. CHOA has integrated GaHIN’s Georgia ConnectedCare product into its Care Everywhere HIE application, which it launched earlier this year to facilitate data sharing with other providers using Epic.

Kennedy Health System (NJ) adopts the MedAptus Professional Charge Capture Solution for hospitalists at its three acute-care facilities.

Sightseeing.com announces the availability of the MyMedicalRecords PHR to its customers. The PHR will offer travelers access to their medical records and such documents as passports, birth certificates, immunization records, and insurance policies.

Practice Fusion announces that its customers will soon be able to order, manage, and receive lab test results within its EHR through Quest Diagnostics. Physicians will also have the option to share test results with patients through the Patient Fusion portal.

Research and Innovation

A survey of 62 ACOs reveals that poor interoperability between organizations remains a big barrier to improving clinical quality. Additional findings include:

• 100 percent of respondents find access to data from external organizations challenging.
• 95 percent find interoperability of disparate systems to be a significant challenge.
• 90 percent feel the cost and ROI of HIT has become a key barrier to further HIT implementation.
• 88 percent face significant obstacles in integrating data from disparate sources.
• 83 percent report challenges integrating technology analytics into workflow.

WEDI releases the results of its ICD-10 Industry Readiness Survey, which finds that vendors, payers, and providers have made some progress in preparing for the October 1, 2015, transition, but not nearly as much as likely needed for a glitch-free switch.

People

Jim Dowling (QuadraMed) joins Qpid Health as vice president of sales.

Michael McDermott, MD (Radiologic Associates of Fredericksburg) takes on the role of CEO at Mary Washington Healthcare (VA) beginning January 1, 2015.

Bob Taylor, DO (Greenway) joins Clinical Architecture as CMIO.

Ryan Witt (Juniper Networks) joins ClearDATA Networks as vice president of growth and innovation.

Steven Steinhubl, MD (Scripps Translational Science Institute) joins Vantage Health as chairman of the board.

Technology

This article covers the debut of Spruce, an app that lets users privately share photos and medical information with dermatologists, and then receive in-app treatment. Baseline, Cowboy Ventures, and Kleiner Perkins Caufield & Byers contributed $2 million to the launch in initial seed round financing.

Other

Samsung, the Children’s Fund, and Columbia University announce at the 2014 Clinton Global Initiative Annual Meeting a two-year partnership to develop the Samsung Innovation Center at the Children’s Health Fund. The center will focus on advancing access to and quality of healthcare for medically underserved children through telehealth and other strategies.

Sponsor Updates

• Intellect Resources describes Ochsner Health System’s (LA) challenges and results of its Epic implementation.
• Connance will share how the University of Rochester Medical Center increased its charity care dollars while reducing bad debt during the HFMA Region 2 Fall Annual Institute October 22-24 in New York.
• ReadyDock discusses the vulnerability of mobile devices to virtual and pathogenic attacks in a recent blog post.
• Aprima and First Databank offer electronic prior authorization through Surescripts connection.
• Etransmedia shares how a pediatric cardiology practice was able to reallocate resources after working with Etransmedia’s RCM team to automate its front office.
• Billian’s HealthDATA shares 10 recent healthcare CIO placements.
• CareSync rolls out V2.5, which combines wearables data with medical records using integrations through Validic partnership.
• Craneware will host its first Revenue Integrity Summit October 14-16 in Las Vegas.
• Greenway becomes the first ambulatory information provider to have a solution recognized as a Validated System by Healtheway’s eHealth Exchange Product Testing Program.

EPtalk by Dr. Jayne

Our hospital recently hosted a healthcare career day for middle school students. We’re in an economically depressed part of town with some serious socioeconomic issues, yet fully realize we’re going to need dedicated and well-educated healthcare workers to deal with the challenges we’ll continue to face. The goal of the day was to expose them to various opportunities either directly in or supporting healthcare. They were able to visit various areas of the hospital, including sterile processing, the laundry, patient care floors, engineering, and an operating room.

Some students were grossed-out by the idea of direct patient care, but were interested in engineering or IT, which is a good thing. It takes an army of people to keep an institution of our size going and often those jobs are independent of patient census or case mix, which is a good thing for job security. The highlight of the day for many was being able to see one of the air ambulances land and speak with the flight crew.

As a member of hospital administration, my role was to shepherd a group of students through various stations set up throughout the hospital, where they could talk directly to staff and learn about their jobs and how they contribute to the healthcare team. As is predictable with students in that age group, frequent questions included: “What’s the grossest thing you’ve ever seen? What’s the worst injury you’ve ever seen?” My favorite question was, “Is the stuff that happens on Grey’s Anatomy really true?” which made me wonder why a parent was letting a 10-year-old watch a show about sex-crazed doctors.

At one point, the air ambulance pilot received a question about emergency situations. He told the student his question was in the top 10 list of things he didn’t want to experience, to which the student responded “What’s number one?” I had to give him full credit for that one. I kind of tuned out after that because I was thinking about what I’d put on my own top 10 list of things of things I never want to happen.

I’ve experienced some things in my IT and practice careers that would definitely make that list:

• Someone accidentally activated the fire suppression system at our corporate data center. Because we were using Halon, the building had to be vented by the local fire department with their positive-pressure ventilation equipment. This took about eight hours for a building the size of our data center. Unfortunately, our “hot backup” failed due to a defective network switch, requiring all practices to go to paper.
• A local road crew cut the T1 line to my office. Luckily, we equipped key staff with wireless cards and network hot spots, so it wasn’t that big of a deal.
• With my first EHR, the clinical documentation workflow went through a “locking” process as the provider finalized the note. This was after the provider reviewed the documentation on screen. Unfortunately, during the locking process some kind of character limit went into effect, causing the documents to truncate. When patients returned for their follow-up visits, their plans (at the bottom of the documents) were missing critical elements. Nothing makes your blood run cold like reading “Counseled patient on…” and having that be all that remains of your highly detailed patient plan.
• Vendor sunsets a product that actually supports your workflow and that your staff likes, transitioning you to a product that is not yet ready for prime time. This has now happened to me twice.

None of these are quite as scary as having rotor failure on your helicopter or having the landing pad collapse underneath you, but in our world they’re pretty unnerving. What’s on your top 10 list of things you never want to happen? 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.

HIStalk Interviews Matt Scantland, Co-Founder, CoverMyMeds

Matt Scantland is principal and co-founder of CoverMyMeds of Columbus, OH.

Tell me about yourself and the company.

My partner Sam Rajan, who’s a pharmacist, and I started CoverMyMeds to address prescription abandonment. We learned about the problem when we built a prior authorization system for a health plan. 

The idea for CoverMyMeds came to us when we looked at the fact that from the perspective of a doctor, it really doesn’t matter how good the prior authorization process is for any one health plan. It’s just one of dozens that the doctor needs to navigate. The idea of CoverMyMeds was, let’s create one-stop shopping so that the doctor can use one process to submit a prior authorization for any drug to any health plan.

Your Inc. 5000 numbers are pretty impressive with $19 million in 2013 revenue and 73 employees. Did you plan for that or did you just happen to hit on a niche that took off?

We’ve been thrilled with how things have gone. We’re growing over 100 percent a year since we started. We’ll do about $50 million in sales this year and have about 130 employees.

I wouldn’t say it’s any genius on our part. The prior authorization process is just incredibly painful for everyone that’s involved. The doctors and also the health plans have been looking to improve this process for decades. Working for them, we were the first to be able to create an electronic process that scales.

It seems you would have competition from someone like Surescripts if business is that strong. Do you have competition?

Surescripts launched a product at the beginning of the year that’s a little bit different than ours. Whereas our process works for any payer, whether the payer participates electronically or not, Surescripts is launching something that works just with payers that connect to Surescripts.

So far, because the PA process has not been something that’s electronic in the past, the value proposition of our service has tended to be much stronger for the participants, where with one integration in the electronic health record or in the pharmacy dispensing system, the PA can be submitted to any payer. We also lead the industry in connecting electronically to the payers, but the process works across the board.

It’s a fascinating business model that drug companies to pay for the service, which they fund from the revenue of what otherwise would have been unfilled prescriptions. Nobody who uses the service pays for it. How do you get the word out to doctors and pharmacies that it’s available and it’s free?

Being free helps. [laughs] You’re right, the drug companies and now the health plans pay for our service. This is a business that has what we call network effects, which means that the more people that use it, the better it gets for everyone.

We have a huge pharmacy network. Almost every pharmacy in the country, including the big chains, uses our service. When they initiate a PA, if the doctor’s office isn’t already a user, we invite them to become a user. Over time, we’ve built that physician network to more than 100,000 distinct providers. It creates that viral process that allows us to grow quickly as a network business.

You’ve connected electronically to EHRs and pharmacy systems. Is that work finished?

That’s really the future of our company, but it’s pretty new. We started in the pharmacy, which is where the PA process begins today. All over the country, the first time anyone tends to think about the prior authorization is after a claim rejection in the pharmacy. 

Today, we’re integrated into almost every pharmacy in the country, right inside the pharmacy management system. We’re looking to do the same thing in the electronic health records, although that’s a new area for us.

We announced a partnership with DrFirst, where we’ll make the PA process available at the point of prescribing. We’ll also connect those pharmacies into the DrFirst system so that PAs initiated in the pharmacy can be sent to DrFirst’s doctors electronically. We’re also working with most of the other electronic health records, so I’m trying to do that same type of an arrangement. We’ve come up with a financial model where we can actually pay the EHRs to do that work. One integration is something that works across the board for every payer.

You offer APIs and also widgets for web pages of both health plans and manufacturers, which is pretty smart to get people to have access to your service through the other sites of the companies that you work with. How much technology is involved in what you do?

CoverMyMeds is really a software company. We don’t do any actual PAs ourselves. Instead, we provide the tools that let providers automate their process in a self-service way.

We provide the APIs. That’s been the main driver of our growth for both the pharmacy management systems to do the integration and then also for the electronic health records. All of those systems can integrate using NCPDP standards or a REST API that can reduce the work effort needed to actually do that integration.

It will surprise people that there’s a company in a very specific, almost obscure niche that has grown so large and is still growing. Do you think you’re under the radar?

Yes. We absolutely are under the radar. But when you look at prior authorization, this is a problem that happens 200 million times a year. This is daily life in a pharmacy or a doctor’s office — 200 million patients that get their claim rejected and potentially will go untreated if this prior authorization process isn’t handled.

While it’s under the radar, it’s really contributing to that $350 billion or so problem of medication non-adherence. In a lot of ways, automating the PA process is the missing value proposition in e-prescribing. It doesn’t make a lot of sense to have an electronic prescribing process if the doctor is just going to then go deal with a fax or a phone call with the health plan. This has become something that’s much more top of mind as life goes on here.

A lot of software startups are trying to find a pain point they can resolve without competing with big companies like EHR vendors. What advice would you have for them?

Listen to customers and solve a big problem. Ideally, do that in a way that doesn’t involve taking a dollar from someone else.

What has really worked well for CoverMyMeds is that this is a way to remove administrative waste from a process without cutting reimbursement to a doctor, pharma company, or health plan. Because it’s truly a win-win for all participants in the market, we have alignment and the help of large companies to make this thing get big.

Your website says you have a chef that creates lunch for employees every day, which is a kind of a Silicon Valley move, but you’re in Ohio. What’s it like working there?

[laughs] We think we’re one of the best places for technology and business people to work in Ohio. We consistently are winning these best workplace awards.

As a software company, we’re nothing without the people. We look at both how do we give a lot more value than our customers expect, and then also how do we give our employees a lot more than they expect? That as a result of that has let us get some great people and then they stick around with us.

As companies grow, there’s always that decision about what comes next – do you acquire somebody, do you get acquired, do you roll out other offerings. Where do you see the company going from here?

Prior authorization seems like a very niche thing. It kind of is, but at the same time, it’s also right at the intersection where a doctor is making a decision about the tradeoffs between the cost of a treatment and its efficacy. We think that that’s a fundamental problem in healthcare.

We have built both the network and the connectivity and then also the relationships with pharma, payers, pharmacies, and providers. We think we can help doctors make more intelligent consumption decisions. We think is a very large opportunity, starting with drug, but helping to get to more personalized medicine in terms of prescribing, and then also other procedures as well.

Because of the growth of the size now, we have a lot of interest from the financial and strategic partners. We’re always willing to listen. We think this is a very big standalone company on its own.

What else could be done with the network you’ve created? You have an athenahealth-type model.

That’s right. We look at athena as a great big brother of the direction that we’re looking to go.

There are very obvious applications. First of all, we’re fundamentally solving the first step in patient adherence, which is get the patient on their drug. The next challenge then is keeping them on the drug. That’s an adherence angle that many of our customers are asking for help with. That’s something that that both pharma and health plans are interested in. We think there are interesting collaboration opportunities there.

The other thing that we’re very focused on right now is helping the electronic health records make this PA process something that happens at the point of prescribing. Right now, if you think about e-prescribing, what you basically have is a shopping cart. The doctor orders a drug and the patient may or may not end up being able to actually get that drug. We think that putting this PA process at the point of prescribing allows it to move from what’s an exception process to something that’s much more decision-supporting for the physician. We’re very focused on helping the doctors and the EHRs achieve that.

Do you have any final thoughts?

I’d really like to thank the HIStalk community and you guys. You’re a huge part of my daily reading list. I don’t think there’s a more credible and important intelligent source as HIStalk in the whole industry. I’d just like to hear from people about what they think.

We’ve been thrilled with how things have gone. In a lot of ways, this business looks a lot more like a consumer Internet company than a traditional enterprise software company because of that network effect. We’re solving something that for a frontline healthcare person is a huge struggle. That’s been one of the most fun things, really, something that truly can impact hundreds of thousands of providers that make their life better. We just celebrated that 10 million patients have now gotten the drugs they needed that they wouldn’t have otherwise. At the end of the day, that’s what keeps us coming in in the morning.

Readers Write: The Consultant and the Investor Look at Cerner’s Acquisition of Siemens

The Consultant and the Investor Look at Cerner’s Acquisition of Siemens
By Lynn Vogel, PhD

The publication of the recent HIStalk interview with Marc Grossman and a post by Ben Rooks offer a rare opportunity to learn about the different perspectives of consultants and investors using the Cerner acquisition of Siemens as a case study.

Full disclosure: I’ve known Marc (the Consultant) for close to 20 years and I consider him to be one of the top HIT consultants in the business today. I don’t know Ben (the Investor) personally, but was so impressed with his discussion of the MModal acquisition several months ago that I started an email exchange and have deep respect for his understanding of the financial aspects of HIT.

But the perspectives of the Consultant and the Investor couldn’t be more different. Here are some noteworthy excerpts from the Marc Grossman interview and from Ben Rooks’ recent “From the Investors Chair.”

From the Consultant

• A lot of it’s going to depend on where the Siemens client is.
• I believe Cerner is buying Siemens for intellectual property. On the patient accounting side, I think they’re also looking at the RCO base that Siemens has, which is a great revenue stream for them.
• Given Cerner’s history and the industry’s history over the last 20-30 years, Siemens Soarian and Invision product support is going to go downhill.
• I think they probably won’t sunset it officially for at least 10 years, just because I know Siemens does have numerous contracts which are going out 10 years.
• Like we’ve seen with many other vendors that purchased other systems, Cerner is clearly not going to put R&D money into two patient accounting systems and two clinical systems if they have an integrated system now.
• I just don’t see any indication that Cerner is going to continue the development of any of the Soarian or Invision products.

From the Investor

• Cerner is now the clear sector leader and will enjoy mammoth cross-selling opportunities given the product fit.
• This was a good use of both the cash hoard Cerner had built up on its balance sheet and its high-multiple stock, allowing the deal to be almost instantly accretive – especially with the $175 million in pre-tax synergies the company guided to in its press release.
• Cerner’s shares are up almost 10 percent as I’m writing this post, more than twice the S&P — Ms. Market seems to be more excited.
• The vast majority of analyst commentary has been positive and we here at the Chair are fans of the purchase as well.
• The only thing that gives me pause as a long time Cerner watcher (and fan) is that the company has zero history of large-scale M&A and the sector has not been kind to such large-scale bets in the past.
• What’s especially noteworthy here though is that the cultures of the two companies are literally more than an ocean apart
• That said, the price Cerner paid clearly de-risks the acquisition, and Cerner is known for its strong culture

The Consultant starts with the impact on the client. How the customer base responds will depend on where they are currently with their HIT implementations. Will customer support for Invision and Soarian go downhill now? Will any level of customer support for Siemens’ products last beyond 10 years? Will there be any R&D for Siemens products going forward? Finally, the question about whether Cerner will “continue the development of any of the Soarian or Invision products?”

The Investor is looking at the Siemens acquisition from an almost purely financial perspective. Is this a good use of Cerner’s cash? What’s the impact on the stock price? What’s Cerner’s experience with large-scale acquisitions? How will the cultural challenges be addressed? In general, this looks like a “good deal.”

In some ways, the comparison of these two perspectives underscores one of the major challenges of HIT today. The investors are looking at the money, while the customers are looking for continued product development and ongoing support.

Unfortunately, the boards of most HIT companies are dominated by investors, with little input by those who understand either healthcare or information technology (Ben’s earlier analysis of the MModal situation is an excellent example). What’s missing, specifically?

1. Looking under the covers. From an IT perspective, the Cerner acquisition of Siemens demonstrates again that acquisitions too often proceed without understand any of the underlying IT challenges. The code bases are different, the database architectures are different, the standards for code libraries are different, etc., etc. Recall the Allscripts acquisition of Eclipsys. A big selling point about this deal was that they were both based on Microsoft tools are architectures. We now know how that turned out. Siemens’ financial products are generally considered to be stronger than Cerner’s, but integrating disparate product suites is a challenge that has eluded almost every previous merger of HIT companies.
2. Understanding how IT decisions are made by healthcare customers. Boards often have little understanding of the healthcare business and even less about how IT decisions are made in healthcare. It can be a long, slow, and often tortuous process (accelerated certainly by recent federal incentives) with lots of customer concern about long term support (note Marc’s observation that even lab systems typically last a decade or more). As a result, assumptions about how quickly financial returns can be generated are often way off the mark and the result is the demise of the acquired company.
3. Leverage and financial returns dominate. Cerner is probably looking at the Siemens’ customer base almost as a captive audience, there for the picking and over time replacing their Siemens products with Cerner’s. We can only assume that Siemens reached the same conclusion about the SMS customer base at the time of that acquisition, and we know how that turned out. On the other hand, simply eliminating a competitor over time is a strategy that many companies both inside and outside healthcare have found to be successful. But taking Siemens out of the marketplace may also leave Epic is a much stronger position.

There are lots of discussions about whether the healthcare industry is really all that different from other industries. Even Drucker noted its extraordinary complexity. But when companies make decisions without a deep understanding—at the executive and board levels—about the technology, about what does make the healthcare industry unique, and worry more about the money than the customers (often not realizing that it in the end it is the customers who provide the revenue), we have a better understanding of why the HIT business is so challenging and probably filled more with company failures than successes.

I would argue that one of the solutions here is more Board level input from experienced HIT professionals. Across the industry, we see company boards with investors and occasionally clinicians, but virtually no HIT professional role.

Full disclosure: I was elected to the board of Glytec, an HIStalk sponsor, due to my specific HIT experience from inside the industry. During the course of my term, I have learned an enormous amount from the investors and the clinicians on the board and from the feedback I have received, it seems that my contributions as an experienced HIT professional have been valued as well.

There is an enormous amount of HIT expertise available that companies could use, but seldom do. This includes former (occasionally retired) CIOs, CIOs who are able to serve on boards while continuing full-time IT responsibilities, and consultants, particularly those who have experienced HIT from inside healthcare organizations, etc. Smart HIT companies would do well to take advantage of this talent to contribute to the success of their business.

Lynn Vogel, PhD is a principal with LH Vogel Consulting, serves on the board of Glytec, is a member of Next Wave Health Advisors, and serves as a senior advisor to Sophic Alliance.

Morning Headlines 9/25/14

New report projects a $5.7 billion drop in hospitals’ uncompensated care costs because of the Affordable Care Act

HHS claims in a report that hospitals will see a $5.7 billion drop in uncompensated care in 2014 due to the ACA, “based on an estimated 10.3 million decrease in the total number of uninsured and an estimated 8 million increase in the number covered by Medicaid.”

DMH may be on the hook to repay $900K: Government audit uncovers failures of compliance for year 2011-12

Drew Memorial Hospital of Monticello, AK will likely have to pay $900,000 of its Stage 1 MU incentive money back to the government after failing to pass an MU attestation audit.

Hospitals Cut Costs by Getting Doctors to Stick to Guidelines

Researchers from Christiana Care Health System (DE) found that they were able to cut costs associated with non-recommended use of cardiac monitors by 70 percent after embedding American Heart Association protocol reminders in their EHR.

A Health Care Success Story

Farzad Mostashari, MD and his investment partner Bob Kocher, MD co-author an op-ed in the New York Times highlighting the cost savings and improved outcomes seen in the small community of McAllen, TX, once famously pinpointed as the most expensive place in the US to receive healthcare, since its physician practices formed an ACO.

Morning Headlines 9/24/14

HCA to Purchase PatientKeeper

164-hospital health system HCA acquires PatientKeeper, which it will roll out as an overlay for physicians using its legacy Meditech system.

ACO bill expands telemedicine use

Diane Black (R-TN) and Peter Welch (D-VT) introduce bipartisan bill H.R. 5558, the ACO Improvement Act, which would enable ACOs to expand remote patient monitoring platforms, and allow them to use “share-and-forward” technologies that improve medical image sharing.

Philips Plans Breakup to Focus on Health, Consumer Goods

Royal Philips will split itself into two companies, one focused on lighting, which generates $9 billion in sales annually, and the other on consumer goods and healthcare, which generates $19 billion.

News 9/24/14

Top News

Hospital operator HCA announces that it will acquire privately held physician systems vendor PatientKeeper. Terms were not disclosed. I spoke to PatientKeeper President and CEO Paul Brient ahead of the announcement. “HCA is a longstanding customer of our view-only portal, our clinical review tool,” he said. “Now HCA will deploy all of our software – CPOE, clinical documentation, and medication reconciliation – over top of their Meditech systems. They will invest to make it even more useful to their doctors.” Brient will serve as CEO of PatientKeeper, which will be operated as a wholly-owned subsidiary of HCA. Its 160 employees will continue to work from company headquarters in Waltham, MA, supporting the company’s 58,000 physician users. The acquisition is expected to close by the end of the year.

Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Acquisitions, Funding, Business, and Stock

Royal Philips NV announces plans to split into two companies – one devoted to lighting, the other to healthcare and consumer goods that will operate under the HealthTech name. The announcement follows in the footsteps of similar moves made by rival Siemens last year.

Sales

Community Health Center of Southeast Kansas and Health Partnership Clinic (KS) select eClinicalWorks EHR and RCM for their 12 combined clinics.

Catholic Health Services of Long Island (NY) chooses Connance predictive analytics and vendor management technology.

Sheltering Arms Rehabilitation Center (VA) deploys Strata Decision’s StrataJazz as its financial platform.

Announcements and Implementations

North Country Hospital becomes the first in Vermont to go live on the state HIE. Larger hospitals like Fletcher Allen Health Care will be online by the end of the year.

Waterbury Hospital (CT) integrates TigerText secure messaging into its Cerner EHR. The hospital has also been in the news due to rumors of a possible takeover by Tenet Healthcare Corp.

Surescripts announces the addition of four pharmacies and three EHR vendors to its Immunization Registry Reporting service.

The Bronx RHIO selects Direct secure messaging services from DataMotion for its affiliated healthcare organizations. The Visiting Nurse Service of New York and SBH Health System (NY) are among the first to use the service.

Zynx Health launches the ZynxCarebook mobile platform to help streamline coordinated care efforts between inpatient and after-care providers.

Government and Politics

White hat hackers from the HHS inspector general’s office report that their attempts to break into Healthcare.gov earlier this year alerted them to a “critical vulnerability.” Their attempts to exploit it were thwarted due to defenses already in place.

Representatives Diane Black (R-TN) and Peter Welch (D-VT) introduce the ACO Improvement Act. If passed, the act would permit ACOs to use remote-patient monitoring and store-and-forward technologies for delivery of images to providers far away.

Alaska’s Department of Health and Social Services files a lawsuit against Xerox for "failing to timely and adequately implement the [Medicaid payments] system and failing to timely and accurately pay Alaska providers." The state is seeking $46.7 million in damages, and has already shelled out $154 million in advance payments to providers to help see them through the Xerox delay.

Research and Innovation

Ali Parsa, MD creator of the UK-based Babylon subscription health service, announces that he is prepared to take the Babylon app to the Middle East and Africa to reach populations with little reliable access to healthcare, but high adoption of smartphones. "We are now looking at parties who have a large customer base, such as supermarkets, big public institutions, mobile phone companies, and newspapers,” he says. "If people can go into Tesco and by an iTunes card, why can’t they buy a Babylon access card?"

People

Mark Hyman, MD (The UltraWellness Center) joins the Cleveland Clinic as director of its new Center for Functional Medicine. Patrick Hanaway, MD (Institute for Functional Medicine) will serve as the center’s medical director.

Jeff Pate (W Squared) joins Aegis Health Group as executive vice president of business development.

White House CIO Steve VanRoekel resigns to join the USAID, where he will work as a senior adviser in the fight to halt the Ebola outbreak.

Doximity hires Emily Peters (Uncommon Bold) as VP of marketing communications and Peter Alperin, MD (Kelvin) as VP/GM of connectivity solutions.  

Bruce Brandes (Valence Health) is named managing director of Martin Ventures. 

ONC Chief Science Officer Doug Fridsma, MD, PhD resigns to become president and CEO of AMIA.

Announcements and Implementations

Billings Clinic (MT) is implementing just-released Caradigm Quality Improvement to identify gaps in care and make improvements in clinical workflow at point of care.

Other

Construction company DIRTT makes news for using open-source software from the classic video game Doom to design hospital wings and office spaces. CEO Scott Jenkins says the system will help hospitals that want to reconfigure a room’s wall panel quickly for patients with different needs, or to accommodate new technology.

Apple CEO Tim Cook announces that the company’s new “spaceship” headquarters in Cupertino, CA, will be the “greenest building on the planet.” Scheduled to open by the end of 2016, the new HQ will be powered exclusively by wind and solar energy.

CompuGroup Medical locks Full Circle Health Care (ME) out of its EHR system in a billing dispute. The financially struggling practice admits that it stopped paying its maintenance fees 10 months ago after CompuGroup bought its original vendor HealthPort and increased monthly fees from $300 to $2,000. The practice has moved to a new EHR and wants access to its old system for 48 hours to copy patient records that will otherwise be unavailable, putting patients in danger, but says CompuGroup installed a “phone home” kill switch without its knowledge that won’t let the practice log on even in read-only mode. CompuGroup makes the analogy that people who don’t pay their electric bill have their power shut off eventually. Meanwhile, the patients get to enjoy being used as human shields as the vendor and customer bicker. Someone should have read their contract more closely before signing it, I suspect.

Weird News Andy summarizes this story as “Three’s a Crowd.” A Florida woman pays $20,000 to have a third breast added, saying she wants to make herself unattractive to men so she wouldn’t have to date any more (as WNA says, hasn’t she heard of just turning men down?) The real reason is likely her stated dream of starring in an MTV reality show, with possible titles being rich in punning opportunities. WNA notes that the story has been declared a hoax (not surprising given the obviously ‘shopped picture), but that shouldn’t stand in the way of its entertainment value.

Sponsor Updates

• Arcadia Healthcare Solutions will demonstrate a new version of its Arcadia Analytics solution at Health 2.0 this week. It uses Informatica technology to integrate information from 20 EHR and claims systems to report on reporting for performance management, cost and utilization analysis, and patient outreach and care planning.
• Amerinet signs a new agreement to offer VitalWare revenue cycle technology to its members at negotiated pricing.
• Alan Rosenstein, MD, an expert in disruptive physician behavior, posts a PerfectServe article titled “Emotional Intelligence – Understanding Patient, Staff, and Physician Needs.”
• DocuSign publishes a blog post titled “BAAs and Beyond: Meeting the September 22 HIPAA Deadline.
• Shareable Ink will work with students from Bentley University on user interface design.
• Park Place International achieves SSAE 16 Type II standards compliance for OpSus Cloud Services.
• EClinicalWorks CEO Girish Navani joins a panel discussion at Health 2.0’s annual conference to discuss how technology is improving the patient experience.
• US News and World Report indicates that 96 percent of Honor Roll hospitals in its “Best Hospitals and Best Children’s Hospital’s 2014-2015” use Wolters Kluwer Clinical Drug Information.
• Gritman Medical Center (ID) is live on AtHoc’s emergency communication solution.
• Validic announces a 20 percent increase in its digital health ecosystem with new integrations including hospitals, health systems, payers, pharma, and wellness companies.

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.

HCA To Acquire PatientKeeper

Hospital operator HCA announced this morning that it will acquire privately held physician systems vendor PatientKeeper. Terms were not disclosed.

HCA Chief Health Information Officer Jim Jurjis, MD said in the announcement, “HCA is investing in advanced, forward-looking informatics approaches to healthcare to improve usability, quality, effectiveness, and efficiency of care. The acquisition of PatientKeeper is an important step in that direction. It gives us important influence in the layer of the electronic record that the doctor sees, creating an innovative platform for workflow improvement.”

I spoke to PatientKeeper President and CEO Paul Brient ahead of the announcement. “HCA is a longstanding customer of our view-only portal, our clinical review tool,” he said. “Now HCA will deploy all of our software – CPOE, clinical documentation, and medication reconciliation – over top of their Meditech systems. They will invest to make it even more useful to their doctors.”

Brient will serve as CEO of PatientKeeper, which will be operated as a wholly-owned subsidiary of HCA. Its 160 employees will continue to work from company headquarters in Waltham, MA, supporting the company’s 58,000 physician users.

Brient confirmed that PatientKeeper will continue to market its products (Charge Capture, Clinical Results Review, CPOE, eSignature, Medication Reconciliation, NoteWriter, and SignOut)  to prospective clients. “There will be no change except the board members will be from HCA,” he said.

The acquisition is expected to close by the end of the year.

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 9/23/14

Billing dispute leads to blocked patient data in Maine

A small practice in upstate Maine is fighting back after its EHR vendor suspends access to its hosted EHR for falling 10 months behind on its $2,000 monthly maintenance payments.

AMIA welcomes Douglas B. Fridsma, MD, PhD, as New President and CEO

Douglas Fridsma, MD, PhD, and Chief Science Officer with the ONC will leave his position to become the CEO of the American Medical Informatics Association.

W.H.’s Steve VanRoekel to take tech to Ebola fight

White House CIO Steve VanRoekel resigns to join the USAID, where he will work as a senior adviser in the fight to halt the Ebola outbreak.

HIStalk Interviews Michael Oppenheim, MD, CMIO, North Shore-LIJ Health System

Michael Oppenheim, MD is CMIO at North Shore-LIJ Health System of New York, NY.

What is North Shore-LIJ doing with interoperability and HIE?

I’ll start at the end and then I’ll back up and explain the thinking that led us in this direction. 

We are making a huge investment — time, personnel, and focus — into developing an internal HIE, health information exchange. The reason we’ve done that — and I think a lot of other large integrated delivery networks have come around to this way of thinking — we were very eager participants when New York state initially put out the request for proposals to develop a number of RHIOs within the state. They’ve since consolidated — the HIEs, the RHIOs from across the state — into a single structure, SHINY, the State Health Information Network of New York. 

In the beginning, when you talked about doing internal HIE within an organization, everyone assumed that you were somehow trying to be exclusionist or not participate in the HIE. That’s far from the case. I think the state has come around on that, and many other IDNs have come to the realization that the kind of interoperability that we want to do goes much beyond what the mission and goals of the RHIOs are. 

The RHIOs are very, very much focused on getting as broad a look at patient information as they possibly can. That’s great because they help broker the politics and provide a common playing field for organizations that may be competitors in the marketplace, but are willing to jointly share data through the third party of the RHIO. You create a huge, consolidated record that people can go to and get a comprehensive look at the patient beyond just what they know from their four walls.

But there are a couple of things that HIE has come to mean to some of us that is beyond the scope of what the RHIOs or HIEs are focusing on today. One is around actionability of the data. The second is around not just aggregating and displaying data, but actually literally moving data from point to point without human intervention. 

The user experience with the standard type of HIE implementation is that the clinician first goes to the HIE or the RHIO to look up what history is there about this patient who I’ve never seen before. Then you go and you actually do your clinical documentation and order entry and everything else, in whatever transactional system, whatever EMR you happen to be using for your environment where you’re caring, whether it’s an office- or a hospital-based practice. 

There are two limitations to that in my mind. One is the intrinsic dissatisfaction with having to go to two places to look at data. The second being that the data out in the HIE is not necessarily actionable. I’m ordering a medication in my EMR and there’s a lab test that hasn’t been drawn in my office or hospital, but it’s known in the RHIO. Based on that lab test, I need a dosage adjustment or there’s a contraindication to the medication. My decision support engine doesn’t see that external data. 

Our focus has been on looking at how an HIE can bring data right to the clinician so that he or she can have one place where they do all their work, as well as have more of that data available for a decision support engine or for any rules or analytics or other things that you want to do on your data set, and have it all consolidated. 

We look at the HIE opportunity because internally, we can do a lot more. There’s a lot tighter integration and have a lot more actionability of the data by having an internal HIE that we control, that’s covered by our consents, and any number of other things that are facilitated by having an internal HIE.

We’re an Allscripts shop. We’re using Allscripts TouchWorks in the practice environment and  Sunrise in the hospital environment. We made this decision before the dbMotion acquisition and before some of the newer interoperability tools that they produced. Let’s put that off to the side for a moment.

The workflow that we wanted to enable was what we built so that when a patient comes to the emergency room, we pull a summary from the ambulatory environment. We place it into the Sunrise record, so it’s available and visible to the docs in the hospital. They don’t have to go out and look somewhere else. They don’t have to look at the HIE’s viewer, don’t have to look in the ambulatory record. It’s right there in the hospital environment.

At the same time, we use the data in some actionable ways. We’ve certainly done more sophisticated things than this, but even on the most basic level, we can fire off a notification. We can put a task notification in the task list of the primary care doc to say, do you know your patient is in the emergency room? If and when that patient gets admitted, we fire off a second notification saying, by the way, not only were they in the emergency room, they have been admitted to the hospital.

We begin to start to getting into what’s really business process management around the transition of care and moving the data for the user. Not requiring them to push it via Direct or something else — by sending off alerts and notifications to the primary doc so they can communicate with the hospitalist. That’s just one of the more basic examples.

To us, the HIE is much more of a process orchestration engine, not just simply a repository of data that someone can look at. It’s actionable. It’s delivered to the clinician when they need it, where they need it. That’s been the driving philosophy behind having an internal HIE rather than simply rely on RHIOs or outside entities.

The example I gave involves an ambulatory practice and a hospital. Certainly in some environments where you have a consolidated platform, maybe that’s not the most important use case. But even in hospitals that are using systems that share a record with their ambulatory facility, there’s always going to be other facilities in a large, integrated delivery network that’s not going to be on the common platform. We have nursing homes. We have a home care company. We have numerous other types of business entities that are relying on this flow of data so that their providers can work most efficiently in what we call the home system.

Whatever you’re used to work in, that’s where we want the payload delivered. That’s where we want alerts and notifications and things to arrive. That will be orchestrated through our HIE.

Will HIEs be challenged to provide business value to offset the cost?

If you look at where our future revenue opportunities are going to be, we’re moving away from our fee-for-service world and very much moving to the risk-based contract in a capitated world. We have numerous risk contracts with commercial partners. We’ve just launched our own insurance company, North Shore-LIJ CareConnect.

To us, orchestrating business process, eliminating redundancy by making sure that everybody’s got full access to the full corpus of clinical data, having a decision support engine that sits and looks at data and reacts to data across the entire health system … I couldn’t hand you a document today that says, “Here’s the amount of dollars I expect to improve my pay-for-performance and here’s how much I expect to cut my readmissions and here’s how much I expect to XYZ.”

But conceptually, we are all bought in that our entire financial success of the health system depends on the successful conversion to be able to do capitated and risk-based contracting. We don’t think we can do that without an HIE to coordinate the transition to healthcare managers and care navigators who identify patient activity, figure out who’s been where, get notifications when things happen that shouldn’t have happened, or get notifications when things that should have happened didn’t.

The HIE, for example, has in it the full ambulatory providers schedule. We can find if a patient has an appointment that’s been missed. We can fire off a notification out of the HIE. The HIE is so much more than information exchange.

The HIE platform also has registry function that allows us to load programs into it. If we have a heart failure program, we can either manually or automatically load in that these are all patients with heart failure that are part of this program. Or patients coming in with a certain payer. We can go into that payer registry and then we can make sure we do the right notifications to the right coordinators of those programs as either activity that should happens but doesn’t happen, or activity that shouldn’t happen but does happen, like unexpected specialist visits or ED visits or things like that. 

As an article of faith, we fully believe that in order to truly be able to coordinate care as an integrated delivery network and provide population health and be able to be financially and clinically successful in capitated arrangements or among our own insured population, the HIE has to be a critical enabler of that. I don’t have a specific financial ROI sheet that I can wave and say, “This dollar is going to be offset by that dollar,” but absolutely the direction of how the health system expects to care for patients in a longitudinal way and a holistic way requires this kind of technology.

Do you think the demands of population health management have turned the expectations for HIEs upside down? I’m referring to the RHIO-type organizations.

I’ll answer that in two ways. We’ve always had this intrinsic discomfort, as I started off by saying, that I’m going to look in point A and then point B and then point C, which is why we use the HIE as central consolidation point  to create a single, consolidated, comprehensive record which we can then push forward to the provider just in time as an encounter is about to happen. We anticipated that that kind of clinician reaction had to be overcome. That’s exactly why we did the things we did — get it in their face and not make them go hunt for it.

But how and when will the RHIOs retool? I think they have to. It’s really not as much their onus as it is the onus of the providers who are going to be held to different types of accountability standards to take on the responsibility to go search and find all of that data. That really is putting a tremendous burden on your providers. The value proposition goes up, but it’s on the back of the provider more than it’s on the back of the RHIO to do anything different.

The one thing, though, that I will say … I’ll editorialize a little bit … is that the RHIOs are being fundamentally pulled in the wrong direction on a lot of this stuff. Because at least in New York state, the privacy concerns around the RHIOs are, if anything, driving more and more and more restrictive rules around access to the data, sharing of the data, then sending us data. Within the context of a single organization that we control, we manage the consenting process end to end. There’s a lot more we can do.

When you get out into the state level or eventually the national level, a lot of the good intentions and the good clinical opportunities are potentially going to be stymied by the restrictive practices and policies that are being built around the RHIOs because of the patient privacy concerns. I don’t mean to minimize the privacy concerns. They’re certainly real and legitimate. But what they ultimately translate into from a regulatory statutory perspective, at least in New York state, runs a little bit counter to what we’re trying to accomplish by saying, hey, wherever this patient goes, we’ve got to be able to assure that everyone’s on the same plan of care. Everyone knows what’s already been done. It’s going to be very tough in the governmental RHIOs because of the privacy concerns and what they’re driving from a policy and practice perspective at the RHIO level.

You mentioned your Allscripts implementation earlier. I’m curious about how that’s going, especially now that they’re retooling into a population health management company.

It’s going well. We made this decision before they came forward with their dbMotion acquisition and some of the new tools that they’re bringing forth, which we’re very excited about. We just met with a number of them a few weeks ago. We have a whole bunch of folks coming on site.

We’ve been talking about population health management, trying to understand the respective roles for our internal HIE for what they’re trying to do to bring their products together. The newer front end that they have been talking about which fuses dbMotion with their front end products to make the community data and the local data appear seamlessly to a clinician look like a very, very attractive set of work flows. We are in detailed discussions with them about how we merge some of the things that we’ve done or are doing internally with some of the things that they’re doing, because we did set off on this track a little bit ahead of them.

What are your biggest challenges and opportunities as a CMIO over the next several years?

The HIE is probably one of the biggest. People think of it as a technology — and there is a lot of very, very valuable technology – but the HIE alone, just simply “data comes in, data goes out,” doesn’t accomplish the mission unless you build lots of clinical workflows over it and around it. You’re supporting any number of clinical programs or any number of potential patient flows or workflows. I have a big team focused just on that, which is working on how we take the power of the HIE and apply it to all the various different programs that are growing up around the system. That’s probably one of the biggest.

The other major area for us as a health system is the development of a data warehouse, which we don’t have today. We have a lot of individual analytic tools and products attached to our various EMRs, plus other types of warehousing — cost accounting, things like that.

We still have work to do with our EMR rollout. We still haven’t put physician documentation out beyond the inpatient space, beyond the admission and discharge documents. We still have to build out progress notes, consult notes, and a couple of other things. We still have about 30 percent of our medical group to whom we still have to roll out our ambulatory EMR. Those are all still in progress.

But my overall goal is to look at, as we make this transition to a different model of care, how do we orient everything we’re doing in the EMRs, align it with everything we need to do in the data warehousing space to provide the analytics that are needed to support these programs, and align all that with all of the clinical workflows that we’re building in the HIE to support the population health types of initiatives that we’re doing with the HIE? Making sure that all these three things work together properly, that they don’t overlap each other in what they’re doing, that we don’t leave gaps where I thought the HIE would do that or the other warehouse would do that. To make sure that all of these things align together to support all of the population health programs that we’re engaged in.

Curbside Consult with Dr. Jayne 9/22/14

A couple of weeks ago, we performed a major upgrade on our ambulatory system. Officially we’re now ready for both Meaningful Use Stage 2 and ICD-10, with all the bells and whistles installed. As upgrades go, this wasn’t my first rodeo. It went smoothly with only one minor IT concern and no significant incidents for the end users.

Since no good deed should go unpunished, management is now looking to cut our personnel resources for the next one. They can’t seem to understand why several hundred hours of work went into the upgrade because clearly it was “no big deal.” Mind you, these are not old-school IT managers, but members of our ambulatory operations team who want to avoid having super users out of the office.

We rely on the participation of super users, not only from the ambulatory practices, but also from our central business office, central scheduling department, and central referrals department. No one knows end user workflows like the super users who work with them day in and day out. We have detailed test scripts for our internal testing, but we need real-world expertise to tease out the smallest bugs. Like any organization, our users have some creative workflows that we don’t train, and if we don’t have their participation, we won’t find those issues until go-live.

We’ve been using the same upgrade methodology for half a decade, which is usually goes off without a hitch. It’s a belt-and-suspenders approach, with some duct tape and baling wire thrown in for good measure. We do a dry-run upgrade just prior to the super user testing so that we can get our timing down pat for the main event. The upgrade weekend playbook has some elements timed to the minute and there is a single upgrade commander responsible for ensuring every step is completed and communicated.

Because of the need to involve a couple of third-party vendors to handle some data migrations that we wanted to perform while we had the system down, timing for this one was even more critical. There were numerous handoffs among DBAs, access management, application analysts, build analysts, internal testers, and end-user smoke testers in addition to the third parties. Although we don’t make everyone sit on a bridge line and talk through their work and the hand-offs, we do require people to notify the team when they complete a step or if they’re running behind so that we can adjust if necessary.

The lead analyst that usually quarterbacks our upgrades had an unexpected medical issue a handful of hours before we were due to take the system down, so I ended up co-managing it with one of our analysts. This meant being on call overnight for issues, which doesn’t bother me. Once you’ve been on trauma call or managed an ICU full of patients overnight, being on upgrade call doesn’t seem very scary. Still, you never want to hear that phone ring in the middle of the night. Shortly after midnight, I decided to grab some sleep since we weren’t expecting a handoff until early morning.

When the phone rang at 3 a.m., my heart was pounding. The tone in the tech’s voice wasn’t reassuring as she apologized for calling. Apparently the upgrade was running nearly three hours ahead and she wasn’t sure if she should wake someone up to tell them or not. I have to say, seeing an upgrade run ahead, especially by that much, isn’t something you see every day. I shuffled out of bed and we walked through the checklists to make sure nothing had been missed. I cruised the error logs as well. Nothing was amiss, so we had to chalk it up to the production server being faster than our test platform.

We must have our share of either insomniacs or nervous Nellies on our team because a couple of people were showing available on our instant messenger service. They were happy to launch the next few steps early. Despite the call being a non-issue, once your adrenaline is flowing, it’s hard to get back to sleep. I curled up on the sofa with some journal articles, which thankfully did the job. By our 8 a.m. status call, I was rested up and eager for the build and testing teams to get to work.

Even though everyone has remote capabilities, we require the regression testers and analysts to be on site. We’ve learned the hard way that people are sometimes less attentive when working remote on the weekends. Sometimes it’s just better to have two sets of eyes looking at the same screen together (without a WebEx lag or dogs barking in the background) for troubleshooting. It’s a sacrifice for the team to come in, but we try to make it as fun as possible. The kind of team-building you get from an event like this is often priceless. It’s also important for the end user and analyst teams to work closely together and build mutual respect.

In response to the questions about why we spend so many hours preparing and delivering an upgrade, I’m going back through the last couple of months and highlighting some key milestones that may have been riskier with a leaner team. We have multiple people trained to do each task, which was clearly helpful when our quarterback unexpectedly sat out the game. I’m also working to quantify the intangible benefits of having disparate teams work together.

We ended up being able to re-launch the system two and a half hours early, which meant less downtime procedural re-work for the patient care sites that are open on weekends. Due to the diligent prep, we also had fewer phone calls Monday morning than we’ve ever had. That’s got to be worth something as well. The question is whether the Administralians will agree with our analysis. If they don’t, maybe we can let them run the next one and see what happens. We’ve already documented our lessons learned and updated the project plan, so it’s ready to ride.

Ever jumped in when someone said “Cowboy up?” Email me.

Email Dr. Jayne.

Morning Headlines 9/22/14

Behind the Curtain of the HealthCare.gov Rollout

A report from the US House Committee on Oversight and Government Reform portrays dissent between CMS and HHS before and after the failed rollout, with internal emails providing evidence.

Can a Computer Replace Your Doctor?

New York Times reporter (and physician) Elisabeth Rosenthal says everybody likes the potential of technology, but results haven’t been impressive and other fundamental questions should be answered first.

Building Mature Medical Software, McKesson Cardiology Achieves CMMI Level 5

The Israel-based development organization earns the highest possible rating in the Capability Maturity Model Integration framework.

CMIO Rant … with Dr. Andy

Andy Spooner, MD, CMIO of Cincinnati Children’s Hospital Medical Center, offers eight recommendations for the AMA to consider instead of complaining about EHRs.

Monday Morning Update 9/22/14

Top News

”Behind the Curtain of the Healthcare.gov Rollout,” a report from the US House Committee on Oversight and Government Reform (the committee is wildly anti-Democrat, but still interesting) contains fascinating details of the internal panic once CMS realized they were in way over their heads right after Healthcare.gov went live and failed. It concludes that infighting between CMS and HHS forced the development team to work through US CTO Todd Park, with CMS attempting to hide security exposure, keep HHS in the dark, and insist on a full site launch instead of a phased approach. Some fun snips from internal emails the committee dug up as HHS and CMS people duked it out electronically, sometimes using their private rather than government-issued email accounts:

• [Unidentified HHS employee]” “Your leadership only wanted to hear beautiful music … clearly these people are not smart enough to pull it off … you could definitely see the CYA moves coming a mile away.”
• [Unidentified HHS executive, referring to CMS Deputy Director of IT Henry Chao]: “I grow wear of the bull#### passive/aggressiveness of Henry … the other way to do this is through a complete covert ops mission to unseat the CMS FFE rules engine.”
• [HHS CTO Bryan Sivak, pictured above]: “It’s all negative. I’m going to embark on a campaign to declare victory without fully launching.”
• [HHS CTO Bryan Sivak, responding to an email in which CMS admitted that the site could not handle more than 500 concurrent users]: “Anyone who has any software experience at all would read that and immediately ask what the f## you were thinking by launching.”
• [HHS CTO Bryan Sivak, responding to US CTO Todd Park’s claim that the site’s problems were all related to user volume even though officials knew that wasn’t the case]: “This is a f###ing disaster. It’s 1am and they don’t even know what the problem is, for sure. Basic testing should have been done hours ago that hasn’t been done.”
• [HHS CTO Bryan Sivak]: “1. Bad architecture. 2. Not enough testing. Pretty simply really.”
• [HHS CTO Bryan Sivak, replying to the former HHS employee who transferred to CMS and suggested she might not be much help]: “If you don’t get access, I’m probably going to start being a little bit of a d###, which will give you ample opportunity to badmouth me and gain the trust of people at CMS.”
• [CMS employee, in urging that Healthcare.gov code be removed from open source repositories]: “This Github project has turned into a place for programmers to bash our system, submit service requests (!), and now people have started copying Marketplace source code that they can see and making edits to that.”

Reader Comments

From LL Fauntleroy: “Re: Cerner shops. The number of major ones that have pulled the plug to go with Epic (the industry term is ‘Cernover’) is the best-kept secret in health IT since neither the company nor clients announce it. Some I know from the last couple of years. Loma Linda, Dallas Children’s, Stanford Children’s, University of Utah, John Muir Health System, Connecticut, etc. There are also hospitals pulling the Cerner plug in Australia (Royal Children’s) and elsewhere around the world. There are also a number of shops that run Cerner inpatient but Epic outpatient, or Epic rev cycle, and are rumored to be considering switching, such as Northwestern. Why doesn’t HIStalk write about this?” I’ve written about those of which I’m aware, which is most of these, but I have to depend on readers to tip me off since I’m not omniscient. HIMSS Analytics could verify this trend (if it is one) or identify other Cernovers (or “Epicstinguishes” since surely a few health systems went the other direction), but they aren’t about to tell me for free.

From SoCalSurfLegend: “Re: Prime Healthcare. Three of their southern California hospitals are implementing Epic. Prime is adamant that they will not use consultants. How long before they realize it can’t be done? I’ll set the over/under at three months considering that Prime’s ownership group is the cheapest bunch around.” Unverified. Prime Healthcare’s majority owner is Prem Reddy, MD, an India-born cardiologist who has made a fortune buying and operating financially aggressive hospitals and is known as a generous philanthropist. His wife, daughter, and son-in-law are doctors.

From BJ Hunnicutt: “Re: BJC. My sources say Cerner won the demo round. Allscripts lacked functionality and the reps interrupted their own demo team to inject irrelevant information, while Epic seemed stale and self-important. BJC uses Allscripts inpatient at two academic campuses, Allscripts ambulatory for the medical school faculty clinics, the FollowMyHealth portal, NextGen for employed physicians, McKesson Horizon at the community hospitals, both Cerner and Horizon lab, and Soarian financials. They also have a homegrown clinical data repository and a massive interface support staff to keep it running. The McKesson Horizon situation is probably a key driver. I make Cerner the favorite because of their strong demo and existing relatively new Soarian backbone, plus the two other major health systems in town (SSM and Mercy) have Epic and BJC won’t want to look like they’re jumping on the bandwagon late.” Unverified. BJC’s site says the IT department has a $200 million annual combined budget and 800 employees who specialize in “clinical-based software solutions, integration of disparate systems, and expert systems intended to support caregivers in clinical practice.” Headcount assigned to that middle one seems entirely justified given the apparently lack of appetite for standardizing systems.

From The PACS Designer: “Re: Windows 9. Microsoft announces September 30 as Win 9 day, with a new Start menu, a virtual desktop feature, and a notification center.” Better get out early to camp out a spot in line. Oh, wait, that’s Apple. It’s pretty bad when the most exciting new feature of a highly touted new release is to restore functionality idiotically removed in the previous one.

HIStalk Announcements and Requests

It’s a 55-45 respondent split on whether Apple will have any influence on health and healthcare. Steven Davidson, MD added this comment to his vote: “Apple is the baby boomer tool of choice. Consumers, aka activated, engaged patients are growing in number and power and will adopt tools that enable/enhance their power. Apple wants to be that tool vendor and is the first major (well maybe Nike, but they’re giving up) consumer brand to offer a mostly complete as it is tool set. I think their presence is important and I think the hospitals still don’t get it–with a small number of notable exceptions.” New poll to your right or here: should the MU 2015 reporting period be reduced to 90 days?

Welcome to new HIStalk Gold Sponsor Phynd. The Kearney, NE-based company offers a cloud-based platform that synchronizes provider data from all of a hospital’s IT systems into a single profile, allowing hospitals to accurately answer the question, “Who are your doctors?” that includes billing address, communications preferences, licensing, internal system IDs, exclusionary lists, and contracting. It uses a patent-pending Universal Provider Profile (UPP) for all 3 million US providers, making it easy for frontline users to add a new provider on the fly, also supporting custom fields and taxonomies on any topic and from any IT system. Data quality can be easily determined by each provider’s UPP Score. Folks at Yale-New Haven Health recently did a presentation on how Phynd solved their problems involving 7,000 Epic users and 40,000 referring physicians: outdated credentialing information, endless calls to get updates, manual lookups, and lack of auditability of updates. Thanks to Phynd for supporting HIStalk.

Mr. Fraustro, the California teacher whose classroom got a 3-D printer courtesy of HIStalk readers, provided some photos of it in use. He says the students were excited when they fired it up for the first time and saw the flashing lights, heard the sounds, and smelled the printing filament and realized it exists beyond YouTube videos.

Andy Spooner, MD of Cincinnati Children’s Medical Center wrote another great “CMIO Rant” posts on HIStalk Practice, this one rebutting the AMA’s list of EHR problems with things they could be doing instead of complaining about technology.

Listening: new from Train, complete with their trademark clever lyrics despite a dangerous turn into “background music for work” territory. Extra points for the jangly “I’m Drinkin’ Tonight.” Decent for a band that’s been plugging away for 20 years and is down to just two original members.

Last Week’s Most Interesting News

• Congresswoman Renee Elmers (R-NC) introduces a bill that would allow providers to choose any three-month reporting period in 2014 for Meaningful Use reporting instead of the full-year mandate otherwise scheduled to begin October 1.
• Apple pulls HealthKit-dependent apps from the App Store after finding unannounced bugs in HealthKit that will take at least two weeks to fix.
• The American Medical Association and then its president take shots at poor EHR design and usability.
• Former Kaiser Permanente CIO Phil Fasano joins insurance company AIG in the newly created position of EVP/CIO, with KP VP named as interim CIO as the national search for Fasano’s replacement begins.
• Outsourcer Cognizant announces plans to acquire TriZetto for $2.7 billion.
• An app developer trade group asks HHS via Congressman Tom Marino (R-PA) to make it easier for them to understand and comply with HIPAA requirements, some of which predate the iPhone.
• Epic holds its UGM with over 18,000 attendees on hand in Verona, WI.
• Illinois-based systems Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system, with a stated expected benefit being the sharing of electronic medical records between their respective Cerner and Epic systems.

Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Acquisitions, Funding, Business, and Stock

Providence Health & Services launches Providence Ventures, a $150 million venture capital fund that will invest in companies focusing on online primary care access, care coordination and patient engagement, chronic disease management, clinician experience, analytics, and consumer health. It will be led by a former Amazon publishing executive. Providence will also create an internal innovation group to help it collaborate with early-stage companies, run by newly hired VP Mark Long (above), who was formerly CTO of Zynx Health.

Identity and access management technology vendor Ping Identity receives $35 million in venture funding, bringing its total to $110 million.  

Announcements and Implementations

The Tel Aviv, Israel-based McKesson Cardiology development group earns CMMI Maturity Level 5, the only FDA-regulated medical device software organization to achieve the highest software process improvement rating. I assume that’s the former Medcon that McKesson acquired for $105 million in 2005.

Other

Cerner and athenahealth say they, like Epic, are working on integrating their systems with Apple’s HealthKit. People seem excited about that for some reason.

A New York Times article calls out “drive-by doctoring,” where surgical patients receive bills from clinicians called in without the patient’s approval, often billing them at out-of-network rates. A disk repair patient was billed $117,000 by an out-of-network “assistant” neurosurgeon he had never met. Another patient complained that plastic surgeons billed him $250,000 to close an incision and a “parade of doctors” dropped by regularly post-op without mentioning that they were billing him every time they said hello. The article points out that the US has more neurosurgeons per capita than other countries and Medicare is paying them less, so they attend seminars on “innovative” coding and convince other surgeons to fraudulently declare emergencies that require their services. This is bizarre to me: the hospital sent a surgical patient’s blood tests and ECG to an out-of-network lab.

New York Times reporter Elisabeth Rosenthal, who is a Harvard-educated physician (and who also wrote the article above about drive-by doctoring), rightly calls out the silliness (and profit-seeking motivation) of entrepreneur Vivek Wadhwa proclaiming that, “I would trust an A.I. [artificial intelligence]” over a doctor any day” since AI provides “perfect knowledge.” Leave it to technologists to utter some of the stupidest imaginable statements about healthcare, exhibiting their lack of knowledge about medicine and putting unwarranted faith in the inaccurate perception that given endless amounts of unaudited data and enough computer horsepower to churn through it, better outcomes will automatically be obtained (let’s match Watson against a skilled physician instead of a “Jeopardy” contestant in treating an elderly patient with multiple chronic conditions and see who wins). Rosenthal makes great points: (a) slick technologies, including fitness trackers, haven’t affected outcomes or costs; (b) “health” can’t be easily defined with the knowledge we have today; (c) it’s easier to collect data than to know what it means, such as whether low testosterone levels in men are relevant; (d) people die even when their data points are perfect; and (e) it’s easy to find measurable abnormalities in patients who are fine, leaving the choice of treating the measurement or the patient. She concludes that some but certainly not all medical outcomes can be affected by collecting more information:

One central rule of doctoring is that you only gather data that will affect your treatment. There are now devices that track the activity of your sympathetic nervous system as a measure of stress. But what do you do with that information? Other devices continuously monitor breathing for wheezing that isn’t noticed or audible. Does that matter? Some studies have shown that continuous monitoring isn’t useful for children hospitalized with bronchial infections.

If you were dieting, would stepping on the scale 1,000 times a day help you lose weight? Or consider the treatment of an abnormal heart rhythm. It’s true that constant monitoring for a few days can be highly useful to identify the pattern and what provokes the attacks. After that, though, for many patients a wearable cardiac tracker might simply record normal beats that normal people experience all the time, increasing anxiety for many patients.

The Minneapolis paper profiles Peter Kane, founder of two failed healthcare IT businesses (ProcessEHR and Phase-1Check), who since started  a co-working space.

Weird News Andy has thoughts about this story, in which a since-fired 33-year-old female nurse is accused in a lawsuit of initiating “unsolicited sexual relations” with a 60-year-old male ICU patient waiting for a heart transplant, which the man claimed had happened with other patients. WNA’s analysis: “Was she so inept that his heart rate didn’t go up, or did alarm fatigue prevent someone from investigating?”

Sponsor Updates

• Validic will announce new clients, integration partners, and connectable fitness devices at the Health 2.0 Fall Conference this week. The company will sponsor a Codeathon and participate in panel discussions.
• Wellcentive will demo its population health management solution at the Health 2.0 Fall Conference.

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 9/19/14

Bug in Apple’s HealthKit hits iOS 8 launch

Apple discovers a bug in its HealthKit service that prompted it to pull all HealthKit-connected apps from the app store prior to the launch of iOS 8. 

Geneinsight Strategic Partnership

Sunquest and Partners (MA) create a strategic alliance to create a genomics software system that will support advanced personalized medicine initiatives.

Resurrecting Healthcare.gov Meant Dealing With Bureaucracy, Incompetence, Politics

Mickey Dickerson, the ex-Google engineer responsible for rescuing Healthcare.gov, discusses federal IT work and calls on his peers to engage with government IT projects.

Medical Records For Sale in Underground Stolen From Texas Life Insurance Firm

Medical records stolen from a Texas life insurance company have turned up for sale on a black market website, some going for as little as $6 per record.

News 9/19/14

Top News

Apple removes HealthKit-powered apps from the App Store on iOS 8’s launch day Wednesday, stating that an unspecified HealthKit bug will keep those apps offline for at least two weeks. Some app developers are reportedly scrambling to remove HealthKit dependencies from their products to avoid loss of momentum.

I upgraded my iPhone 5 to iOS 8 Thursday hoping to fix an ongoing “no SIM installed” error. While the Health app is present, it only supports basic data entry (body measurements, sleep, vital signs) until connected to source apps, so nobody’s going to get excited about that. It does offer a new Medical ID option so that users can enter emergency information (allergies, meds, contacts) that can be displayed on the iPhone’s emergency dialer screen when needed. Reader Is-It-The-Future-Yet says that feature could have “more impact than anything HealthKit or the silly watch is going to do to actually impact care,” although my observation is that you would still need a medical alert bracelet since first responders aren’t going to check your phone on the off chance you’ve entered something important there.

Reader Comments

From St. Louis Cardinal: “Re: BJC. Looks like they’ve gone out to the market for EMR replacement. Order of demonstrations: Allscripts, Cerner, Epic.” Demos were completed four weeks ago. I don’t remember what they’re using, although I know they chose several Siemens Soarian apps a few years back and I think they have some Allscripts products as well.

From MD Backle: “Re: Amazing Charts. Thought you might enjoy this email ad, in which they misspell EHR three times (twice as ERH, once as HER) plus misspell ‘it’s’ as ‘its.’ They need some proofreading!” Hopefully their programmers are better keyboarders than their salespeople.

From A Reader: “Re: KLAS report on Epic consulting, released as hordes of consultants are at Epic UGM. It would be great to hear your input on the report.” I don’t have access to KLAS reports, so I generally don’t bother mentioning them since there’s not much I can say having read only the teaser press release that intentionally discloses little of the expensive report’s contents.

HIStalk Announcements and Requests

We’re already planning for HIStalkapalooza at HIMSS15 in Chicago. We’ve booked an amazing (huge) venue, hired a band, and started planning the details that will ensure that this will be the best and biggest HIStalkapalooza ever. Contact Lorre if your company wants to participate as one of five sponsors who will get great benefits like event recognition, a private hosting area, a welcome/display space on the main floor, and a bunch of invitations to share with prospects, customers, or employees. We needed to exert more control and decided to forego the “single sponsor” approach, although we might still consider it if a company agrees to our terms in making it a great experience for attendees. I like this approach (which companies have suggested for years) because the event’s sponsors can make a big impression in front of a huge audience without having to bear the full effort and expense.

This week on HIStalk Practice: One family physician sticks up for EHRs. Dr. Gregg provides perspective on Meaningful Use. Alisha Smith shares last minute prep tips for the HIPAA Omnibus deadline. Research shows Apple won’t reach critical mass for world healthcare domination any time soon. Elation EMR CEO Kyna Fong discusses the importance of physician shadowing. New Jersey Physicians ACO goes with eClinicalWorks. Brad Boyd offers strategies for onboarding financial systems. Thanks for reading.

This week on HIStalk Connect: Keas raises a $7.4 million Series C to help expand its employee wellness platform. 6Sensor Labs announces a $4 million seed round for a portable food analyzer that can detect gluten and potentially other allergens. Researchers at the European Respiratory Society’s International Congress present study findings suggesting that lung cancer patients have measurably warmer breath, a characteristic that may lead to innovative new screening tools. 

Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Our secretive government health IT expert Dim-Sum delivered an amazing webinar Thursday on the Department of Defense’s $11 billion EHR project. We had large attendance and lots of questions in covering the EHR vendors and prime contractors that are bidding, the military health system’s structure, the opportunities for companies to do business as subcontractors, and the strengths and weaknesses of the competing teams (CSC-HP-Allscripts, IBM-CACI-Epic, Leidos-Accenture-Cerner, and PWC-GDIT-DSS.) It’s more like a conversation since we didn’t use slides, but it held my attention throughout and I highly recommend it to anyone with even a casual interest in how several billion of our taxpayer dollars will be spent or how our military members will be cared for. Thanks to the brilliant Dim-Sum for delivering a frank, funny, and highly useful presentation. 

Acquisitions, Funding, Business, and Stock

Medseek changes its name to Influence Health to reflect its mission to influence consumer choice, brand loyalty, and health behaviors before, during, and after healthcare encounters.

Larry Ellison will step down as CEO of Oracle. The 70-year-old company founder will be replaced by co-CEOs promoted from within, Mark Hurd and Safra Catz.

China-based Internet and e-commerce vendor Alibaba conducts the highest-yielding IPO in the history of American stock exchanges, raising $22 billion and valuing the company at $168 billion. The company made tentative moves into healthcare IT in the past few months with an investment into a Hong Kong-based pharma software vendor.

Perceptive Software, fresh off a move to a new headquarters building, announces layoffs and the closing of  its offices in Beverly, MA and San Francisco.

Cerner gets Federal Trade Commission approval to acquire Siemens Health Services with early termination of the waiting period, keeping the acquisition on track for Q1 2015.

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People

Kaiser Permanente names SVP of Enterprise Shared Services Dick Daniels as interim CIO, replacing Phil Fasano.

Baptist Health System (AL) promotes CMIO Chris Davis, MD to CIO/CMIO. He has served as interim CIO since June.

Announcements and Implementations

Sunquest and Partners HealthCare establish a strategic alliance to develop a next-generation genomic information system. Sunquest will make an investment in GeneInsight, a Partners-owned company that offers software for genetic testing reporting, results delivery, and collaboration.

The Denver Office of Economic Development names Aventura as a Denver Gazelle high-growth company.

Holyoke Medical Center (MA) goes live on T-System’s EV physicians documentation system.

Dallam-Hartley Counties Hospital District (TX) implements Holon’s CollaborNet HIE.

Identity and access management solutions vendor Tools4ever will use technology from Boston Software Systems to automate its solutions.

High Point Regional Health (NC) begins its implementation of Epic, which will replace Allscripts outpatient and McKesson inpatient now that the health system has merged into UNC Health Care. According to High Point’s COO, “This is one of the main reasons we sought out and merged with UNC, that is, to be able to take advantage of centralized resources, and high on that list was Epic. For us, it’s a great opportunity because it is becoming the default, go-to system in the state.”

Government and Politics

Congresswoman Renee Ellmers (R-NC) introduces the Flex-IT Act that would allow providers to choose any three-month quarter for 2015 Meaningful Use reporting, explaining,

Healthcare providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.

The Meaningful Use Program has many important provisions that seek to usher our health care providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.

The Flex-IT Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.

Mikey Dickerson, the former Google engineer brought on as administrator of the White House’s US Digital Service, says Healthcare.gov was a mess when he was called in to fix it as part of the “tech surge.” There was no system status dashboard, so “there was no place to find out whether the site was up or down except for watching CNN,” none of the project’s 55 contractors were tasked with maintaining uptime, and nobody seemed surprised or anxious that the site was down since government projects fail regularly. He explains his job change: “We have thousands of engineers working on picture-sharing apps when we already have dozens of picture-sharing apps. These are all big problems that need the attention of people like you. These problems are important, and fixable, but you have to choose to take them on. This is real life. This is your country.” I noticed that his LinkedIn profile lists his previous government-related service as “No Fancy Title, Thanks.”

Technology

The Portland, OR business paper profiles startup ReelIDX, which offers platform for creating, managing, and sharing medical video content. It emphasizes recording the patient encounter for patient education and clinician review.

Does that graph help? "@CraigJoseph: Epic makes case that they should be recognized for interoperability. #EpicUGM pic.twitter.com/USYNDqhc9c"

— Farzad Mostashari (@Farzad_MD) September 16, 2014

This tweet from Epic’s UGM seemed to polarize the Twitterverse – do the disproportionate Epic-to-Epic numbers support or dispute Epic’s interoperability claims?

AMIA joins the Commission on Accreditation for Health Informatics and Information Management Education to develop accredit master’s programs in health informatics.

Faculty of the School of Biomedical Informatics at Texas Medical Center don hats to celebrate National Health IT Week.

A clickbait Venture Beat article titled “EHR giant Epic explains how it will bring Apple HealthKit data to doctors” takes 16 paragraphs to state the obvious: user information from iOS’s HealthKit can be grabbed by Epic’s MyChart (with the patient’s permission) and then populate Epic. It misses the real challenge as to what happens on the Epic side, not only in the form of alerts or actions, but what clinicians are supposed to do as a result. The challenges aren’t technical:

• The data that an iPhone can collect is basic and not all that useful diagnostically except perhaps trended over time (such as a gradually increasing weight).
• Most app developers won’t get FDA approval to add logic that would find the one piece of potentially useful information out of thousands of data points, so that means tons of useless and unreviewed junk will get dumped into Epic.
• Providers aren’t paid to watch consumer-captured information. Even now patients could email their doctor with logs of weights, blood pressure, and blood glucose, but doctors aren’t paid to read them. It’s also not clear who should be watching the information – PCP, specialist, nurse, or someone else?
• Healthcare is designed around encounters, not monitoring. App developers don’t understand that medicine isn’t as digitally right or wrong as their world – most of us as patients want to be treated as individuals, not worksheets of measures limited by the convenient availability of sensors.
• Hospitals and practices may decline to allow patients to send them information since that accepts responsibility for doing something with it. Nobody wants to get sued for malpractice for missing one abnormal measure.

Steven Stack, MD, president-elect of the AMA, says EHRs are immature, expensive, and poorly designed. He adds that poor EHR usability is a significant driver of physician dissatisfaction. He doesn’t explain why AMA’s members greedily and voluntarily bought those systems despite their faults hoping to pocket a few dozen thousand dollars in free MU money. The market is where it should be, at the intersection of supply and demand, and perhaps the AMA should be convincing its members who are providing the demand as customers instead of scolding the companies that meet it. It’s like complaining that you hate Taco Bell while waiting in line to get your daily bean burrito. Stack has done committee work for ONC, was involved with the PCAST Report (that mostly touted Microsoft as the answer to all healthcare IT problems), and is on the board of eHealth Initiative (which includes quite a few vendor members). He’s always been a usability critic.

At least 15 children die in Syria after receiving UN-provided measles vaccine, with a preliminary WHO report speculating that medics accidentally gave the muscle relaxant atracurium instead of the vaccine since the drugs are packaged in similar vials and were stored in the same refrigerator.

A security publication finds medical records on sale in bulk on a black market Internet site, apparently stolen from a Texas life insurance company’s applicant database. The writer bought records and verified their accuracy, with prices as low as $6 for each “fullz,” slang for a complete set of records that the buyer can use to open fraudulent credit card accounts, access bank accounts, or take over someone’s identity.

UCSF surgeon Wen T. Shen says he’s embarrassed for patients to see his lack of typing skills, but doesn’t like the alternatives:

Wait until after the patient leaves to start charting (impractical given our clinic workflow); hire a medical scribe to do my documentation for me, as detailed in a recent New York Times article (not happening with recent budget cuts); use the nifty speech-to-text dictation device provided to all clinicians (feels extremely weird and off-putting to do this in front of patients); actually learn to type (old dog/new tricks, dwindling brain plasticity).

Weird News Andy says, “I <3 this password,” although he adds that it might be tough to get into your phone to dial 911 during a heart attack. Researchers develop an authentication method that uses wristband-detected ECG patterns as “the perfect password,” although people with fibrillation might not be ideal users.

• Nordic announces that it has earned the top ranking among Epic implementation support and staffing consulting firms in a new KLAS report. Also named in the report is Orchestrate Healthcare, the highest ranked vendor-agnostic consulting firm in the implementation support and staffing category.
• ADP AdvancedMD’s EHR earns ONC-ACB certification as a Complete EHR.
• Huntzinger Management Group recognizes its clients and IT professionals for National Health IT Week.
• Access provides Normal Regional Hospital (OK) with giveaways to help celebrate National Health IT Week.
• EClinicalWorks names several ACO clients that are generating savings after deploying its CCMR.
• ESD’s Phil Sierra discusses the value of healthcare IT in a recent blog.
• Etransmedia shares a video about its success and growth.
• SRSsoft is participating in the American Society for Surgery of the Hand conference in Boston this weekend.
• Truven Health Analytics and National Business Group on Health partner to facilitate an improved Employer Measures of Productivity, Absence and Quality program.
• AirWatch by VMware offers instant support for devices running on iOS 8.
• An Imprivata survey finds that 65 percent of hospitals will use Virtual Desktop Infrastructure within two years and 84 percent of those will add single sign-on.

EPtalk by Dr. Jayne

The physician lounge was buzzing this morning with the news of HR-5481, the “Flexibility in Health IT Reporting Act.” If passed and signed into law, it would allow providers to report 90 days rather than a full year in 2015.

I have to say my pulse quickened when I saw it. Congress set precedent with their ICD-10 push. This one might have less of a chance, however, since it’s not being tacked onto another high-profile bill. Maybe we can hook it to a bill everyone can get behind, such as the “We Love Mom, Apple Pie, and America Act.” If this passes, it just might defibrillate Meaningful Use, moving it from “mostly dead” to “slightly alive.”

In other bandwagon-jumping news, the American Medical Association releases a paper on setting “Priorities to Improve Electronic Health Record Usability.” I’m not a big fan of the “blame the EHR” game since there are so many more factors that influence usability, user behaviors, and generally how the health system runs. Rather than putting all of our eggs in the proverbial basket and assuming that if we just “fix” the EHR everything will be awesome, let’s look at the other issues that cause slowness and waste in health care.

My laundry list includes E&M Coding, obnoxious precertification requirements placed on physicians without good reason, The Joint Commission requirements, RAC audits, payer audits, Meaningful Use, other certification body requirements, and numerous non-value-added steps throughout the day. I could go on, but it would be aggravating. Although some of these have been shown to improve outcomes, many are just nuisances. Let’s take a multi-pronged approach and stamp out ALL poor usability, not just that of the software variety.

Back to the AMA, they again sent Medicare reimbursement codes for end-of-life care discussions to CMS for consideration. I’m in favor of efforts that would actually help physicians be paid for non-procedural work. We don’t die well in the United States. TV and media paint a picture of heroic lifesaving measures where everyone recovers fully, but don’t ever show patients with poor outcomes. The last time this came up, the scare tactics around “death panels” crushed any hope of approval.

As a primary care physician, one of the best things I can do as part of our partnership is talk to you about end-of-life care, getting your wishes out in the open and ensuring you have a support system that can carry them out when the time comes. Unfortunately, this isn’t for just Medicare patients. We need a national dialogue (heck, our EHRs all have prompts for it anyway) for patients of all ages. Young women die in childbirth, people are in horrific accidents, and overall stuff just happens.

I had some nurses make fun of me when I rolled into an outpatient surgical procedure with my healthcare power of attorney and living will at the tender age of 31. As a physician, I don’t want “everything” done and am firmly convinced there are things worse than passing on. Unfortunately, there’s no way commercial payers will cover this service until Medicare takes the lead or until patients pay out of pocket.

Until then it’s just one more thing we have to do without compensation, like keeping your diagnosis list maintained in both SNOMED and ICD-9 and explaining ethnicity to elderly people who have no idea why we would need to gather that type of information. I’m expected to share all data, but patients can pick and choose what I see, potentially placing them at risk. Proponents of MU argue that the potential of up to $44K worth of incentive payments effectively compensates us for all the extra work, but it doesn’t even scratch the surface.

I’m interested to hear what else we should ask Congress to fix for us while they’re at it. Got an idea? Email me.

Contacts

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

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Morning Headlines 9/18/14

Bill Would Cut 2015 Meaningful Use Reporting Period To 90 Days

A bipartisan bill introduced by representative Renee Elmers (R- NC) will reduce the 2015 attestation period from 365 days to 90 days if passed. Elmers explains the intent behind the bill, saying “By adjusting the timeline, providers would have the option to choose any three-month quarter for the EHR reporting period in 2015 to qualify for Meaningful Use. The additional time and flexibility afforded by these modifications will help hundreds of thousands of providers meet Stage 2 requirements in an effective and safe manner.”

EHR giant Epic explains how it will bring Apple HealthKit data to doctors

An Epic spokesman comments on Apple HealthKit integration points, saying “If the patient has given permission for the MyChart app on their phone to know about that data, HealthKit “wakes up” the MyChart app and tells it there’s new data.”

 What the new uninsured numbers don’t tell us about Obamacare

Several new polls indicate that the US uninsured rate is dropping, presumably due to the introduction of the Affordable Care Act.

2014 Survey of America’s Physicians Practice Patterns and Perspectives

The Physician Foundation publishes survey results representing 20,000 physician respondents. The report finds that 46 percent of physicians feel that EHRs have detracted from their efficiency, 47 percent feel that EHRs have detracted from patient interaction, and 24 percent report that EHRs have detracted from quality of care.