Morning Headlines 11/18/14

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

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

Some New Frustrations as Health Exchange Opens

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

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

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

Curbside Consult with Dr. Jayne 11/17/14

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 11/17/14

eHealth Initiative 2020 Roadmap

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

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

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

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

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

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

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

Monday Morning Update 11/17/14

Top News

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

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

HIStalk Announcements and Requests

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

Last Week’s Most Interesting News

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

Webinars

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

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

Recent webinar videos on YouTube:

Keeping it Clean: How Data Profiling Leads to Trusted Data

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

Mercy chooses Emmi Solutions to provide patient information tools.

People

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

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

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

Announcements and Implementations

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

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

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

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

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

Government and Politics

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

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

Technology

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

Other

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/14/14

Capturing Social and Behavioral Domains and Measures In Electronic Health Records

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

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

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

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

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

Former Shelby County Hospital CFO Guilty in EHR Incentive Case

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

Meaningful Use. Born, 2009, Died, 2014?

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

News 11/14/14

Top News

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

Reader Comments

 

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

HIStalk Announcements and Requests

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

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

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

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

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

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

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

People

 

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

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

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

Announcements and Implementations

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

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

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

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

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

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

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

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

Government and Politics

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

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

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

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

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

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

Innovation and Research

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

Other

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/13/14

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

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

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

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

AMA backs interstate compact to streamline medical licensure

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

CIO Unplugged 11/12/14

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

China

Thanks to a recommendation by friend and peer Pamela Arora, I was invited by the Chinese government to speak about health information technology. Having visited 29 years ago for my honeymoon, I was eager to return. This time, I would not be smuggling in bibles, but freely sharing lessons learned from my healthcare technology experiences.

After a 14-hour plane ride, I landed in Beijing and was greeted by my gracious host, Michael Wang. Michael is an English-speaking administrator at the China-Japan Friendship Hospital, the primary hospital for the city and party officials. We shared much in common and bonded over many meals, discussing our values and ideologies. Heck, we even did Starbucks together! We would later catch up with Pamela, who was also invited as a speaker.

You may be wondering how I survived eight days without Facebook, Twitter, Google, and YouTube. The answer: barely.

I had shared in advance my Top 10 list of sites to visit and they gave me a personal tour guide. It was freaking unbelievable. Although not a fan of Asian cuisine, I promised I would eat and drink everything set before me. Gulp. I managed. Incidentally, sea cucumbers are not ocean vegetables!

We also bonded through the ritual of shared shots. In China, each toast is a three-shot minimum. I, well … lost count of the toasts. What happens in Beijing stays in Beijing.

As you would expect, we toured the magnificent Friendship Hospital. Our guide and senior host was hospital president XU Shuqang MD, PhD. Dr. Shuqang now serves as the Party’s undersecretary of health for emergency management. A very friendly man with a great sense of humor. We connected on several levels, as both China and USA share many of the same challenges in healthcare.

As a big believer in the power of technology to help transform healthcare, Shuqang was personally responsible for the content of this conference. Every hospital in China took part. The equivalent of the ONC sat in the first row. The 2014 Chinese EMR and Hospital Information Management Association Congress was underway. I still pinch myself. Was I really a featured speaker? Humbled.

They employed simultaneous translation, which helped my speech go very smoothly. Until slide 12. Michael had entered the Chinese translation for all of my English bullet points, but for some reason, for every slide after the 11th, the English bullets disappeared.

It gave me pause, but I collected myself and then went on from memory. Thankfully, I recognized the pictures along the way that told a story related to the content. All was good. Who would know?

What did they want to learn about? Meaningful Use, HIE, privacy and security, and HIMSS stages of EHR maturity. Because I couldn’t imagine not talking about it, I threw in a few nuggets on leadership as well. What good is all that other stuff if nobody can lead and execute?

They were ahead of us in some areas such as telehealth, but behind in other areas such as EHR adoption and HIE. We learned from one another and developed a lifelong friendship that transcends political ideology. We are in this to transform healthcare. Indeed, the world is flat.

As I headed home, I reflected. My new friends. The amazing sights and sounds. The beautiful people. I came away with renewed hope. Hope for the world.

What resonated with me most was one of the triple-shot toasts given by Dr. Shuqang. “Despite ideological differences,” he said, shot glassed raised, “our two super powers can collaborate and truly transform healthcare and make this world a better place for the citizens of every country.”

They will be in Texas visiting Pamela and Children’s Health. I aim to catch up on progress made since we first met. I also hope they’re ready for some Texas cuisine!

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

Morning Headlines 11/12/14

BULLETIN: HIPAA Privacy in Emergency Situations

HHS updates its HIPAA guidance in light of the ongoing Ebola outbreak to authorize disclosure of PHI to any member of the public in danger of contracting the disease.

New AMA Policy Continues Call for Penalties to Be Removed From the Meaningful Use Program

The American Medical Association is calling for MU-related penalties to be dropped and for the program be refocused on interoperability.

KLAS Offers Performance Insights on HIE and EMR Interoperability

KLAS publishes interoperability survey responses that suggests that Cerner offers more advanced interoperability features, but that Epic customers are reporting much higher overall interoperability success.

Walgreens’ Greg Wasson kicks off an extraordinary roster of HIMSS15 keynotes

HIMSS publishes its 2015 annual conference keynote speakers, with Walgreens CEO Greg Wasson kicking off the event and George W. Bush taking the Wednesday afternoon slot.

News 11/12/14

Top News

HHS’s Office for Civil Rights issues a bulletin covering HIPAA privacy obligations in Ebola-type emergency situations. It bends the HIPAA rules a bit, clarifying that a provider can share patient information “with anyone” as needed to prevent an imminent public health threat, but points out that media disclosure is limited to acknowledgment (not announcement) that an Ebola patient is being treated and a statement of their condition, provided that the patient has not expressed a preference otherwise. That means hospitals can’t release an Ebola patient’s name unless a reporter asks about that patient specifically, in which case the hospital can acknowledge their presence and condition.

Reader Comments

From The PACS Designer: “Re: Dropbox. It can now operate inside Microsoft Office.” Office users can edit their documents directly from Dropbox and share them from inside Office apps, which are now free for iOS users and as such are residing at the top of the App Store popularity lists. Gartner predicted previously that standalone file storage and sync would be dead within a few years, emphasizing that users don’t want to screw around with a separate app like Dropbox as much as they just want to save and share within their software of choice. The competitive landscape gets murkier with Microsoft’s recently announced unlimited storage for Office 365 users, which you might expect would take Dropbox (and certainly the lagging #2 Box) out of the picture entirely. That doesn’t even factor in Google, which offers free basic storage and a full terabyte for $10 per month. The differentiators for healthcare should be: (a) the provider’s willingness to sign HIPAA business associate agreements; (b) enterprise-grade audit trails and permissions to give the IT department some degree of control; (c) controlled sharing within the enterprise only; and (d) APIs that allow vendor and self-developed apps to store information in a HIPAA-compliant manner in the cloud to eliminate the most common breach exposure of misplaced unencrypted devices. Vendors offering only consumer-grade storage will find it hard to survive commoditized competition, especially at the ridiculous valuation levels given to the top few.

From Lysandra: “Re: our new company infographic. I thought you might want to run it on HIStalk.” I hate infographics, which dumb down already easily understood factoids into simplistic picture for those folks whose lips tire from reading more than three words. I don’t trust anyone, particularly an anonymous infographics creator, to tell me how I should think by packaging up often questionable information into a pretty graphic, urging me to not worry about the trees they have dismissed in providing their own description of the forest.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Stella Technology. The San Jose, CA-based company offers consulting and technology services and has strong domain expertise in HIE — its tagline is “exchange, coordinate, and collaborate.” They can help with Meaningful Use, ACOs, registries, patient engagement, remote monitoring, systems integration, messaging, provider and patient identity management, consent management, public health reporting, and Direct Secure Messaging. They are experts on interoperability standards for messaging, documents, and semantic interoperability. They can assist HIEs with architecture, emerging technologies, analytics, governance, business and marketing plans, privacy, and stakeholder engagement. The company offers turnkey products as well: Caredination (a communications and handoff tool that connects the care team with patients as they move among care settings) and Clinical Staging Database (an extensible relational store with a canonical clinical data model). Integration Toolkit will be introduced in 2015. You might know some of the executive team since the CEO, CTO, implementation SVP, and founder were all involved in leading Axolotl (now Optum) through its 2010 acquisition. Thanks to Stella Technology for supporting HIStalk.

Thanks to Elsevier, which will be co-sponsoring HIStalkapalooza at HIMSS15. I’ll have more sponsors to announce later, but in the meantime, I still have openings for companies that want to co-sponsor or to book a private box for entertaining guests (which includes much-coveted tickets to the event itself). The amount of support will drive the number of people I can invite since events are a lot more expensive per attendee than you might think when you’re offering an open bar, dinner, and a topnotch band (I still have fantasies about a cheap outdoor barbeque and keg party instead). Email me if your company is interested in participating in HIStalkapalooza.

HIStalk readers funded the purchase of English/Spanish picture dictionaries to help students in Ms. Weigand’s Louisiana middle school class who are newly arrived in the US (with a matching grant from the Bill & Melinda Gates Foundation via DonorsChoose.org). Ms. Weigand, a Teach for America teacher, sent the photo above of students using the dictionaries.

Webinars

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

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

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

Acquisitions, Funding, Business, and Stock

Telehealth provider MDLIVE acquires Breakthrough Behavioral, which offers online behavioral health counseling. Former Apple CEO John Sculley is mentioned as being investor of the $49 per visit MDLIVE, but then again he’s best known for firing Steve Jobs from Apple and we know how that turned out.

Specialty EHR vendor Modernizing Medicine secures $15 million of a planned $20 million funding round.

Healthcare.com, which benefits from the mistyped web addresses of people looking instead for Healthcare.gov, raises $7.5 million in Series A financing for its health insurance policy search engine.

Premier announces quarterly results: revenue up 15 percent, adjusted EPS $0.33 vs. $0.31, beating Wall Street expectations for both. From the earnings call:

• The company’s revenue growth was fueled by its SaaS-based informatics products, particularly its population health management offerings that include contributions from recent acquisitions Aperek and TheraDoc.
• Premier has 3,400 hospital customers representing 68 percent of community hospitals.
• The company is developing the first surgical home collaborative with the American Society of Anesthesiologists in 43 hospitals.
• President and CEO Susan DeVore says the company’s Aperek acquisition is critical in supporting the supply chain management need of members, while TheraDoc’s offerings will be integrated with PremierConnect to drive further clinical surveillance solutions.
• The company is using technology from its Meddius acquisition to integrate ambulatory information across diverse EHRs in a given health system.
• Premier continues to review potential acquisitions in the areas of supply chain, pharmacy, alternate site, physician preference, care management, risk stratification, ambulatory data, and population health management.
• DeVore said of the demand by customers to unleash EHR value, “We do hear from our members that they are frustrated with the difficulty in connecting disparate vendors, disparate transactional systems, and EMRs and they’ve spent a lot of money installing EMRs. They are looking for more efficient ways to get data… it is driving not only our SaaS based-subscriptions, but our PremierConnect Enterprise as Mike discussed and the advisory services that wrap around it because remember it’s not just the technology, but it’s how do you take those insights and how do you actually reduce cost or improve quality. We are hearing actually a lot more from our members now too, something Mike mentioned, which was this need for data scientists, and data managers, and data governance and all the complexities that go with data, which we can provide as a service.”

Sales

Sundance Behavioral Healthcare System (TX) chooses HCS Interactant Revenue Cycle, Financial, Mobile, and Insight.

Mercy Health (OH) expands its Explorys relationship by adding Risk Models and Value-Based Care Program Framework.

Catholic Health Initiatives (CO) chooses Allscripts Hosting Solution for its TouchWorks EHR. CHI signed a $200 million hosting and IT management contract with India-based Wipro just over a year ago, so that status of that deal isn’t clear.

Humana chooses Valence Health’s tools for population health management.

The VA selects Jive Software’s collaboration tools to share medical best practices.   

People

Neiman Marcus hires Sarah Hendrickson (Children’s Medical Center of Dallas) as its first VP/chief information security officer.

Joe Norris moves from interim to permanent CIO of New Hanover Regional Medical Center (NC).

Awarepoint promotes Tim Roche from CFO to CEO.

Carl Smith (Best Doctors) joins CompuGroup Medical US as GM of the laboratory division.

The FCC names informatician Chris Gibbons, MD, MPH of Johns Hopkins Bloomberg School of Public Health as distinguished scholar in residence, where he will contribute health IT, analytics, and population health expertise.

Accretive Health names Dave Mason (RelayHealth) as chief strategy officer.

Announcements and Implementations

Mitchell County Hospital District (TX) connects to the Texas Tobacco Quitline using Holon’s CollaborNet HIE platform.

Allscripts adds secure patient payments capability from TrustCommerce to its FollowMyHealth patient engagement platform.

Xconomy profiles Madison-based startup HealthMyne, which appears from its poorly descriptive website to be doing something with merging diagnostic images and text to make them searchable.

Appointment reminder technology vendor Talksoft introduces the ability for hospitals and practices to develop brand-specific iPhone and Android apps that use its technology.

Kronos will integrate technology from TeleTracking to offer an integrated staff management solution that uses TeleTracking’s Capacity Management Suite for real-time patient volume data. 

Non-profit health decision information vendor Healthwise announces that its materials have been used 1.5 billion times as of Tuesday morning.

Government and Politics

The American Medical Association just won’t give up its griping about Meaningful Use. It now demands that penalties be eliminated and that the Meaningful Use program be refocused on interoperability. In other words, nobody complained when taxpayers threw $25 billion at providers (including AMA’s members), but now that they have to start earning it, it’s unfair. AMA also voiced its support for FSMB’s previously published telemedicine policy — more details in my interview with Alexis Gilroy, JD, who served as a subject matter expert to FSMB.

Two HIV-related government sites finally start using SSL encryption for web- and smartphone-based user sessions. A security expert drily notes the irony that HHS enforces HIPAA, yet wasn’t protecting confidential patient information.

A movement claiming to be grassroots (without providing details) urges that Congress support the nomination of Vivek Murthy, MD as surgeon general. He was nominated a year ago but wasn’t confirmed because of his stated beliefs that guns are a health hazard.

Other

Farzad Mostashari, MD tweeted out the comment he left on the New York Times article that described how hospitals make it hard (and expensive) for patients to get copies of their own records. His comment wasn’t approved, so his screen shot is the only record.

A federal investigation finds that clinical staff attending to Joan Rivers failed to notice her deteriorating condition and didn’t start CPR until several minutes afterward. The report says her anesthesiologist initially documented that she was given 300 mg of propofol, but changed the record afterward to note a 120 mg dose instead, saying that the initial dose documentation was a mistake caused by double-clicking the default value. I’ve seen doctors falsify documentation (both paper and electronic) after making a mistake, so it will be interesting to see if the wrong dose was actually given and not just charted.

Anthem Blue Cross customers in California receive wellness emails that contain their private information in the subject line, with an example of: “Don’t miss out — call your doctor today; PlanState: CA; Segment: Individual; Age: Female Older; Language: EN; CervCancer3yr: N; CervCancer5yr: Y; Mammogram: N; Colonoscopy: N.” 

The summary graphic from KLAS’s just-released EHR interoperability review shows Epic and athenahealth leading the pack in contributing to the success of their customers. Meanwhile, KLAS corrects Politico’s overhyped headline that proclaimed “KLAS to Epic: Stop Putting Words In Our Mouth.” KLAS simply said that Epic’s claim as being #1 for interoperability isn’t technically correct since KLAS issues separate reports for interoperability and HIE, but it clarifies that “KLAS never had any such discussion with Epic to stop putting words in KLAS’s mouth.” So if you’re keeping score at home: KLAS corrected Epic, Politico dumbed it down incorrectly, then KLAS corrected Politico.

A law firm’s telemedicine survey (and obligatory cute results infographic) is getting exposure from sites that aren’t paying attention to how the survey was performed. The conclusions seem insightful on first glance: 90 percent of organizations are implementing telemedicine and 36 percent expect 10-30 percent usage among patients within three years. Those glossy conclusions inspired ecstatic headlines from some sites anxious to summarize uncritically, but what they missed is that only 57 people responded (of an unstated number of surveys sent, making calculation of the response rate impossible) and job titles and organization types were all over the place. Example: only 52 percent of respondents were from hospitals, which means that big, seeming bold and authoritative insights were drawn from only 27 hospital respondents. The survey also asked questions that no single respondent was likely to have answered correctly given that they covered technology, reimbursement, and strategic planning. It’s embarrassing that people cover lame surveys as news, much less without critiquing their methodology.

HIMSS makes iffy choices in its “extraordinary roster” of HIMSS15 keynotes. Greg Wasson, president and CEO of Walgreens, gets the Monday morning slot, which in my mind should be reserved for someone with selfless healthcare-related accomplishments that might inspire non-profit provider attendees instead of a $14 million per year big-company CEO. At least Wasson is a pharmacist by training and has only ever worked for Walgreens, starting there as a pharmacist intern, and the company’s use of IT in its retail setting is nothing short of brilliant. Tuesday’s keynote is the CEO of Humana, which hasn’t always been a beacon of patient-focused healthcare practices, while President George W. Bush gets pushed back to an awful Wednesday 4:30 p.m. slot. HIMSS seems to be moving toward having for-profit CEOs as keynotes, having done the same with the mHealth Summit in the past two years — Aetna CEO Mark Bertolini got the prime spot in 2012 even as his underlings in Aetna’s healthcare IT vendor companies were setting up their booths in the exhibit hall and the same thing happened in 2013 with Qualcomm’s CEO as the opening keynoter.

Canada is observing the first Digital Health Week this week, although the only events scheduled appear to be some tweet chats and webinars.

Brigham and Women’s Hospital hires an SVP/chief business development officer to launch a consulting service, saying it needs “new sources of revenue in order to sustain our precious mission.”

Wellcentive establishes a $1,000 scholarship for a military veteran attending medical school.

A 30-year-old Madison, WI woman tries to avoid bankruptcy caused by her cardiac arrest at 29, when an ambulance mistakenly transported her to out-of-network St. Mary’s Hospital. She’s stuck with a $50,000 bill instead of the $1,500 one she would have owed as a patient of in-network Meriter Hospital three blocks away. Blue Cross Blue Shield paid $156,000 of her $254,000 tab for a 16-day stay and the hospital reduced her balance owed to $10,000, but she still has to pay the other bills that included out-of-network physicians, the ambulance ride, and therapists. She can’t afford to get married until she sees what numbers her various providers make up.

Weird News Andy sends his greetings as follows: “Their has bin found a vieres that makes u less smart. LOL.” Scientists determine that a virus found in lake algae shortens human attention span, although even they aren’t quite sure why that’s important.

Sponsor Updates

• CIO Review names DataMotion to its “20 Most Promising Healthcare Consulting Providers” list for its Direct Secure Messaging solution.
• Gartner recognizes VisionWare in its “Magic Quadrant for Master Data Management of Customer Data Solutions” for the sixth consecutive year.
• Visage Imaging will demonstrate its Visage 7 Enterprise Imaging Platform along with its integration capabilities at RSNA.
• PDR Network will exhibit at and sponsor iPatientCare National User Conference (NUCON 2014) November 14-16, exhibiting its PDR Brief and PDR Search patient drug education solutions.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/11/14

CHIME, HIMSS Letter To HHS

In a just released letter sent to HHS on November 3, CHIME and HIMSS call on Secretary Sylvia Burwell to replace national coordinator Karen DeSalvo, MD quickly if her new appointment as Acting Assistant Secretary of Health is going to be permanent, citing the need for leadership that can focus on the ONC in a full time capacity.

Identification of undiagnosed diabetes and quality of diabetes care in the United States

Researchers with Oxford University were able to identify over 60,000 undiagnosed diabetic patients by developing a search algorithm to pour through a data set of 11 million electronic medical records.

AHA unveils toolkit to help hospitals hire veterans

The American Hospital Association partners with the White House Joining Forces initiative and unveils a new toolset designed to connect hospitals with medically trained soldiers now actively looking for civilian employment.

Curbside Consult with Dr. Jayne 11/10/14

Assuming that it doesn’t get delayed yet again, ICD-10 is a little less than 11 months away. For those of us who had been preparing for the most recent and now-postponed transition date, it’s time to dust off our implementation and training plans if we haven’t done so already.

My organization had already done a fair amount of informational outreach to physicians and other providers, so most people know what it is and that eventually they will have to use it. Their actually readiness to do so, however, is variable.

I have to admit that I’m not well versed on our plans for the transition in the hospitals. As our employed physician base has grown, I’ve had to focus more and more of my time on the ambulatory projects. Although I’m still privileged for inpatient medicine, I rarely see patients in that environment.

Even so, the communication from our hospital to rank-and-file admitters has been spotty at best. I think I’ve seen maybe a handful of emails since the last delay. Hopefully they will get on their game soon at least as far as communicating with community providers is concerned.

On the ambulatory front, however, we’re really gearing up. We’ve been on the ICD-10 ready version of our EHR and practice management software for a year. It was helpful that they bundled the ICD-10 functionality in with the 2014 Meaningful Use Stage 2 content so we didn’t have to take multiple upgrades.

Now that they’ve had a little bit of a hiatus with regulatory requirements, our vendor has again turned to coding actual functionality and usability updates, which puts me in the lane again for an upgrade prior to ICD-10.

Timing the need to educate everyone around an upgrade is tricky with ICD-10. We do plan to bring all the ambulatory end users in for some type of formal training for both processes and don’t want them too close together (training fatigue) or too far away from the go-live dates. We also have to remain sensitive to the realities of pulling people out of office.

Although I wrote a few weeks ago that we’re doing computer-based modules for new practice go-lives and for addition of incremental staff, we’re still planning to do classroom training for these two projects. We’ll likely supplement them with on-demand resources as well, but right now I’m planning for traditional training.

We did purchase some external vendor content for ICD-10 for certain high-dollar and complex subspecialties, but I’m responsible for organizing the plan for medicine-based subspecialties and primary care. We had external trainers in last year to train our core team (physician leaders, compliance officers, auditors, training staff, etc.) but I’m sure most of us have forgotten the nuances. We’re going to have them back after the first of the year to deliver a refresher.

In addition to the classroom training planned for closer to October 1, we’re scheduling monthly lunch and learn sessions to re-familiarize people with the concepts of ICD-10 and prepare them for more intense documentation. During the decade we’ve been on EHR, many of our providers have developed an affinity for voice recognition-based narrative documentation. Since they’re not using the discrete elements of the EHR as much as they used to, their ability to leverage discrete data to suggest appropriate ICD codes will be limited.

We anticipate that those who are afraid of learning a new coding system may want to rely more heavily on the EHR’s computer-assisted coding features, which will require retraining on the template-based workflows for those providers. Being able to identify those individuals early will be good, especially since we didn’t exactly budget for basic EHR retraining as part of our ICD-10 transition. I’m hoping we can leverage super users in the practices and our regional physician champions to assist, but I want to make sure all the bases are covered.

Although some of our providers complain about the restrictions of being employed, ICD-10 is a prime example of why physicians are willing to give up a degree of autonomy in exchange for corporate management structures. I’m working with two other people to put together our strategy and it will be rolled out to all of our practices. If those sites were independent, they’d be on their own to find a consultant, develop a program, or potentially try to just wing it.

Of course, those organizations that aren’t even on their ICD-10 ready software yet have additional work cut out for them. I don’t envy the upcoming months for them. With the estimated cost of the transition ranging from $50K for small practices to millions of dollars for the rest of us, there’s a lot at stake.

Are you ready for ICD-10? What’s your strategy? Email me.

Email Dr. Jayne.

Morning Headlines 11/10/14

Allscripts Healthcare Solutions’ CEO Paul Black on Q3 2014 Results – Earnings Call Transcript

Allscripts holds its Q3 earnings call after shedding 15 percent of its share price Thursday on disappointing earnings. CEO Paul Black and CFO Richard Poulton both acknowledged the poor performance, citing lower full system sales and hardware sales, and noted that Q3 is traditionally the slowest quarter for the HCIT industry.

Proposed EHR/Meaningful Use Regulations

The Massachusetts medical board presents its recommendations on how to implement a state law requiring physicians to demonstrate EHR proficiency as a condition of licensure prior to the law’s January 2015 effective date.

Nurse Value-Added and Patient Outcomes in Acute Care

Researchers with the University of Michigan compare data from the hospital’s EHR system and its HR system to evaluate individual nurses and the effect they had on patient outcomes. The study attributed 7.9 percent of variance in patient clinical condition to nursing skill.

Most people don’t know they have the right to view medical records online

In England, only three percent of practices have a patient portal in place despite an April 2015 federal mandate that requires all citizens be given online access to their medical records.

Monday Morning Update 11/10/14

Top News

Allscripts shares dropped 15 percent Friday after turning in underwhelming revenue, earnings, and sales numbers after the market’s close Thursday. From the earnings call:

• CEO Paul Black admitted that “we would have liked to have delivered a stronger performance.”
• The company says it’s making big investments in remote hosting capabilities, but that effort has hurt short-term profitability.
• CFO Richard Poulton said, “It’s not lost on us that the stock has gotten beaten up a little bit. It’s something we’re talking about.”
• Black says Q4 is always a strong quarter and expects that to continue.
• Of the DoD EHR bid, Black said, “They’ve made some very specific requirements in the RFP response that you have an innovative and interoperable platform with world-class content, workflows, and an open systems architecture. So we feel very good about where we are.”
• Black said the hospital EHR business is all replacement sales now, adding, “The folks that are looking at the next 10 years are looking at organizations who have thought through and have invested in a long-term strategy and approach to having an open systems approach to and a very robust set of offerings for the multitude of caregivers that exist in a total population health-centric environment as compared to a traditional environment from the past years.”
• Black said reduced sales don’t mean things have stalled, but rather that Q3 is always slower except for last year.
• Black said the company won’t break out population health management sales as an overall percentage even though that’s the greatest demand area, saying, “We wanted to make sure our client base did not think that we are abandoning our foothold of being a core systems provider of EHR and rev cycle management solutions.”

HIStalk Announcements and Requests

It’s a fairly even split among a large number of poll respondents as to whether CommonWell will have a significant impact on interoperability. It’s also interesting to see which IP addresses brought out the vote, with the big ones being CommonWell members McKesson and athenahealth as well as non-member Epic. New poll to your right or here: have you ever withheld information from a provider because of medical record privacy concerns?

Tuesday is Veterans Day, set aside to honor every person who has served in the US Armed Forces. If you served, thank you. If not, this is a good day (like every day) to thank someone who did. Military members don’t get to choose the locations or causes for which they are asked to put their existence on the line, which makes their service even more selfless. I observed the upcoming holiday by reading and enjoying “The Last of the Doughboys: The Forgotten Generation and Their Forgotten War,” in which the author interviewed the last World War I veterans before they all died shortly after, being 100 or more years of age. It’s not just a recap of World War I (which like the Korean War, tends to get lost in the shadows of World War II and even Vietnam), but rather a reminder of what it’s like to be on front lines that are full of confusion, irrational leadership, and the horrors of war.

Last Week’s Most Interesting News

• Cerner and Epic exchange barbs about Epic’s interoperability capabilities and what CommonWell’s interoperability contribution will be.
• The 2015 work plan of HHS’s Office of Inspector General indicates that it plans to extend its audits to include cloud-based EHR services and vendors as well as hospital downtime readiness.
• Allscripts is hit with several negative news items: poor quarterly results that send its share price south, a $9.7 million judgment against it in a lawsuit brought by Etransmedia for deceptive trade practices, and public reports of Sunrise system problems at South Australia Health.
• The Medicare physician fee schedule for 2015 adds several telehealth payment items and relaxes the EHR requirements for earning Chronic Care Management monthly checks.
• The HIT Policy Committee reports that total Meaningful Use payments have reached $25 billion.

Webinars

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

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

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

Acquisitions, Funding, Business, and Stock

MedAssets reports Q3 results: revenue up 5.5 percent, adjusted EPS 0.34 vs. $0.31, beating expectations for both.

The Advisory Board Company announces Q2 results: revenue up 12 percent, adjusted EPS $0.43 vs. $0.31, beating earnings expectations but falling short on revenue. Shares dropped 11 percent Friday on the news. Above is the one-year share price chart for ABCO (blue, down 22 percent) vs. the Nasdaq (up 18 percent).

CompuGroup Medical US will move its headquarters from Boston to Phoenix on January 1.

Orion Health chooses Scottsdale, AZ as the North American and UK headquarters of its population health management division, expecting to hire 100 people within a year and up to 400 over the next three years. Incentives pushed Scottsdale past Nashville, Atlanta, and Raleigh.   

Truven Health Analytics will acquire life sciences stakeholder management software vendor Heartbeart Experts. I spent several unsuccessful minutes perusing the company’s website to try to figure out what they do, which led me to conclude that it would probably be clear if I needed its services. 

Sales

Envision Medical Group (MI) chooses Aprima’s RCM services.

Rite Aid will pilot the use of HealthSpot’s telemedicine kiosks in some of its Ohio markets.

People 

Rick McCarthy, CIO of St. Vincent’s Health Services (CT) and a retired US Navy commander who served as a CIO and ran a medical unit in Afghanistan for a year, will deliver the keynote Veterans Day address in Trumbull, CT on Tuesday.

Jay Deady (Awarepoint) joins Recondo Technology as CEO.

Announcements and Implementations

The 2014 Midwest Fall Technology Conference will be held November 12-14 in Chicago, organized by six Midwest HIMSS chapters. It’s offering a hefty provider registration discount in order to hit its desired 50-50 ratio of providers to vendors.

Georgia Health Connect launches as a regional HIE using technology from Liaison Technologies. It plans to connect to the Georgia Health Information Network.

Government and Politics

The Massachusetts medical board makes its final recommendations for a law going into effect in January 2015 that will require all physicians to demonstrate EHR proficiency and Meaningful Use skills. The final wording hasn’t been approved, but proposed regulations would require physicians to meet one of the following:

• Participate as an EP in Meaningful Use Stage 1.
• Be employed, contracted, or credentialed by a hospital that is participating in Meaningful Use Stage 1.
• Complete a three-hour accredited CME program on EHRs.
• Sign up for Massachusetts Health information Highway.

Innovation and Research

A study finds that EHR information paired with human resources system data can be used to measure the value added by individual nurses, finding that individual nurse performance explained 7.9 percent of the variance in patient clinical condition changes. It concluded, not surprisingly, that a nurse’s educational level and work experience correlated positively.

Technology

Iodine releases a Google Chrome browser extension that displays the definition of a medical term when the user hovers over the word on any web page.

Other

A New York Times article describes the difficulty that a featured patient had in getting his own medical records from the hospital, as it turned into a six-week ordeal of snail mail, phone calls, $100 in copying fees, and an eventual physical trip to the hospital to wait for a stack of paper documents to be handed over. A Harvard professor blames competition, saying that medical records are held hostage to prevent patients from going elsewhere. Former National Coordinator David Blumenthal, MD, weighs in: “When hospitals talk about HIPAA or charge for releasing records, what they’re really saying is, ‘I don’t want to do this and I have to find an excuse.’”

In the UK, a survey finds that 71 percent of citizens aren’t aware that they’ll be able to review their own medical records online by April as promised by the Patient Online initiative spearheaded by Health Secretary Jeremy Hunt. Only 3 percent of practices offer online access at the moment, but all are supposed to be ready by April. Doctors are worried about the time they’ll spend explaining medical records to patients given that 75 percent of patients want records written in plain while only 21 percent of doctors agree. The survey found that percent of doctors say the medical record is a reference tool for their use, not something intended for patients.

The widow of IDX co-founder Robert Hoehl donates $5 million to a variety of Burlington, VT non-profits.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/7/14

Changes in Medical Errors after Implementation of a Handoff Program

A New England Journal of Medicine study finds that implementing a structured process for resident handoff procedures at nine hospitals led to a 23 percent medical error-rate decrease, and a 30 percent decrease in preventable adverse events.

Epic replies to comments made by Cerner CEO Neal Patterson at health conference

Typically media shy,  Epic’s media spokesman responds to charges from Cerner that her company shrugs off its interoperability responsibilities, claiming that, according to KLAS, it is an industry leader in this segment as well.

Allscripts Healthcare: Blue Harbour Group Won’t Go Lightly

Activist investor Blue Harbour Group has increased its stake in Allscripts from five to seven percent.

News 11/7/14

Top News

The 2015 work plan of HHS’s Office of Inspector General includes several EHR-related items beyond the usual Meaningful Use payment audits. OIG will audit the security of cloud-based service providers (including EHR vendors) and will review the downtime policies of hospitals. OIG’s future efforts “may consider the significant challenges that exist with respect to overseeing expenditures for health IT, the interoperability and effective sharing and use of health care data for medical care, and emergency preparedness and response.”

Reader Comments

From Zippy: “Re: Alameda Health System. The outgoing CEO removes the blame for its financial problems from Siemens Soarian.” The five-hospital system’s CFO told its board last month that its financial meltdown was caused by its $77 million Siemens/NextGen implementation, but the outgoing CEO says the system’s own managers — not Siemens — caused its problems. He specifically blamed two unnamed former health system executives.

From Sauerkraut: “Re: Siemens. The hearing aid business sold for more than twice the HIT business with lower revenues and the usual higher multiples of software businesses. Perhaps Ben Rooks can explain.” Singapore-based Siemens Audiology Solutions posted $860 million in 2014 revenue and just sold for $2.68 billion, or three times revenue. The healthcare IT business had about $1.2 billion in annual revenue and sold for $1.3 billion. I would guess the revenue multiples are based on profitability, market position, and future prospects rather than revenue. My impression is that Audiology is a turnkey business while Health Solutions is a slightly shabby fixer-upper with a reputation problem. There’s also the issue of having few qualified buyers, which would have kept the price down and given Cerner a clear shot at picking it up for a bargain basement price.

HIStalk Announcements and Requests

This week on HIStalk Connect: Microsoft and Jawbone unveil new fitness trackers, Microsoft in an attempt to capitalize on the digital health trend and Jawbone trying to differentiate itself in the emerging smartwatch market. Rock Health raises its next investment round and announces that it will fund accepted startups with a $250,000 seed round. Google revamps its Flu Trends platform to include CDC data in an effort to boost accuracy.

This week on HIStalk Practice: Healthcare buzzwords reach a "tipping point." DuPage Medical Group begins offering e-visits. The Eye Institute of Utah implements a new patient portal. Portland’s healthcare IT accelerator scene doubles. 5 O’clock Records rebrands. ONC launches a new innovation challenge. Thanks for reading.

I was clearing out space on my phone for an iOS upgrade, which forced me to decide which apps to delete since some are data hogs. My “can’t live without” survivors are below. What are yours?

• Yelp. Probably my most-used app.
• Motion-X GPS Drive. The best GPS I’ve used and the only paid app on my list, although it barely qualifies at 99 cents.
• Slydial. lets you call someone’s cell phone voicemail directly in case you just want to leave a message without talking to them.
• Airline apps. American is my most-used one.
• GateGuru. Helps me find decent airport food and check an airport’s flight board.
• OpenTable. I will sometimes make a restaurant reservation an hour before eating just to make sure there’s a table waiting, plus I trust the reviews and lists (I often also look at TripAdvisor).
• Uber. I use it occasionally, although I’ve been burned expensively a couple of times by the surge upcharge.
• Kindle. I don’t mind reading books on my phone’s small screen.
• Spotify. I subscribe to Premium so I can play music offline.
• Speedtest. I check Internet speed the moment I set foot in a hotel or house where I need to work, although usually I can’t do much more than swear and fret at Stone Age speeds (less than 3 Mbps down and 1 Mbps up).

Listening: new indie folk from Portland, OR-based The Decemberists, which sound a bit like R.E.M. Peter Buck has played on some tracks, although not on their pretty good cover of my favorite R.E.M. track, “Cuyahoga”.

Webinars

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.

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

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

Acquisitions, Funding, Business, and Stock

Aspen Advisors will be acquired by healthcare management consulting firm Chartis Group, with Aspen’s Managing Principal Dan Herman joining the board of Chartis.

Allscripts announces Q3 results: revenue up 4 percent, adjusted EPS $0.06 vs. $0.05, missing analyst expectations for both. Shares dropped sharply in after-hours trading following Thursday afternoon’s announcement, down around 15 percent to levels not seen since early 2013.

Meanwhile, activist hedge fund Blue Harbour Group increases its ownership in Allscripts to 7 percent of the outstanding company shares, up from 5 percent. Blue Harbour Group says it avoids public shareholder fights by investing only in companies that welcome its ideas for unlocking value, happy to make money from share price appreciation rather than selling off parts piecemeal. Its Allscripts ownership stake looks like around $170 million worth, right in line with its stated sweet spot of $100-$200 million. Allscripts shares have dropped 7 percent in the past year and 38 percent in the past five years.

Healthgrades acquires digital marketing form COCG to enhance its strategic marketing services for hospitals.

Siemens reorganizes its remaining healthcare lines into a separate business as it suggested it might do several months ago, which won’t do much to squelch the rumors that it wants to sell of the whole package and get out of healthcare completely. Siemens just announced that it will sell its hearing aid business for $2.7 billion. It previously sold the HIT business to Cerner and its microbiology line to Beckman Coulter. Like GE, Siemens is putting big money into energy-related product lines.

Francisco Partners invests an unspecified amount in medication benefits network provider CoverMyMeds.

Shares in Merge Healthcare hit a 52-week high Wednesday, having jumped 33 percent in the past two weeks. Above is the one-year MRGE share price (blue, up 23 percent) vs. the Nasdaq (red, up 18 percent).

The Department of Defense awards Fulcrum a five-year, $13.9 million contract to update the systems used by DoD’s year-old Richmond, VA EHR testing facility and to open a second health IT testing center in West Virginia. Both will support DoD’s DHMSM EHR replacement project.

Global Healthcare Exchange will acquire Atlanta-based procurement software vendor Vendormate.

Etransmedia wins a multi-million award in its deceptive trade practices lawsuit against Allscripts. An arbitration panel ruled that Allscripts convinced Etransmedia to buy MyWay EHR licenses in advance to improve its own financial performance, but then “deliberately sabotaged” MyWay sales by retiring the product in October 2012, leaving Etransmedia holding millions of dollars in unsold licenses. Etransmedia has since developed its own Connect2Care product.

Sales

Beaumont Health System (MI) chooses PHYND’s Provider Population Management Platform for 20,000 physicians.

Rhode Island awards 3M the analytics contract for its All-Payer Claims Database that will aggregate claims and provider data to publish consumer-facing quality and cost information.

The VA will add two service networks to its Philips eICU program, expanding its ICU remote monitoring service to 1,800 beds.

People

Prison health provider Corizon Health names Andy Flatt (HealthSpring) as CIO.

Fogo Data Centers hires William Esslinger, Jr. (Esslinger Tech Law) as CEO and board member.

Peter Dolphin (PatientKeeper) joins Advanced Practice Strategies as EVP of sales.

National Library of Medicine Director Don Lindberg, MD will retire in March 2015 after more than 30 years on the job. He was also the first president of AMIA.

Announcements and Implementations

Cerner CEO Neal Patterson says in a blog post that the company will provide CommonWell services to its clients at no charge (after a “nominal setup fee”) through January 1, 2018. He adds that CommonWell will make its interoperability services available at a low cost, passed through from participating vendors to their clients. He emphasizes that CommonWell will never sell data.

A new startup, MD Revolution, launches RevUp, which allows providers to collect Medicare’s new $40 per month chronic care management payment through team-based monitoring of a user’s fitness device data. The HealthKit-enabled RevUp supports provider-user messaging, personal health coaching, and an unspecified level of integration with EHRs. It appears that the company provides all of the coaching services. Founder Samir Damani, MD, PharmD is a Scripps cardiologist. Also on the executive team is CIO Jean Balgrosky (former Scripps SVP/CIO) and SVP of Business Development Parker Hinshaw (founder of maxIT). The company’s page also neatly summarizes the requirements to collect the monthly payment that starts in January 2015 — 20 minutes of non face-to-face care of Medicare patients with two or more chronic conditions. .

Blood Bank of Alaska implements Mediware’s blood center management and donor recruitment systems.

Government and Politics

An ONC survey finds that most consumers (75 percent) are concerned about the privacy of their medical records whether paper or electronic, but few (less than 10 percent) are worried enough to withhold information. Three-quarters of respondents want their providers to use EHRs and share their information with their other providers. Survey pluses:  it was a random-dial telephone survey that removes online-only and self-selected participant bias and it had a good number of responses, but the folks willing to take a cold-call survey may not be representative. Survey minus: it was conducted last year.

CMS postpones its eHealth Summit, scheduled for December 5, until further notice.

Innovation and Research

The Wall Street Journal highlights companies that are working on diagnostics that can detect Ebola quickly, including BioFire Defense (which I wrote about quite a bit last week), CorGenix Medical (a $15 non-instrument system that works like a home pregnancy test), Chemnio Diagnostics Systems (a $10 finger-stick test),  and OraSure Technologies (which is considering development of a mouth swab-based test like the one it offers for HIV).

A nine-hospital study finds that use of a structured patient handoff procedure among medical residents was associated with a 23 percent reduction in medical errors and a 30 percent drop in preventable adverse events. Residents used a mnemonic-driven checklist for both oral and written handoffs.

Technology

Microsoft announces free versions of Office for the iPhone and updated versions for the iPad, with Office for Android coming soon.

Qualcomm Life Director of Business Development Kabir Kasargod urges wearables developers to move from activity trackers to the real healthcare industry:

Go from the children’s table to the grown-up table. If you’re serious about this, embrace the FDA. Learn how HIPAA works. Make sure it’s connected to the [electronic medical record] and that all the health laws are observed. There’s a tremendous dearth of innovation here. I would move away from fitness and go hardcore into health. That’s where the money is.

Other

A Pennsylvania business paper profiles Pittsburgh-based Health Monitoring Systems, whose service monitors hospital EHR information to provide real-time outbreak information to public health departments.

PayPal co-founder and early Facebook investor Peter Thiel says he is skeptical about healthcare IT, big data, and cloud computing.

Epic responds to Cerner CEO Neal Patterson’s calling the company “immoral” for being an interoperability “black hole” among EHR vendors at Cerner’s user group meeting. Epic’s statement:

Epic is No. 1 for interoperability performance as ranked by actual users surveyed by the highly respected firm KLAS. Epic can interoperate with any other electronic health record that meets government standards, regardless of vendor. We support open standards rather than private platforms such as CommonWell that further privatize and monetize exchange of health information.

A Health Affairs blog post by MedStar Health’s influential informatics expert Peter Basch, MD says the Meaningful Use program is impeding interoperability by its rigid, metric-driven approach that fails to meet the needs of providers and patients. He adds that EHRs don’t work well for advanced primary care models that emphasize chronic disease management and care coordination and observes that today’s version of interoperability makes matters worse by more widely spreading clutter-filled summary of care and visit summary documents.

S&P downgrades the bonds of Wake Forest Baptist Medical Center (NC) because of large receivables write-offs and the high ongoing expense of its Epic system.

PeaceHealth (WA) ends affiliation talks with Ocean Beach Hospital (WA), with PeaceHealth’s CEO saying his organization is too busy and too far over budget on its Epic implementation to take on a new hospital.

The tweets of Scripps cardiologist Eric Topol, MD have the highest signal-to-noise ratio of just about anybody even though he gets a bit app-happy at times, so I enjoyed this interview, in which he made some interesting points. He’ll be delivering a keynote presentation at the Digital Health Conference 2014 November 17-18 in New York City.

• Patients will help diagnose and monitor themselves using algorithms, leaving doctors to focus on treatments.
• Continuous monitoring will allow patients to stay at home, reducing hospital usage.
• Virtual visits can help with the difficulty involved in getting a PCP appointment, which he says requires a six-week lead time in Boston.
• A major shift to virtual visits will reduce trips to the doctor’s office.
• Patients will bear much of the responsibility and cost of their health.

Weird News Andy expects this story to fill a void. A bus driver in Egypt attempts to dodge a mandatory urine drug screen by submitting a sample from his wife and is surprised to hear from officials, “Congratulations, you’re pregnant.”

Sponsor Updates

• RazorInsights publishes a company video, a brilliantly done history that includes founder interviews.
• Surgical Information Systems names Indiana Orthopaedic Hospital (IN) as a Center of Excellence.
• HCI group posts “Meaningful Use to Meaningful Care” by William Bria, MD and Robert Steele, RN.

EPtalk by Dr. Jayne

The November 30 deadline for eligible hospitals to report for the 2014 Medicare EHR Incentive Program is fast approaching. I haven’t been on the attestation site lately, but I am told that the 2014 Flexibility Rule options are available. If that doesn’t work, you can still apply for a hardship exception, but if you’re just now figuring out that you need one, I feel for you.

Speaking of Meaningful Use, several providers at my hospital forwarded links to articles about the dismal attestation statistics, demanding that we consider “stopping this nonsense” and “get back to practicing real medicine.” They’re not alone, although most national groups are focusing on shortening the reporting period for 2015 and adding additional flexibility. CHIME, the AMA, MGMA, and of course HIMSS are among the loudest voices.

With the Flexibility Rule slowing some organizations’ upgrade schedules, CMS also made some updates to the final 2015 Medicare fee schedule. Primary care practices can report Chronic Care Management codes on whatever certified EHR they were on as of December 31 of the previous calendar year, rather than being required to use 2014 CEHRT. Additionally those services can be billed using a CPT code instead of a G code. I’m not sure why that’s an advantage, but provider groups seem happy about it.

If you have nothing else to do this weekend, it’s 1,185 pages of glory and includes summaries of comments received while it was under consideration. Comments are being accepted through December 30 and it goes into effect January 1, so read up. Any document that includes five and a half pages of acronym explanations is bound to be a hit.

I’ve been recovering this week from a Continuing Medical Education conference. I’m not a huge fan of Las Vegas, but it seems like a lot of conferences are held there. After learning about dermatological diseases in a drab hotel ballroom for two days, a conversation in the row ahead jogged my memory that the NextGen One user group meeting was starting at the tail end of my trip. A quick call to Bianca Biller confirmed that she was also in town, which improved my spirits. In addition to being one of the smartest revenue cycle experts I know, she is also the most fun.

She warned me that tight security was keeping non-registered people out of the conference center, but was able to score me a pass to the Navicure client event on Monday at the Hard Rock Live. I was feeling a little giddy when I got carded at the door until I realized they were carding everyone. We arrived fairly early, but the party was already in full swing. The Atlanta-based band was fantastic and it was fun to watch medical practice folks kick back to Journey and James Brown covers. Since MGMA had wrapped up a few days earlier, she said there were a lot of vendors staying over, so we headed out to hit a couple more get-togethers. We ended up with the obligatory wild and crazy taxi ride, during which Bianca received a marriage proposal from the cabbie.

We dialed it down a notch and stopped by the Intelligent Medical Objects suite at Mandalay Bay for a glass of wine and some much-needed time off our feet. There we ran into one of Bianca’s nurse informaticists, who lured us to the casino with the promise of riches to come. I was content to watch others gamble and to do some people watching – the number of folks still in Halloween costumes several days after the fact was pretty entertaining. Although I missed MGMA this year, I felt like I at least got my party fix and that will hold me until HIMSS.

My new nurse friend was the big winner of the night, where I was lucky to walk away with the same $20 I started with. The Cerner conference was also this week, but I haven’t heard anything about it.

Do you have conference pictures or a crazy taxi story? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 11/6/14

More Problems Expected on Federal Health-Insurance Site in New Year

The Wall Street Journal reports that known bugs and unfinished development efforts on Healthcare.gov will likely cause a fresh set of problems for consumers this enrollment period, including erroneous renewals of cancelled policies and duplicate enrollments for those that try to switch insurers.

AHIMA/eHealth Initiative 2014 ICD-10 Readiness Survey Results

A recent survey conducted by AHIMA finds that 63 percent of health systems will be ready for end-to-end ICD-10 testing by the end of 2014, while 10 percent report that they plan to forgo testing altogether.

Office of Inspector General: Work Plan 2015

HHS’s OIG will increase its focus on EHRs in 2015, according to its recently published work plan. Audits will focus on validating downtime contingency plans, securing medical devices that interface with EHR systems, and verifying entitlement to Meaningful Use incentive payments.