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Weekender 3/30/18

March 30, 2018 Weekender No Comments

weekender


Weekly News Recap

  • South Australia reportedly halts the rollout of its troubled, Allscripts-powered EPAS systems.
  • President Trump fires VA Secretary David Shulkin via Twitter and nominates as his replacement White House Physician Rear Admiral Ronny Jackson, MD, who has no significant management experience.
  • Investors in the largely defunct lab startup Theranos sue the company, hoping to get some of their money back from the proceeds of selling the company’s patents and by going after the rumored $100 million fortune amassed by former President Sunny Balwani.
  • FDA says it will expand its digital health pre-certification program to more companies by the end of the year.
  • Finger Lakes Health (NY) pays a hacker an unnamed sum to recover its systems after a week of ransomware-caused downtime.
  • Israel announces plans to make the health data of its 9 million citizens available to researchers and private companies for work on preventive and personalized medicine.

Best Reader Comments

Can someone explain the value of LinkedIn? It’s handy when looking someone up at times, but the amount of spam and vendors asking to make a connection is overwhelming. (2 antisocial?)

Women tend to use LinkedIn differently – more privacy settings and fewer public announcements, posts, or interactions. I wouldn’t be surprised if this extends to other aspects of online identity, like being less likely to email Mr. HIStalk to notify him of a promotion. (People/ LinkedIn)


Market Research Study Reader Feedback

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Reader Steve works for a market research company and applauds my calling out of offshore firms whose reports – written in nearly undecipherable fractured English — fail to notice that companies they cover have been acquired or have exited the market. He provides this commentary.

I’m increasingly seeing the industry plagued by “report factory” outsourced studies. As you rightly state, the model seems to increasingly involve investment in masses of PR on every topic and keyword imaginable, yet always with high growth forecasts to entice busy health tech execs and VC’s desperate for data to reach for their Amex. More interesting is that if you dig into many of these firms, their report announcements are copycat replicas (same forecast title and keyword, just different company name).

Here are five quick pointers to aid in calling BS on these cowboys.

  1. Contact the analyst behind the report. A quick email conversation or phone call is the quickest way to know (a) if they know what they are talking about, and (b) if they even exist. Also check their LinkedIn / Google press mentions. Good analysts should build up a reasonable online presence of industry press mentions and well-written market insights.
  2. Ask for a detailed view of how the data is put together. The best analysts and firms are acutely aware of the accuracy of their data and both the pros and cons of their chosen methodology. I expect every party that is seriously interested in my research to grill me on methodology behind it.
  3. Beware of big growth rate headlines. Markets go both up and down. I’m still yet to see one of the report factories putting out PR showing a market decline.
  4. Buying market research should not be a single interaction. You are buying a report, but also included should also be analyst time and support to help you disseminate the information, ask questions, and mine the knowledge of the author. The best analysts I know are not just good at producing reports and PR, but as advisors to their customers. Avoid firms where analyst access is restricted or interaction is limited to an account manager or salesperson.
  5. Question timelines. Good data and insight takes time to put together. Market research based on primary research (vendor or consumer) involves investment financially as well as established industry relationships. There are rarely shortcuts that can be made. Compiling a high-quality, detailed report on complex markets is not possible in a few weeks. Short timeline reports usually resort in low quality, mistake-laden research or a very expensive bookend.

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. F in West Virginia, who asked for programmable Lego robots for her special needs high school class. She reports, “We have been very busy learning about coding. My students have learned the hard way that you must follow ALL directions in order or your creation will not work. I get excited when they come in and show their classmates what they have done and what they have learned. When their creations run, they are so proud of themselves, and when they don’t, my students don’t get frustrated (which is a really big deal) —  they just look to see what they did wrong. Thank you for making learning exciting for my students and for building skills and confidence!”

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First grade special education teacher Ms. M from North Carolina says of the math games we provided, “My students have a hard time grabbing these new math concepts, but I have learned that learning through play makes retention much easier. The students are showing signs of understanding and they are able to focus on the problem at hand. Some have even told me they did not want my help, that they wanted to try to figure it out themselves, now this blew me away. I am ever so grateful for your generosity with this project and this great new way for my kiddos to learn math concepts.”

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The US Attorney’s Office wants to take millions of dollars and several replica cars as part of its investigation into their Cleveland owner’s for-profit addiction treatment companies, which submitted $49 million in Medicaid claims in 29 months of which $31 million was paid. The reproduction cars, which were used in Hollywood movies, include a 1981 DeLorean from “Back to the Future,” a 1959 Cadillac hearse from two “Ghostbusters” movies, and a Batmobile replica.

A California OB-GYN on the first day of his medical malpractice trial rushes to the aid of a prospective juror who is undergoing cardiac arrest, raising concerns that the doctor’s actions might bias jurors in his favor. More interestingly, James Nilja, MD is one of several former drummers for rock band The Offspring and is rumored to have suggested the band’s name. He parted ways with the band in 1987, with front man Dexter Holland explaining in a blog post that, “He was so intent on getting into medical school that he didn’t really even practice with us much, which is part of why he‘s not our drummer any more … I hope his patients don‘t find out that he once helped write a song called “Beheaded!” Here’s video of the now-doctor playing in the band in 1987.


In Case You Missed It


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Morning Headlines 3/30/18

March 29, 2018 Headlines No Comments

Doctors put patients in charge with Apple’s Health Records feature

Apple moves its Health Records app out of beta, with 39 healthcare institutions signing up to make patient records available via the app.

David J. Shulkin: Privatizing the V.A. Will Hurt Veterans

Former VA Secretary David Shulkin, MD explains in a New York Times op-ed that his ouster was the result of political infighting amongst those who want to privatize the VA; a move he soundly denounces as “a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”

Walmart talking with Humana on closer ties; purchase possible

Sources say Walmart and Humana are in talks to expand their partnership beyond a co-branded drug plan that prompts members to visit the retailer’s stores. Walmart’s acquisition of Humana is a possibility – one that sources say would enable the company to better manage prescriptions through access to EHRs.

News 3/30/18

March 29, 2018 News 6 Comments

Top News

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President Trump fires VA Secretary David Shulkin, MD after a wave of negative press around questionable funding for Shulkin’s trip to Europe last summer. Shulkin believes the ouster came from political opponents who want to privatize the VA, a move he was quick to slam Wednesday in a New York Times editorial.

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President Trump will nominate the White House physician, Rear Admiral Ronny Jackson, MD, as Shulkin’s replacement. Shulkin had reportedly recommended Jackson for a VA undersecretary position last fall, but the President wanted him to remain in the White House.

Though Jackson served as an emergency medicine physician during Operation Iraqi Freedom, veterans groups question his nomination, citing concerns over a lack of administrative experience. I tweeted on the news, “Choosing an unbeholden outsider in hoping for disruption or believing that character (good or bad) outweighs experience sounds good. But I’m not sure I’d want as my first management job to be running a $200 billion, politically microscoped organization. Whatever the VA pays isn’t enough.”

The status of the VA’s proposed no-bid contract with Cerner remains cloudy as Shulkin departed without signing it. Experts are expressing confidence that Acting Secretary Robert Wilkie – who has no VA or healthcare experience — won’t want to take on the responsibility of executing the Cerner contract, but I wouldn’t be so sure: Jared Kushner pushed Cerner in the first place and the White House may tell Wilkie to just get it done as a purely administrative chore that lets the White House take immediate credit. That’s the bet I’d make.


Reader Comments

From CanadaEh: “Re: Novia Scotia. Has released its provincial RFP to the two short-listed vendors, Cerner and Allscripts. Demos are planned for May and June.” Unverified.


HIStalk Announcements and Requests

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Thursday was National Vietnam War Veterans Day, honoring those who served and died in the conflict that ended 43 years ago. If you were deployed to Vietnam then and are still working in health IT all these years later, fill out my online form and I’ll list you in an upcoming post.


Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Intermountain Healthcare (UT) will shift 98 of its 358 IT staffers to employment with DXC Technology, an IT and consulting services company it has worked with since 2012. The health system previously announced plans to transition 2,300 billing employees to employment with R1 RCM beginning April 8.

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The FDA approves Dexcom’s G6 interoperable continuous glucose monitoring system.

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Mercy Health-Cincinnati invests in local startup Crosswave Health and its FindLocalTreatment.com addiction services look-up tool. Mercy Health formed an Addiction Treatment Collaborative in January to help its patients find longer-term treatment options.

Two hundred investors wonder how their lawsuit against Theranos and its founders will fare once the SEC is done with its criminal investigation. The investors, who bought shares through their investment funds, are looking to graze over the company’s remains, which include dozens of patents and potentially the personal fortune of former President Sunny Balwani, recently estimated by a magazine at $100 million.


Sales

  • Tenet Healthcare (TX) selects Inovalon’s VantageCPS cloud-based analytics software for its post-acute care services.
  • Western Maryland Health System chooses Artifact Health’s physician query software.
  • Plum Healthcare Group will implement FormFast Connect Powered by Salesforce for resident intake across its 65 SNFs.

Announcements and Implementations

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Vanderbilt University Medical Center (TN) integrates mobile voice, text, and broadcast functionalities from Mobile Heartbeat with its Rauland-Borg nurse call system and Epic EHR and goes live on the system.

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Image Stream Medical develops EasySuite 4K imaging software for the OR.

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VA Southern Nevada Healthcare System implements LiveData’s PeriOp Manager with EHR integration help from DSS.

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Healthfinch announces GA of its Refills Lite prescription refill management app for practices using AthenaClinicals.

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Apple moves its Health Records app out of beta. Thirty-nine healthcare institutions have signed up to make patient records available via the app.

The Patent and Trademark Office awards Glytec two more patent allowances for its FDA-approved EGlycemic Management System.


Privacy and Security

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Northwell Health (NY) staffers help concerned citizens at DataBreaches.net and UpGuard alert a New York-based medical group with zero Web presence that it had left 42,000 patient records and millions of patient clinical notes exposed on a misconfigured rsync backup for over a month.

UnderArmour says the information of 150 million users of its MyFitnessPal app was exposed in a February breach, although the information it stores is minimal (username, email, and encrypted password).


Other

A new paper by Google Cloud researchers says that while AI can help radiologists do their jobs more efficiently, it can’t replace them, noting that it can only do a small part of their job.

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The only newspaper article I could find is behind a paywall, but it appears that the new government of South Australia will follow through on its promise to halt the SA Health rollout of its over-budget, behind-schedule, Allscripts-powered EPAS system.

A NEJM Catalyst article says the “two-canoe system” — in which nearly all physicians work under both fee-for-service and value-based payment arrangements – encourages doctors to provide suboptimal care at a higher cost. Their moral dilemma of doing what’s best for their patient vs. what’s best for their wallets is contributing significantly to their burnout, the authors conclude, also noting that the public may start pushing back on their focus of generating revenue.

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A study of VA facilities finds that reducing low-value EHR inbox notifications saved 1.5 hours per week of PCP time, although the information overload remains unmanageable and will require more work to fix.

Child protection workers across Montana are using Project ECHO’s telemedicine capabilities to compare notes and connect with child psychiatrists and other therapists at Billings Clinic (MT), which launched a Project ECHO hub several years ago.

An analysis of 7 million patient reviews on Healthgrades finds that patients place the most value on the amount of time their physician spends with them, particularly in the areas of their willingness to answer questions, listen to concerns, and ensure they understand their conditions or procedures.

A coroner’s inquest into the death of a knee surgery patient in a hospital in Australia finds that clinicians had a “persistent failure of critical thinking” when an anesthesiologist mistakenly ordered him a fentanyl patch and PCA that was intended for a different patient. The anesthesiologist noticed the PCA later but assumed someone else had ordered it, while nursing and pharmacy employees failed to catch his mistake. The doctor said he was distracted while trying to manage two patients and forgot which patient’s record was displaying on the EHR. He overrode system warnings for overdose, drug interaction, and duplicate therapy. It was his third time using the newly implemented system. The coroner recommend further training, changes to EHR screen and label layouts, and a hospital review of medication administration procedures.

Weird News Andy refers to this story as, “Not going, not going, not gonorrhea.” A UK man receives an unwelcome surprise after a sexual encounter in Southeast Asia – the “worst-ever” case of gonorrhea that is resistant to all common antibiotics.


Sponsor Updates

  • CommonWell Health TV features Ellkay CIO Kamal Patel.
  • Consulting Magazine recognizes The HCI Group CEO Ricky Caplin as a global leader in consulting.
  • The local news interviews Imprivata CMO Sean Kelly, MD about the company’s palm vein scanner ID technology.
  • Liaison Technologies partners with Tierion to extend blockchain capabilities to its Alloy platform.
  • Black Book Research recognizes LogicStream Health for highest client satisfaction and clinical process improvement.
  • HealthcareNow Radio interviews Medicomp Systems CEO Dave Lareau.
  • Mobile Heartbeat will exhibit at the American Organization of Nurse Executives annual meeting in Indianapolis April 12-15.
  • Nordic publishes a podcast titled “How to use change champions for a more successful go-live.”
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the annual IA Conference on Perinatal Medicine April 3-4 in West Des Moines, IA.
  • Experian Health will exhibit at HFMA Hudson Valley April 5 in Tarrytown, NY.
  • In the UK, St. Stephen’s Clinical Research implements Elsevier’s Macro electronic data capture solution.
  • The US Patent and Trademark Office issues two more patent allowances for Glytec’s eGlycemic Management System.
  • Medicision adds CarePlanner 360 to its line of Aerial care management solutions for payers and risk-bearing organizations.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 3/29/18

March 29, 2018 Dr. Jayne 1 Comment

The obnoxious post-HIMSS vendor behavior I mentioned last week is getting worse. One vendor was already harassing me, having left messages every day or two by both phone and email. After a week of this, one might assume that your potential sales lead is cold and give it up. This guy hasn’t gotten the message, though, and is now leaving messages that don’t even mention the company name. Maybe it’s intentional, like I will assume he’s someone I know and return the call, or maybe it’s just sloppy. But, “Dr. Jayne, it’s Dave. I’ve been trying to reach you. I’ll try again tomorrow if I don’t hear from you” isn’t terribly professional. I recognize the number from last week’s harassment and you’re not going to hear from me.

My suggestion for salespeople: if your lead seems cold, leave one last message and include who you are and what you have to offer, then give it a rest. “Hi, Dr. Jayne, it’s Dave Smith from HotVendor. You might remember speaking to us at HIMSS about our new retina-scanning drug inventory system. We’ve tried to reach you and I know you’re busy, so if you’d like to connect, you can reach me at 888-555-1212 or by email at DaveSmith@hotvendor.com and we thank you for your time.” That message is more likely to get filed for the next client I run into that needs your particular solution.

A few other vendors have called but all have left reasonable messages, so no complaints about those. Also, plenty of emails even from vendors I don’t remember talking to or visiting. Those are interesting, because I almost always visit their website to play the “what was I thinking” game to try to remember if they caught my eye with their advertising, booth presence, or product. Even with the website, sometimes I can’t figure out what a vendor really does. That always makes me chuckle, so it’s a good mood booster.

Speaking of websites, Mr. H mentioned the announcement of Canvas Medical entering the primary care EHR fray. I had mentioned them a few weeks ago, but not by name. I received a mailing from them pre-HIMSS, but they didn’t mention HIMSS and weren’t there. I thought the timing was odd and would have wanted to look at their product. I’ve checked their website a couple of times in the last few weeks because they did get my attention and found it not ready for prime time, with the blog page having several “lorem ipsum” type placeholders. It looks like they cleaned it up in preparation for yesterday’s actual launch, which is good, but makes me question why they did a direct mail piece directing users to the website if they weren’t ready to roll.

I pulled out the original mailing that I had filed in the “keep an eye out” category. I noticed that they use “EMR” rather than “EHR” to refer to their product. Not sure if that is intentional, but might be since it doesn’t look like they offer a patient portal or maybe they just don’t mention it. They’re up to six practices mentioned on the website,  but one is using the Medfusion portal (along with “non-secure email and Skype”), three appear to have no patient portal, one kicked me over to ihealthinterview.com, and the remaining practice doesn’t seem to have a website. The company is very small and I don’t see anything about certification, which makes it a no-go for many practices. They do offer a MIPS guarantee, stating “if you receive a negative adjustment, we will cover it,” but it’s not clear how they’re executing this. Having worked with a startup EHR that died a rapid death due to lack of certification, I wish them well.

Another item that reached the end of the line was the proposed merger between Providence St. Joseph Health and Ascension that would have created the largest hospital operator in the US seems to be over. It appears the organizations will work independently to restructure, feeling that a merger would have taken attention away from the need to restructure as health care deliver moves away from hospitals. Both systems also appear to want to continue to grow, with Ascension acquiring Chicago-based Presence Health earlier this month, even as its CEO told employees via video last week that it will focus on outpatient care and telemedicine.

Ascension has already slashed spending over the last couple of years and plans to save more money by “aligning its pay practice,” which I can tell you from experience at other health systems won’t involve bringing underpaid workers up to the level of their peers. The employee communications mentioned that executives have already taken pay cuts and hinted that employees would be asked to do the same. I touched base with one colleague in an IT-related department and people are already buffing their resumes.

I read with interest Mr. H’s comments on privacy and security and figuring out how much Facebook and Google know about us. I’m relatively “off the grid” despite my being immersed in the tech industry. The fact that I don’t use location services on my phone unless absolutely necessary and rarely identify where I am makes it trickier to know where I’ve been. Since I got new Internet service, my PC thinks it’s in Wisconsin for some reason, so that adds to the mystery as well. If Facebook really wanted to understand our preferences and make sure we saw marketing, maybe they’d give us features such as “hide posts about recipes even if they’re from people we like” and “hide pictures of abused animals.” I have a couple of people I dearly love, but they post so much in these two categories, I worry that I’ll miss something important from them.

Speaking of missing something important, I had the unsettling experience this week of learning somewhat via Facebook that a colleague had passed away. Someone had posted earlier in an email group that we’re part of that he had no-showed a meeting on Monday, which was unusual for him, and wondered if anyone had heard from him. I had corresponded with him last month about an upcoming meeting, but hadn’t heard anything since. One group member had met with him on Friday and things seemed fine. A few hours later, another email popped up with a screenshot from his Facebook page, where someone posted “Can’t believe the news, RIP.” Since he joined the gig economy as an independent contractor, it’s not like there was a corporate office that would notify his customers, so I guess finding out this way makes sense. Emerging technologies and scattered social networks make for some uncharted etiquette waters at times. My condolences to his loved ones, wherever they may be.

Email Dr. Jayne.

Morning Headlines 3/29/18

March 28, 2018 Headlines 6 Comments

Trump pushes out Shulkin at VA, nominates Jackson as replacement

President Trump fires VA Secretary David Shulkin, MD after a wave of negative press and nominates his personal physician, Rear Admiral Ronny Jackson, as his replacement.

98 IT employees of Intermountain Healthcare transition to DXC Technology

As Intermountain Healthcare (UT) prepares to shift 2,300 jobs to billing company R1 RCM, it announces it will also shift 98 IT staffers to employment with DXC Technology, an IT and consulting services company it has worked with since 2012.

Theranos Investors Turn Scavengers on Wounded Unicorn’s Remains

Two hundred Theranos investors prepare to vie with the SEC to obtain some type of recompense for the $724 million they helped raise for the private company that is now all but obsolete.

Cyberattack disrupted Baltimore emergency responders

A cyberattack over the weekend forces Baltimore’s emergency dispatchers to revert to manual processes for 17 hours.

Morning Headlines 3/28/18

March 27, 2018 Headlines No Comments

CDRH to Open Digital Health Pre-Cert Program to More Companies by Year’s End

FDA will expand its digital health pre-certification pilot program by the end of the year, taking on more companies beyond the 10 current participants.

Cybersecurity team will ‘lie, cheat and steal’ to protect Blue Cross patients’ data

The 24×7 regional security monitoring center of Blue Cross Blue Shield of IL, MT, NM, OK, and TX employs 200 analysts to look for foreign access and unusual member activity.

CFO says hospital district remaining positive

The CFO of Medical Center Health System (TX) blames its credit downgrade to a worsening local economy and the hospital’s Cerner implementation, which he says “has really hurt us from an accounts receivable standpoint.”

Finger Lakes Health pays ‘ransom’ over cyber attack

Finger Lakes Health (NY) pays an unspecified sum to to bring its systems back online after a week of ransomware-caused downtime.

News 3/28/18

March 27, 2018 News 4 Comments

Top News

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FDA will expand its digital health pre-certification pilot program by the end of the year, taking on more companies beyond the 10 current participants.

FDA says it regrets labeling the project as a “pilot” since it is more of a co-development project that will allow app vendors who earn FDA’s pre-certification to fast-track getting their products to market. 


Reader Comments

From Headcounter: “Re: your ‘People’ section. Today, 100 percent of those listed are men and your overall ration is about nine to one male. I can’t give you a pass any longer. Many women are powerful in this field, but for some reason don’t get the same recognition. Maybe your criteria are male-centric and you need to adjust them?” As the messenger you’ve just shot, allow me to explain my criteria for reporting job changes: (a) full-time VP positions and above, and (b) either the hiring company is one I’ve heard of or the new hire has enough industry history so that readers will likely know him or her (few readers would care about a health IT company hiring an HR VP from a local bank). My sources of information are press releases, someone notifying me directly, or LinkedIn if the person is connected to me. Any gender imbalance you see in the People section reflects the industry, not my coverage of it. That solution lives far above my pay grade.


HIStalk Announcements and Requests

My favorite response so far to “What I Wish I’d Known Before … Retiring or Career Downsizing” notes the impact of “an insufferable department director and an incompetent CIO.” What say you on the topic of getting off the career treadmill?

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I’m having a post-HIMSS swag fest in wearing a great Cantata Health sweatshirt and sampling Ellkay flavored honey (the chocolate is way dangerous, but I wouldn’t kick the cinnamon, vanilla, or Himalayan salt versions out of the kitchen either).

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In another post-HIMSS moment, I now know what Brianne and Lorre were doing with the Polaroid cameras in our booth – inviting visitors to have their photo taken with the Smokin’ Doc and to write their messages to me on the result. Thanks to the 100 or so folks who participated. Lorre sent me the album in which she mounted the photos in and I’m pretty sure I’ll page through it often since this hobby (sitting alone trying to fill an empty laptop screen with something interesting while remaining anonymous) makes it easy to feel disconnected and to forget that actual people are on the other end. Now I can see them.

Here’s a fun fact told to me by a guy who has used repeated “trial subscriptions” to SiriusXM to get years of service for free (which I’m not advocating). Email servers usually ignore periods to the left of the @ sign, so you can sign up with “thisisme@myserver.com” and then sign up again later with “thisis.me@myserver.com” in looking like a new subscriber while still receiving the confirmation emails.

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A fun item I found: Pushbullet, an app and Chrome extension (versions are also available for Firefox and Windows) that automatically mirror your phone’s notifications and SMS messages to your computer and also let you exchange text messages, links, and files right from your computer’s browser to a phone. I didn’t know I needed it as a minimal phone user, but since I’m on Android, I kind of do.


Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

Previous webinars are on our YouTube channel. Contact Lorre for information.


Announcements and Implementations

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Gay dating app Grindr will send its male users reminders to get an HIV test every 3-6 months, give them directions to the nearest testing site and allow non-profit testing centers to advertise their services at no charge.

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Apple announces a new 9.7” IPad that will start at $329 for the 32 GB model. It lacks some of the advanced features of the Pro, but still has the Retina display, the A10 Fusion chip, and Apple Pencil support. It appears to be targeted to schools since it was announced at an education conference and schools get modest discounts. The IPad Mini 4 — like the clearly obsolete Macbook Air — makes even less sense than it did before since its display is just 7.9 inches and it costs $70 more, although with 128 GB of memory.

Primary care technology vendor Canvas Medical announces GA of its EHR, claiming that its autocomplete-powered documentation is three times faster than the top three EHRs, requires 80 percent fewer clicks, and eliminates the need for separate population health management software. Pricing starts at $599 per month. CEO Andrew Hines used to work for Practice Fusion. The company appears to have about a dozen employees, which isn’t many when you consider ongoing support, further development, and keeping all those bosses of non-concierge doctors (insurers and the government) happy. Cascade Family Practice (WA) was quoted in the announcement, but I notice that its patient portal is still Athenahealth.


Privacy and Security

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A fascinating article describes how scammers make a fortune using Facebook (and so does Facebook) by using Facebook’s targeting software to push affiliate ads based on location and language, often buying phony Facebook accounts to keep the ads going. The king scammer — a 31-year-old whose dubious career accomplishments have made him one of Poland’s richest people at a net worth of $180 million (and a billboard purchaser, above) — says Facebook sends a mixed message by claiming to shut down suspicious accounts while it also sends company reps to scammer conferences to encourage them to buy more ads. He admits that affiliates – companies that pay him a percentage of sales when his ad for their product is clicked — are stealing from the poorest people, but says the real problem is a capitalistic society that is based on convincing people to buy things they don’t need. His next idea is creating a cryptocurrency that will turn his business into a billion-dollar company.

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I don’t know who Dylan Curran is, but click these links he provided in Twitter to see just how much Facebook and Google know about you:

  • https://www.google.com/maps/timeline?pb (every place you’ve been with your phone turned on).
  • https://myactivity.google.com/myactivity (your search history from every device combined).
    https://adssettings.google.com/authenticated (your profile as provided to advertisers).
  • https://www.youtube.com/feed/history/search_history (every YouTube search you’ve ever performed).
  • https://takeout.google.com/settings/takeout (where you can download your entire Google history). Dylan’s 5.5 GB file contained bookmarks, emails (including deleted ones), contacts, Google Drive files (including deleted ones), photos taken, calendar, businesses from which goods were purchased and the items bought, websites create, phones owned, pages shared, and how many steps he took each day.
  • Facebook also offers a download that includes every message sent, files sent or received, phone contacts, audio messages sent or received, a list of topics it thinks you’re interested in based on your Facebook interaction.
  • Windows 10 enables by default tracking location, installed apps, when the apps were used, access to the webcam and microphone, emails, calendar, call history, files downloaded, photos and videos, and search history.

The Dallas paper profiles the regional security monitoring center of Blue Cross Blue Shield of IL, MT, NM, OK, and TX. The 200-analyst, 24×7 center looks for foreign access and unusual member activity. It’s run by SVP/CISO Kevin Charest, PhD, who held a similar job with UnitedHealth Group and was CISO of HHS. He was also previously a VP of Greenway Medical and a US Army captain. 

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Finger Lakes Health (NY) pays an unspecified sum to to bring its systems back online after a week of ransomware-caused downtime.


Other

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The CFO of Medical Center Health System (TX) blames its credit downgrade to a worsening local economy and the hospital’s Cerner implementation, which he says “has really hurt us from an accounts receivable standpoint.” The previous CFO attributed the hospital’s 2017 bond downgrade to the $55 million it spent on Cerner.

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A poll finds that high costs caused 40 percent of Americans to skip doctor visits, prescribed tests, or treatments in the past year. Around 30 percent said they had to choose whether to spend their money on medical bills or on necessities such as food, heating, or housing, while respondents who faced with healthcare expenses used up their savings (36 percent), borrowed money (32 percent) or saved less (41 percent). Half said the were billed for services they thought their insurance covered and one-fourth of respondents had a medical bill turned over to a collections agency.

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NC-based mental and behavioral services managed care provider Cardinal Innovations Healthcare sues former CEO Richard Topping for the $1.68 million he convinced the organization’s board to pay him in the severance agreement he drew up himself. Cardinal’s investigator also claims that former CIO Pete Murphy committed wrongdoing by helping Topping download 1.5 GB of confidential company information a few days before he was fired. The two were apparently planning to launch a privately backed competitor to Cardinal. “I can’t wait until we’re rich,” Murphy said in an email to Topping. The other fired executives who received severance were Murphy ($740,000), the COO ($690,000), and the chief medical officer ($684,000). Topping and Murphy have since started the DC-based Shao, described on LinkedIn as “a technology partnership between health plans and telecom carriers to provide plan members with digital connectivity and the tools to maximize that access for better health and wellness.” The most interesting aspect of this is that fired CEO Topping has impeccable credentials – he earned a JD degree, an MPH from Harvard, was a judge advocate in the US Army, served as legal counsel for Brigham and Women’s Center for Bioethics, and was a US Department of Justice trial attorney.

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Belgium-based Materalise earns FDA approval for its 3D printing software that creates anatomical models for planning surgeries.

This offshore market research company’s $4,450 report predicts “incredible” (7.3 percent – is that incredible?) growth for the LIS market, although one might question its qualifications even beyond the fractured English — it lists products from McKesson (sold to Allscripts last year) and Eclipsys (sold to Allscripts in 2010 – Eclipsys had acquired SysWare in 2006 but its LIS seems to be defunct). You get the feeling that the report won’t actually be written until someone orders a copy.

A Brigham and Women’s ICU doctor observes in a New York Times article that patient end-of-life wishes are often not respected because clinicians don’t see them in the moment of need. Reasons: the advance directives are buried in the EHR progress notes and lack of interoperability means that the preferences won’t be seen if the patient falls ill away from home or after transfer to a nursing home. The author likes the idea of patients being able to maintain their own advance care planning documentation on a smartphone app, but wishes that “the EHR isn’t just a clunky online version of a paper chart but actually a tool to help us do our jobs better.”

A small interview study of patient portal users finds that two-thirds of them viewed test results that did not contain an explanation from their doctor, triggering frantic phone calls (sometimes after office hours) and online searches as the patients tried to get more information. The authors conclude that just posting test results on a patient portal without context isn’t adequate. A Kaiser Heath News article describes an internist who checked her husband’s patient portal with his permission and found from it that he had widespread metastatic cancer, after which she kept rebooting her computer and rechecking it in disbelief (he’s OK now).

Sometimes I run across bizarre items that earn the Weird News Andy seal of approval even though WNA didn’t send them to me. Here’s one: surgeons in India determine that a woman’s eye and nose pain are being caused by the wriggling of a 2.5 inch worm lodged right behind her eye, which they remove via nasal surgery. Larvae of the Lua Lua worm (also known as the African eye worm) are spread by biting flies and live under human skin. You can thank me later for not including the BJM Case Reports photos.


Sponsor Updates

  • Boston Software System publishes a white paper titled “EHR Migration Guide.”
  • Solutionreach integrates its patient relationship management system with Epic and adds its app to Epic’s App Orchard.
  • CSI Healthcare IT employees volunteer with Habitat for Humanity as part of its Gives Back program.
  • The Sequoia Project re-elects Surescripts Chief Administrative, Legal, and Privacy Officer Paul Uhrig to its board.
  • Fortified Health Security partners with Beach Health System to strengthen its cybersecurity program.
  • HealthcareNow Radio interviews Aprima COO Neil Simon.
  • Chiropractic software vendor EZBIS will integrate Ability Network’s all-payer RCM application into its practice management system.
  • Optimum Healthcare IT publishes an infographic titled “EHR Trends – Usage and Adoption.”
  • CenTrak empowers IoT solutions in the Australian healthcare sector.
  • CTG publishes a new case study, “Inova Health System Relies on CTG for Post-Implementation Helpdesk Solution in a Production Environment.”
  • Heather Espino (Centura Health) joins Culbert Healthcare Solutions as Epic manager.
  • Dignity Health features Docent Health on the cover of its Hello Health magazine.
  • Meditech publishes a case study of patient engagement at Ontario Shores Centre for Mental Health Sciences, which uses Meditech’s patient portal to improve recovery, improve patient self-assessment scores, and reduce appointment no-shows.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 3/27/18

March 26, 2018 Headlines No Comments

Shulkin survival odds decline

Rumors continue to swirl around predictions that President Trump will soon fire VA Secretary David Shulkin, MD, with the AP reporting that former Cleveland Clinic President and CEO Toby Cosgrove might be a replacement frontrunner.

Data Breaches at Hospitals Associated with Thousands of Additional Patient Deaths

After taking into account quality scores, remediation activities, regulatory inquiries, litigation, and diverted resources, a Vanderbilt University researcher concludes that hospital data breaches lead to 2,100 patient deaths annually.

California Medicaid expansion enrolled hundreds of thousands of ineligible people, federal report finds

Citing deficiencies in the state’s computer system, an OIG report concludes that California spent $1,893,000 on enrolling ineligible or questionably eligible Medicaid beneficiaries as part of its Medicaid expansion.

Consortium led by London CSU wins national contract to build population health dashboard

NHS England awards a consortium led by North East London CSU a contract to build a population health management dashboard built on Cerner’s HealtheIntent software.

Curbside Consult with Dr. Jayne 3/26/18

March 26, 2018 Dr. Jayne No Comments

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I received quite a bit of feedback on last week’s piece that mentioned the concept of moral distress. Someone experiences moral distress when they know there is a “right” thing to do, but are blocked from pursuing it by institutional constraints. It was previously spoken of in clinical circles and can contribute to burnout. We’re seeing more and more people experiencing these symptoms even if they’re in support roles as opposed to being frontline clinicians.

One reader noted:

Spot on. Having been in the vendor side of the house for over 40 years, I’ve seen the challenges of performing daily duties grow exponentially, especially in the clinician environment. Volume over value is one direct contributor to this headache. As long as earnings per share remain king in the mind of the C-suite (indirectly, but this is how the folks on the carpet think if you ever have a meaningful discussion with any of them) and maintaining decent margins is the most important focus, the system will never be people-centric. Empowering mid-level leadership has been the nemesis of success for many, many years. We have a disease management system in that generates $3.7 trillion annually; makes this system the largest employer in the domestic US (outside of the US government); and is trying to transition to a true healthcare system. Until the right entities and people are brought to bear and focused upon, status quo will remain king.

With the push towards analytics and true disease management (capturing the most expensive patients and figuring out how to care for them in a way that is less expensive) we’re starting to see some movement, but not enough. Many primary care practices are caught in the chicken-or-egg situation where you have to have money to buy software and hire care coordinators to manage complex patients to get paid for care coordination. Even the “incentives” available as CMS payments don’t cover the overhead of actually performing the care coordination for many practices, and unless you’re involved in full risk contracting, you’re not likely to see that money returned to your practice as “savings.”

On the software front, I see many vendors pushing slick-looking analytics platforms, but they’re not able to deliver the education needed to help practices actually move the needle. It’s one thing to learn how to identify the patients and document on them, but it’s another thing entirely to learn how to interact with those patients and come up with creative strategies to work around their barriers to care. Most of the care coordinators I know are magicians, pulling from a bag of tricks to fight complex situations involving lack of financial resources, unemployment, neglect, depression, anxiety, abuse, trauma, food insecurity, and more. When the frontline team caring for these patients doesn’t have enough “tricks” in that bag, it really doesn’t matter whether you’re working from the shiniest application or from the much-maligned Excel spreadsheet to track your patients.

Still, people are working hard to try to minimize the problems that care teams face. A reader on the Informatics side of the house had this to say:

We implemented quarterly release cycles. We first defined what we considered support and maintenance (change a price on a fee schedule, update a med on an order set, add a new employee to a work queue, etc.) with specific turnaround times. This was ongoing work that was on a daily o rweekly basis. Everything else, including optimization enhancements and projects, were on a strict quarterly release cycle. Originally, we implemented this as a way to achieve economies of scale with our build, testing, training, updates to policies and procedures, etc. For example, prior to release cycles, we ran the same test script multiple times to test a variety of build items for different projects. With release cycles, we streamlined this so we only had to run the script once that would test the build for those same projects. We found that we gained a significant amount of capacity back to those same teams.

In an employee engagement survey conducted approximately nine months after the implementation of release cycles, we noticed an almost 40 percent improvement in scores related to stress, burnout, and anxiety. It was the best improvement across the entire survey. Because of the significant increase, HR conducted many follow-up surveys and focus groups to try to better understand the increase. One of the major contributing factors was the implementation of the release cycles. When asked why, people (nurses, physicians, IT, etc.) almost universally said that the predictability of the release cycles (we started a new cycle the first Monday of a calendar quarter and would go live on the last Tuesday of the quarter) allowed for better change management and to plan their schedules accordingly. Part of their stress levels was that people felt everything changing constantly on them from a day-to-day basis. The release cycles allowed them to better understand the changes to their workflows and adopt the new change before introducing additional changes. We never thought about release cycles in those terms, but it became a significant factor in its continuing success. In fact, when we had to deviate from our cycles for ICD-10 implementation due to external factors, it created significant pushback from operations. I just wanted to share my experience for a potential strategy that other organizations might find useful.

Well said, and solid concepts. I continue to see organizations (and vendors) who don’t have a well thought out release strategy. Or perhaps it’s well thought out but poorly executed. From an end user standpoint, I see the best adoption when break/fix is separated from enhancements and new features, even though that might mean a bit of overlap in training strategies. It’s tempting to say lump it all together, but that can mean users spending more time on broken platforms while trying to save a buck.

Employees are more resilient than we think as far as being able to compartmentalize different types of change. In my CMIO life, we rolled out “urgent fixes” such as new drugs or charge changes after hours on a relatively real-time basis, with notification to those who had logged the issues. The rest of our fixes were deployed monthly, with communication of the emergency items added to that communication so that we weren’t bombarding general users with all the “urgent” items. The monthly package was always deployed the same night as the physician IT advisory board meeting, so that we could re-communicate the changes (and because the analysts were already staying late, so we could save on the catering by feeding both crews at the same time).

Major upgrades to the application happened twice yearly and we opted to hold some workflow changes until those releases — even though they may have been patched earlier — in the event that we thought more intense training was needed for successful adoption. Those major releases included Web training, in-person training, and 1:1 training where needed, whereas the monthly patches were basically described in newsletter format.

It worked well for us and seemed logical, so I was surprised when I went out into the larger world and saw the mess that some groups make of application change management. One organization just threw patches on the system every Thursday night, regardless of whether the patches addressed issues of record. There was no communication to end users. Another communicated every little thing, whether it was relevant or not, causing the users to miss important issues.

Of course, if you’re on a vendor-hosted platform, you might not have the choice to identify how and when you’ll be updated and upgraded. In my clinical world, I often come in to some surprises regardless of how well the team has tried to communicate them. Usually they’re small, though, and our clinicians are adaptable, so not having that level of control isn’t as major of an issue as one might think. Of course I might feel differently if this was software for the operating room, the ICU, or another high-stakes environment, but for urgent care, it works.

I always appreciate hearing from readers, especially when there is concrete advice involved. How is your organization working to reduce burnout? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Nancy Ham, CEO, WebPT

March 26, 2018 Interviews No Comments

Nancy Ham is CEO of WebPT of Phoenix, AZ.

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Tell me about yourself and the company.

I’ve been in healthcare for 25 years now, which is hard to believe. I’ve been fortunate to work my way across the continuum of care, starting with primary care, then specialist, hospital, and now post-acute, with some forays into payer, pharma, and lab along the way. I’ve been fortunate to work in a lot of different kinds of companies, from a startup that became a billion-dollar IPO to VC-backed companies that became part of bigger companies to being in a Fortune 50 division. I’m currently at WebPT, which is the leading EMR for the $30 billion rehab industry.

What are the similarities and differences between software used in an outpatient therapy setting versus that used by hospitals and physician practices?

It’s all about fit for purpose, especially EHR. As the name implies, it is purpose-built for its user base, which in our case is physical therapists, occupational therapists, and speech-language pathologists. You can imagine how different the diagnostics and clinical workflows might be from dermatology to cardiology to physical therapy. That’s why you’re seeing a lot of growth and activity in vertically specialized EHRs, like WebPT, Modernizing Medicine, and others.

Are outpatient therapy clinicians happier with their specialty-specific EHR than EHRs in general?

We were founded by a physical therapist, Dr. Heidi Jannenga. We often hear from our customers that it’s obvious that the product was written by a physical therapist. It supports their clinical workflow and thinks the way they think. We work very hard on that because we want to be as unobtrusive into the patient conversation as possible and be as compliant and efficient as possible to let therapists spend as much time as with their patients and as little time as possible with documentation. That’s a hard task, and something we constantly come back to. How can we improve? How can we make it better? How can we incorporate new, emerging technologies, like voice?

I also think it’s worth noting that there’s a lot of dissatisfaction with EMRs, both general and specialty. In fact, the last survey I saw showed that only one of the eight major general EHRs had a positive Net Promoter Score. We’re very proud to have a strongly positive NPS at 32, which I think is a reflection not only on the software, but on all the other pieces we bring that help our customers achieve their goal and our mission, which is to help therapists achieve greatness in practice. That means clinical greatness, financial greatness, and patient satisfaction greatness and then wrapping all that with stellar service and education.

We often focus a little bit on the product when having this dialogue as an industry. But to me, it’s about the entire ecosystem that you provide to your clients — we call them members — to support them in every aspect of what they’re trying to do.

Is the trend of consolidation at every level of healthcare, from providers to insurers, affecting your customer base?

Very much so. There are about 36,000 to 40,000 outpatient rehab clinics and we’re very privileged to serve 12,000 of them, so about a third of the industry. But as we’ve seen in virtually every other healthcare vertical, bigger companies are now being created. We have customers ranging from a single clinic to our largest customer’s 1,600 clinics. That’s an exciting change for the industry, because as we create more clinic operators of scale, it opens up a broader opportunity to participate in value-based care, for example. You now have some geographic density that matters to an IDN or a payer and you can participate in bundles or an ACO or whatever value-based care arrangement might happen.

We also see larger operators become able to invest more in data-driven clinical outcomes, which is a topic we’re particularly passionate about as a company. They are able to participate more vibrantly in that care continuum. I don’t know if you’ve been to PT, but I myself am PT patient. I spend a lot more time in that clinic than I do in my doctor’s office. We also think there’s an interesting opportunity for physical therapy to have a louder voice in primary care because of the hands-on time they’re spending with their patients. That’s something we want to support.

The opportunity here is that every year, 128 million adult Americans have a musculoskeletal condition that lasts more than three months that would benefit from physical therapy. Only 8 percent of them make it to physical therapy, so the other 92 percent are getting opioids or pain meds. They’re getting imaging, surgery, or perhaps nothing at all and they’re just sitting at home in pain.

As the industry is consolidating and expanding, it affords us a better opportunity to bring more patients to PT and make that 8 percent 10 percent or 15 percent. There’s a growing body of clinical evidence that PT is the best clinical pathway for a number of conditions in terms of cost and quality and in terms of the patient not just getting better, but getting well.

I’ve read that a big problem in physical therapy is that patients don’t complete their treatments, either because of cost or because they feel better. What have you learned about how your provider customers engage with their patients?

I’ll admit that I was initially a PT dropout myself. I quit going after my third visit because I felt better. But I was not well. I’ve since returned, completed my course, and returned to my best health. That’s a common issue. Patients are busy, and if they’re paying out of pocket, it’s expensive, so they tend to quit as soon as they’re seeing some progress.

That’s where we can use technology to help patients understand what their best outcome is. We have a data-driven clinical outcomes product. We can predict how much recovery of function you will gain based on the number of visits. If we can illuminate that to patients — to show them that if they would complete their course of care, their range of motion, for example, might improve another 30 percent — that would be motivational.

We acquired a company last year that allowed us to launch a new digital mobile platform to help patients communicate securely with their clinician to continue their therapy between visits from home exercise programs, or HEPs. HEPs are an important part of the PT story. Also to share their honest feedback on a Net Promoter Score basis.

Patients drop out because they have a bad experience. It could have been parking, the front desk, understanding their bill, or the clinical care. By helping illuminate that in real time to our practices, we’re giving them a real-time chance to intervene with that patient and have that conversation. We’re seeing good data that this combination of tools increases the stickiness of patients with their prescribed therapy. We’re excited about that as a trend for both patients and our clinics.

Is there any movement toward PTs using technology to help patients do their exercises effectively at home, like a video PT visit?

Yes. One of our new products is a robust, video-based mobile platform for patients to understand what they should be doing. To see it, repeat it, and communicate with a therapist how that’s going.

There’s a lot of invention happening in the next wave of virtual rehab, whether it’s using an avatar or using a 3D camera to literally measure your performance. We’re in the early stage of those technologies and maybe a little early stage on the business models to support them, because telemedicine at large has not yet penetrated into the rehab market the way it has in other verticals. There’s a lot of opportunity there for both patients and for sponsors, like employers who want to offer more convenient, more affordable ways for patients to recover from a work injury, perhaps. It’s an area we’re watching very closely.

What are your biggest takeaways from the HIMSS conference?

It was my 25th year attending. I learn less from HIMSS than I used to. It’s more an opportunity to see customers and partners and network with thought leaders in the industry.

I was struck by the amount of virtual assistant technology being shown. This introduction of voice to make technology easier for clinicians to use while they’re in direct patient engagement is encouraging. While perhaps machine learning, artificial intelligence, and big data are being over-hyped, we’re starting to see some real, practical uses of that data. That’s something we’re doing in continually improving our outcomes product — getting more predictive about what’s your best course of care and what is your likely outcome. Blockchain — not Bitcoin, but blockchain — is something that’s very interesting and I’m starting to become more optimistic that we’ll see some real adoption of it in healthcare.

What would you recommend to women who want to move into health IT leadership roles?

I would suggest they watch the amazing HIStalk webinar that Liz Johnson and I did on secrets to success for women in HIT. Thanks to HIStalk for affording us that opportunity.

Things are getting better, but it is incumbent upon women to actively study and learn what they can do to be more effective in their roles, to be more effective in leadership, and to be more effective in managing their careers.

My best advice to everyone is to make networking a part of your everyday life. Healthcare is such a collegial industry. I’ve virtually never been rebuffed when I’ve reached out to someone to say, “I’m interested in learning from you. I’m interested in your career path.” In those connections, you both learn and are inspired by someone else’s story. You make a new friend and maybe come away with a good idea for your project, your company, or your career.

Do you have any final thoughts?

In my 25 years, I’ve been a passionate advocate for interoperability. I started out in the mid-1990s trying to build CHINs — community health information networks — and most recently led Medicity, the large HIE company in our industry, processing billions and billions of real-time clinical transactions a year.

I would like to call upon my fellow EHR and EMR CEOs to continue to open up our platforms to innovators, to data exchange, and to supporting the patient’s journey. It is the patient’s data. We are honored to be entrusted with that data. Our job is not to lock it up, but to digitize it in an appropriate way that helps the patient achieve their best outcome while achieving the Triple Aim. I would love to see my fellow CEOs step up and do more in this regard.

One thing we’ve done here at WebPT since I joined is to create a vibrant partner ecosystem. We are supporting our customers as they find and implement all sorts of innovative, interesting other technologies that help them run their practices and serve their patients.

Morning Headlines 3/26/18

March 25, 2018 Headlines No Comments

Israel to launch Big Data health project

Israel will spend $287 million to make the health data of its 9 million citizens available to researchers and private companies for work on preventive medicine and personalized medicine projects.

Health IT groups happy with the omnibus

The federal government’s spending bill leaves ONC’s annual budget unchanged at $60 million – at least through September – instead of being reduced to $38 million as requested by the White House.

As Ascension restructures, it hints at smaller hospital footprint

Ascension Health (MO) President and CEO Anthony Tersigni tells 165,000 employees that the 151-hospital health system will embark on a “dual transformation” that will shift its focus from hospital services to more outpatient care and telemedicine.

CMS Deputy CIO to Replace HHS CISO Departing Amid Controversy

HHS CISO Chris Wlaschin announces his resignation, putting the Healthcare Cybersecurity and Communications Integration Center on even more tenuous ground given the departure of its director and removal of its deputy CISO.

Monday Morning Update 3/26/18

March 25, 2018 News 1 Comment

Top News

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Israel will spend $287 million to make the health data of its 9 million citizens available to researchers and private companies for work on preventive medicine and personalized medicine projects, Prime Minister Benjamin Netanyahu announced Sunday.

Most citizens of Israel belong to HMOs, whose EHRs will provide the electronic patient data to the government unless they opt out.

Concerns have already been expressed about patient confidentiality and whether the billions of dollars Israel could charge drug companies for using the data will trigger higher drug prices.


Reader Comments

From Imaginary Lover: “Re: Dr. Jayne’s comments about SteadyMD’s CEO declining to comment on its SEC-reported funding. It’s unusual, but understandable. Funding comes at a cost that includes loss of control and dilution (sometimes massive) of previous shareholders. The co-founder and CEO who declined to comment was probably a major shareholder before this infusion, but maybe not afterwards. New funding may save a company from certain death (bankruptcy) but can be the beginning of another kind of sickness – now the company has to pull a rabbit out of the hat for the new investors in short order to give them a return. If it can’t, investors may pull the plug or fire the CEO. The fellow who invested his time, sweat, money, and lifeblood is taking on risk and losing equity, all in one fell swoop. Trying to act like the belle of the ball in those circumstances must be a challenge. I feel for the guy.” I enjoyed the wit, warmth, and insight of this comment so much that I’ve asked the author to consider making further contributions. Sometimes you just read something that elicits a “I want to hear more from you” response.


HIStalk Announcements and Requests

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Not only do we have much work to do in delivering a “comprehensive health record,” we can’t even agree on how far along we are. Reader comments note health system data hoarding, the lack of semantic standards needed to make exchanged data useful, and health systems that don’t fully populate what could be a complete medical record.

New poll to your right or here: what online sources have you used in choosing a doctor? I always pair up my insurer’s director with Healthgrades and haven’t used any of the other sources I listed.

Responses to “What I Wish I’d Known Before … Being Admitted to a Hospital or Being Seen in the ED” suggest that while hospitals provide many of us with our living, our experience as patients in them is frustrating and sometimes dangerous. One bizarre example: a hospital insisted on giving a newly-admitted patient the meal that the room’s since-discharged previous occupant had ordered (a fruit cup), so the famished poll respondent ordered a nice dinner on discharge day so the next patient wouldn’t starve.

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Let’s hear from folks who have retired or downsized their careers – what do you wish you’d known?


Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

Regulators approve the merger of Advocate Health Care and Aurora Health Care that will create the country’s 10th-largest non-profit health system upon closing next week. Advocate Aurora Health will have 27 hospitals, 3,300 employed physicians, 70,000 employees, and annual revenue of $11 billion. The organizations predict that synergy will support the always-promised, never-delivered goal of higher quality and lower cost.

Wolters Kluwer completes its acquisition of 16-employee medical student learning platform vendor Firecracker.


Sales

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USC’s Keck School of Medicine joins the global health research network of TriNetX.


Decisions

  • MultiCare Deaconess Hospital (WA) will go live with Epic in summer 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

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The analytics-powered insurer that is being created in a joint venture between Sutter Health and Aetna hires Steve Wigginton (Valence Health) as CEO. Evolent Health acquired Valence Health for $219 million in October 2016, after which it replaced Valence’s CEO Andy Eckert with Wigginton, then Evolent’s chief development officer. 

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Culbert Healthcare Solutions hires Wayne Thompson (Mount Nittany Health) as executive consultant.


Announcements and Implementations

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Alex Scarlat, MD publishes “Medical Information Extraction & Analysis: From Zero to Hero with a Bit of SQL and a Real-life Database.” It gives clinicians an introduction to SQL using hands-on exercises running against a de-identified ICU patient database from BIDMC. It also helps IT folks understand the data elements that interest clinicians.

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I also noticed when looking up Alex’s book on Amazon that Springer has published a review and self-assessment for the ABPM’s clinical informatics board exam. I can’t vouch for the ultimate outcome of improving test scores in return for your $125, but the material looks solid, the writing is meaty, and the sample test looks darned hard. The other available review book ($129) has just three Amazon reviews, but one titled “Not fit for sale” raises a red flag in noting that “clinical” is misspelled on the book’s spine.


Government and Politics

The federal government’s spending bill leaves ONC’s annual budget unchanged at $60 million – at least through September – instead of being reduced to $38 million as requested by the White House.

In Canada, New Brunswick offers a $2,500 bonus to doctors who start using its provincial EHR, hoping to entice the 400 of its 750 physicians who haven’t transitioned off paper charts to do so. The EHR was implemented in 2012. 

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A surgeon in England believes that the Syrian military hacked his laptop to determine which hospital he was helping with video surgery consultations as featured on a BBC program, after which suspected warplanes destroyed the hospital with a bunker-busting bomb. A security expert suggests creating a VPN connection for secure laptops, but the surgeon has since stopped offering video help to doctors in war-torn areas.


Other

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Harvard Business Review describes Mayo Clinic’s effort to reduce ICU clinician overload caused by a never-ending stream of data. They’re using “ambient intelligence” in applying NASA methods to identify clinicians whose workload requires them to filter vital information from data clutter, identifying the 60 data elements that are important for taking quick action. The end result was an EHR-connected, rules-based, color-coded dashboard that saves an ICU clinician an hour each day while improving outcomes and reducing costs. Mayo has licensed the technology to Ambient Clinical Analytics.

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A North Carolina state legislator who used her background as a nurse to sponsor several health-related bills isn’t a nurse after all. The state’s Board of Nursing orders Beverly Boswell – whose only healthcare background is as a phlebotomist – to remove her claims of being a nurse from her website, which Boswell says was due to a campaign volunteer’s error. However, video shows her telling an audience in 2014 that her background includes “providing nursing skills and medical care.” The Republican lawmaker earned more attention last week when she called a school outside her district after believing a fake news report saying that students were being required to walk out to protest gun violence, posting on Facebook afterward, “So the students that were eating Tide Pods last week run your school this week?”

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An addiction publication profiles OpenBeds, software developed by Johns Hopkins medical school faculty member Nishi Rawat, MD. Indianapolis social workers are using it to find available space in opioid addiction treatment facilities.

In China, a media company tells a woman applying for a live-streaming job that her appearance is “far from that of an Internet celebrity,” advising her to have cosmetic facial surgery at their expense. An employee went to the hospital with her on the day of surgery and told her she would need to borrow the $6,300 cost from an online loan company and would be reimbursed afterward. She wasn’t, and she was let go because she still didn’t meet appearance standards. She is suing the company. Such financing is called a “face loan” in China, where would-be Internet stars with poor credit histories often find themselves unable to pay the money back.

Vince and Elise pored over health IT vendor financial filings to name their Top 10 hospital system vendors by annual revenue. Most are unsurprising and the Top 3 hold a giant chunk of the total, but let’s hear it for those #7-10 companies that get less attention as significant players – Harris Healthcare, Medhost, and Cantata Health. Vince notes that Meditech is back in growth mode after four years of declining revenue and also observes that none of today’s top five vendors were on his 1998 version of the list at all. It’s pretty interesting that it took just 20 years for acquisitions (some of them ill-advised and three involving Allscripts buying its way into today’s Top 5) to decimate all of the 1998 Top 10 other than Meditech and CPSI. 

This is fantastic: a Columbia University surgery resident dryly analyzes the accuracy of ED and OR scenes from several dozen movies and TV shows in a  video that has earned 1.6 million YouTube views in barely more than a week. One of her many quotable lines involves her observation of Dr. House running around the OR in street clothes: “In real life, that guy would have been tackled by about six tiny perioperative nurses far before he got to the operating room.” She compares surgery to her hobby of running marathons: “You have to be a masochistic glutton for punishment with obsessive compulsive tendencies.”

Weird News Andy confidently labels this honey of a story as T63.442A, “toxic effect of venom of bees, intentional self-harm, initial encounter.” A woman dies of an allergic reaction caused by a bee sting intentionally administered in a cosmetic procedure called “apitherapy” that has been lauded by anti-medical Hollywood goofball Gwyneth Paltrow. WNA consulted the primary literature in noting the line, “after getting bee venom therapy from an unlicensed apitherapist in South Korea,”which he takes to mean that South Korea has actual, licensed apitherapists. He extends the nomenclature to counselors for software developers in suggesting that they call themselves “APItherapists.”


Sponsor Updates

  • QuadraMed celebrates Health Information Professionals Week.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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What I Wish I’d Known Before … Being Admitted to a Hospital or Being Seen in the ED

How much my ambulance / ED / hospital bill would be for a three-day emergency admission at an academic medical center in Tokyo. Being an American, I spent much of that time stressing about how much it would cost me, assuming I’d be presented with the usual five-digits-or-worse sums we get slammed with in the US. Turns out I didn’t need to stress out so much The ambulance ride was free, courtesy of Japan’s taxpayers. The ED workup, including tons of labs and imaging orders plus the three-day stay, ended up being about $2,000. I expected at least one more digit on that number. The standard of care and facilities was actually better than what I’ve seen at most US hospitals. A good reminder of just how absurdly out of hand healthcare costs in America are by comparison. In related good news, my employer’s surprisingly generous health insurance plan reimbursed the full cost, no questions asked, probably because it was way cheaper than paying for a comparable situation here at home.


1. In the Emergency Department, even though I confirmed with the reception-triage nurse that my physician earlier had called into the ED to discuss my condition and to refer me to the ED and hospital, my medical record, under referring physician, listed SELF-REFERRED.

2. For the next 5 1/2 hours, while I was waiting for a decision to be made about my painful condition and hopeful admission to the hospital, two or three of my “neighbors” in the Emergency Department room were seen and admitted to the hospital. In addition, an Emergency Department staff nurse who complained of flu onset was immediately admitted to the hospital in an available pediatric bed.

3. After another three hours, finally a call was made to the gastroenterologist on call, a Fellow. She never came to see me. I was told by the attending Emergency Department physician 1) that GF did not think I needed to be admitted; 2) that except for requiring a blood transfusion, which would be risky, I was “healthy” and I should be discharged home.

4. Three days later (after the weekend), when I appeared for a rescheduled Clinic appointment, I was immediately admitted to the hospital with intractable diarrhea, failure to thrive, iron deficiency anemia, and a urinary tract infection. I remained in the hospital for TEN days.

5. After discharge, ONLY one day later, the home health nurse, my referring physician, and the on-call hospital physician advised me to return to the ED so I could be readmitted to the hospital.

6. This time in the ED, an NG tube was placed down my throat. From the time I received the NG tube to the time I was finally re-admitted to the hospital, eight and a half hours transpired! I was told that the reason for this intolerable delay was that the Medicine and Surgery Department physicians could not determine what was really wrong with me, and so they argued back and forth about which service should admit me!


Information about your condition and treatment will be verbally communicated to you regardless of your ability to comprehend or retain it due to pain and medication. And your care is overseen by a series of non-employee hospitalists that come and go, leaving nothing but a bill and an 800 number where you can leave a message but never hear back.

Upon discharge, you will be given a paper prescription for three days of medication and instructions to contact your PCP that wont be able to see you for a week.

Within three weeks, the bills for out-of network providers that you don’t remember seeing begin to arrive and will continue to arrive over the next year.

The only coordination of care that exists is what you personally enforce so take notes as best as you can keep copies of what little information is shared with you.


I took my wife to the ED late at night one time. After a thorough examination of her condition (ectopic pregnancy / ruptured fallopian) and in consultation with her OB practice’s on-call physician, the ER team decided to wait for my wife’s personal OB to come in for his morning rounds to see her. So they admitted her, without really consulting us and considering any alternative options, for the few hours until he came in and could get prepped for emergency surgery. She had a private room for all of about four hours, but of course that resulted in a significantly larger bill. I wish we had known more about this plan and had an opportunity to weigh in on the admission decision.


My wife was admitted following a skating fall and a early evening broken wrist. The ED did not tell us that a doctor would not be available to set the break until the morning, when we could have gone to a nearby hospital and had it done right away.


Admitted after about twelve hours in the ER bay (not too much of a complaint, they’re a busy hospital) to a room shared with a women with an altered mental state who rang the nurse call button about once every half hour.

I was brought a hospital gown and trousers, which were left folded on a chair that was past the end of my bed. I was hooked up to an IV on one side, and a heart monitor on the other, so I couldn’t even crawl to the end of my bed to try and reach for them.

The main light in the room was a bright overhead fluorescent light that spanned the width of the room, directly over the head of both patient beds, meaning that every time they checked on her in the middle of the night, they turned on a light that shone through my eyelids.

Eventually they stopped turning it off altogether, so I had to try and sleep with a pillow over my eyes, while hooked up to a drip and a heart monitor.

Similar experience with meals: I was moved to a new room that was “private” (until the next patient moved in) and when dinner came around it was a fruit cup and nothing else.

  • “That’s what you ordered.”
  • “I didn’t order anything, I just got here.”
  • “That’s what the last person in this bed ordered.”
  • “They were discharged, they aren’t here to eat their dinner. I am.”

The nurse felt really bad for me and rustled up something a little more substantial, but the total lack of coordination and apparently awareness that beds turn over was startling. I made sure to order a nice full meal before I was discharged so that whoever came after me got at least something they could eat.

Being provided instructions by the nurse on how to make my own bed with new linens. I don’t know what to make of that. On the one hand, nurses aren’t maids, so it seems weird to be churlish that the nurse wouldn’t be making a bed, but on the other hand it definitely seems weird to ask a patient (who is still hooked up to a heparin drip with a heart monitor in the gown pocket) to do it.


I wish I had known that just because nurses don’t get technology doesn’t mean they can’t give you excellent care. At the time I was doing desktop support at a hospital and went to the ED with a particularly virulent GI bug. Due to a combination of factors, they decided to admit me after six hours in the ED. I went to the floor where I felt the nurses were particularly incompetent based on the interactions I had had with them about their computers. The care I got was wonderful and I was incredibly grateful and humbled.


The difference between being admitted and being observed.


That the hospitalists may not be in my insurance plan and I don’t really get to choose the one that will see me.


That the doctor treating me while at an in-network hospital was actually out of network. Then that HDHP out-of-network charge single-handedly emptied my HSA for co-pay and co-insurance.


Even though the wait at the ED seemed shorter than at urgent care, by the time you add in waiting around for the doctor to get results and then actually share them with you, it ends up equaling out, except from a money perspective. ED is definitely more expensive.


As CIO, I was shocked at how folks taking care of me used the systems we had deployed. In discussion with them, it turned out their training was not adequate or they were told “this is how we do it.” What disappointed me most was that my staff was well aware of it and had done nothing to improve the situation, including giving management a heads up. Turning that around took a long time.


I’m probably not a very good person to answer this one, but I honestly felt very prepared for my inpatient surgery a few years ago. I owe this to a pre-op surgery instruction program I attended which was hosted at the hospital a month or so before the actual day of surgery. My doctor and his staff were also very organized and on top of their processes before the day. I had all my questions answered, fears allayed, and was pretty ready to go on D-Day. In fact, my care while at the hospital was so good, I almost didn’t want to come home. Yep, I know, this sounds like a paid advertisement. But I think it was my own initiative to educate myself and the the doctors’ / hospital’s efforts to plan how to educate patients to be ready.


 

Weekender 3/23/18

March 23, 2018 Weekender No Comments

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Weekly News Recap

  • A comment made by a member of the House Appropriations Committee suggests that the VA’s cost to implement Cerner will be at least $16 billion, of which Cerner as prime contractor will be paid $10 billion.
  • RCM outsourcer Constellation Healthcare Technologies files Chapter 11 bankruptcy, accusing former executives of falsifying its financials and blaming the high debt it took on to fund acquisitions.
  • Former Vice-President Joe Biden calls for HHS to cite providers for data blocking if they fail to give patients their information electronically within 24 hours of their request.
  • A New York Times article says the NIH’s $1.4 billion “All of Us” data collection project that hopes to enroll 1 million people is moving slowly, spending a lot of money, mired in the challenge of harvesting information from disparate EHRs, and facing the reality that the US doesn’t have enough DNA sequencing machines to handle the load.
  • The IPO of Siemens Healthineers in Germany raises $5.2 billion.

Best Reader Comments

HIMSS is a necessary evil. From my perspective (i.e. for my role/life) it’s overly focused on “hospitals” and “information technology” (I get that’s a feature, not a bug – this was, after all, the Hospital Management Systems Society). Not every problem in healthcare is going to be solved using software in a hospital. Most of them are probably not. But every year, in rolls HIMSS with big booths from the heavy-iron hospital vendors (Epic, Cerner, Meditech, et al.) looking to meet with CIOs who are focused on incremental improvements to ancient and inadequate systems. All of the “education” sessions at HIMSS are some combination of hopelessly in the weeds and a veiled pitch for a piece of software that I don’t really want to buy. I really don’t need to sit in some nosebleed seats to hear Peyton Manning or Magic Johnson tell me something about healthcare. The best part of HIMSS is the Mos Eisley Cantina that is the basement or adjunct hall where HIStalk usually camps out. In those 10×10 booths are the dreamers and builders who might really be the next big thing. HIMSS has to exist, real work does get done there, but it’s really pretty deep in the machinery of the healthcare system. Will HLTH be different? I don’t know, but I’m willing to give it a shot. (Debtor)

Do we really mean data? Most of what I see in motion, even with interoperability initiatives and FHIR APIs, are records — which is to say, documents and text representing the documentation of care, mostly in a legal medical record sense. As a clinician, I can say that, no doubt, this information has use and value, especially compared with the alternative. Still, it is far from computable. Biden’s interest in data sets shows he is reaching for the latter, and I am beginning to think the lack of distinction is really a problem, expectations-wise. Hopefully, ongoing progress in natural language processing (is the language really that natural?) will save us (by which I mean, me, the clinician) from fixing it, by becoming even more of a data entry worker. (Randy Bak)

Orwellian Aeron chair: If sitting is the new smoking, I’m sure this exercise motivator will have some real health benefits. Perhaps a little electroshock to get us up and about on a regular basis? I’m looking forward to Weird News Andy’s updates covering the exhaust analysis feature: colon cancer screening, dietary recommendations, etc. (Another Dave)

Epic, Athena, Allscripts, NextGen, Cerner, and others are all doing the same thing – they have open APIs, but make it very difficult to get approved to access data. (Annon)

I agree that it’s unfair and irresponsible to lay this [social determinants of health] at the feet of physicians. They certainly aren’t in control of all the economic and social factors that inform the health of this country, but its equally unfair to point the finger at patients themselves as if all the external circumstances that impact them (housing, job, food access, sexism, racism, homophobia, you name it) are 100 percent in their control, as well. (HIT GIrl)

I work in an IT department of a large IDN. The physician salaries and perks are obscene. We talk about all “waste” in health dollars, but I would like to see all these hospital costs out in open and distinguish between the costs borne by the hospital for conducting the tests and costs due to physician salaries / payments. Looking at what goes on in our system, physician compensation is the biggest elephant in the room. (IT Guy)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. C in Utah, who asked for science books for her Friday morning STEAM lessons. She reports, “We have been so excited to open our boxes and find high-interest books for our third graders. Our class is excited to start planning our projects to demonstrate their understanding of a major science standard in third grade: interactions between living and non-living things. We have already started looking through our books. The kids can’t put them down!”

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We also funded the request of Ms. A, who asked for an air quality meter for a project her fifth grade class in Pennsylvania is doing. She says, “Students are taking turns taking home the air quality meters every three or four days. They have found enough places in their own home to check air quality from the attic to the bathroom to their stinky brother’s room to the basement. Students are recording their results in science notebooks that they take home with the books, but when they come back to school, they transfer their data to a shared spreadsheet. The kids love looking at the results. I can’t wait until everyone has had a chance to take the meters home. Then we can really explore what the numbers mean, and I can teach the students how to create graphs using Google Sheets.”

Listening: the cover of “Zombie” by otherwise forgettable metal band Bad Wolves, which while missing the seething Irish anger of the original by the Cranberries and its late singer Dolores O’Riordan, offsets it with searing guitars. O’Riordan died the day she was scheduled to perform the vocals with the band on the recording, so they released it her honor instead. Speaking of angry political songs of that era on SNL, there’s the prophetic sneering thrash of 1989’s “Rockin’ in the Free World” by Neil Young. But arguably the most discomforting social protest song ever was Billie Holiday’s 1939 “Strange Fruit.” Switching to something new, there’s a just-released album from hard rock band Dorothy.

Our booth neighbor down in the basement of HIMSS18 was integration platform vendor MuleSoft. Some of their self-absorbed sales guys were kind of rude to Lorre and Brianne, but maybe they knew what was coming —  Salesforce just bought the company for $6.5 billion.

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ProPublica reports that IBM – panicked by competition from more nimble and often global competitors and its own failure to execute – has intentionally ditched its older, higher-paid workers to replace them with cheaper newbies and offshore workers while breaking US age discrimination laws or using loopholes to avoid them. Techniques include:

  • Laying off older workers in telling them that their skills were outdated, but then hiring them as contractors at a lower rate
  • Encouraging laid off employees to apply for other company jobs, but telling managers not to hire them
  • Requiring laid off employees to pursue age discrimination complaints via private arbitration rather than lawsuits
  • Using employee privacy as an excuse for not publishing legally required layoff lists that would allow those employees to see how many of those laid off were older
  • Labeling layoffs as retirement even when the employee refused to acknowledge it as such
  • Using what IBM called “lift and shift” to lay off US employees and send their work offshore, causing IBM to now have more employees in India than in the US

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Meanwhile, Bloomberg says that GE sent former CEO Jeff Immelt packing with millions of dollars in parting gifts but has reduced benefits to employees and retirees in an attempt to make its financial numbers look better. Example: the company changed its pay schedule to push the final paycheck of 2016 to a week later, improving its year-end cash flow position; it implemented an “unlimited vacation day” policy that also means it doesn’t have to pay out the unused days as severance; and it replaced merit raises with bonuses tied to unstated objectives. The article notes, “GE has lost more than $100 billion in market value since CEO Jeff Immelt announced his retirement in June, and not because anyone misses him.”

A sharp Vox opinion piece observes that Facebook is like casinos, cigarette manufacturers, and companies that sell alcoholic beverages – it makes most of its massive profit from addicts who feel depressed and lonely and are therefore less healthy after using its product. It concludes that Facebook is “optimized for fakeness” in deliberately turning news consumption into a confirmation bias machine even as it kills off the business model of real news sources.

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Researchers find that a substantial portion of Americans – even those with health insurance – take a big financial hit after being hospitalized. A significant number of those patients never return to work, are disabled, or require unpaid recovery time. A health economist questions whether health insurance is enough to to protect people from significant income loss, as other countries also offer wage insurance, mandatory paid sick leave, and disability insurance.

Drug companies are merrily jacking up prices even as the White House claims that it will intervene, as 20 drugs had price increases of over 200 percent since January 2017. Leading the pack was skin cream SynerDerm, whose price has increased 1,500 percent. Its main ingredients: water and vegetable oil.


In Case You Missed It


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Morning Headlines 3/23/18

March 22, 2018 Headlines No Comments

HHS official who approved Tom Price’s flights resigns

John Bardis, the former MedAssets founder who as HHS assistant secretary of administration signed off on the charter flights of long-time friend HHS Secretary Tom Price, resigns effective April 6.

Finger Lakes Health: ‘Minimal patient impact’ from cyber attack

Finger Lakes Health (NY) is still recovering from a ransomware attack over the weekend that forced it to revert to paper-based processes and EHR backups.

The Yelping of the American Doctor

The threat of a negative patient Yelp review holds more sway with physicians than educational campaigns encouraging them to reduce unnecessary prescribing of antibiotics.

News 3/23/18

March 22, 2018 News No Comments

Top News

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John Bardis, the former MedAssets founder who as HHS assistant secretary of administration signed off on the charter flights of long-time friend HHS Secretary Tom Price, resigns effective April 6. He says he always intended to serve just one year. Bardis’s responsibilities include the HHS CIO office.

Second in command in HHS to Bardis — and presumably the frontrunner to replace him in overseeing HHS HR, the CIO office, and Equal Opportunity compliance — is former technology executive and Trump campaign worker Jon Cordova, who just completed his two-week HHS suspension for his pre-election social media posts.

The Facebook posts written or shared by Cordova include calling Hillary Clinton a “slimy trailer trash huckster;” accusing the Clinton Foundation of paying Gold Star parent Khizr Khan to criticize Trump; making up sex scandal stories about Senator Ted Cruz; and sharing a doctored photo of a black man holding a sign reading, “No mother should have to fear for her son’s life every time he robs a store.”


Reader Comments

From Cowtown: “Re: Microsoft’s March 15 copyright infringement lawsuit brought against Community Health Systems. Microsoft alleges that CHS stalled software audits for years and intentionally under-reported SQL Server usage by claiming only one-sixth of the production footprint. Maybe that’s not surprising when your CIO is Manish Shah, who was fired in 2002 from EMC for making his sales quota by falsifying invoices.” Shah joined CHS in 2013 after spending time at Aurora Health Care and no time in prison since he was never charged with a crime as far as I can tell and thus has never admitted guilt. I don’t have access to the filings to see what Microsoft is claiming.

From Clara Barton: “Re: the attached news item. This, apparently, is still a thing.” Indeed it is. An RN who presumably forgot to lock her car the night before wakes up to find her nursing license, laptop, and thumb drive with PHI on it missing.


HIStalk Announcements and Requests

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Please tell me what you wish you’d known before being admitted to a hospital or seen in the ED. I’ve spent only one night in a hospital and that was a waste of time since nothing turned out to be wrong with me, but what I wish I’d known (not that it would have helped except as incentive to go elsewhere) is:

  • That the ED person who reassured me that the hospital has only private rooms was either misinformed or lying since I was placed in a room with a guy who sounded like he was on death’s door.
  • That I would lie for hours in the ED waiting for a bed, only to find when I got there that I had just missed dinner and nothing would be available to eat until breakfast. This was after being told that I missed lunch in the ED, being offered only apple juice instead.
  • That I would be awakened all night by loud employees in the hall and by frequent vital sign and IV checks.
  • That every med I received was late and some were never administered at all, including one that the ED insisted afterward was important.
  • That the hospital would steadfastly refuse to give me an electronic copy of my information after my visit — they said they weren’t required to and would only give electronic information to doctors, not patients — and that my OCR complaint would be dismissed with no action taken against the hospital.

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Welcome to new HIStalk Gold Sponsor OmniSys. The Dallas-based company offers innovative solutions for retail, outpatient hospital, and independent pharmacies. Products include an omni-channel patient communications platform; revenue cycle management for immunizations, DME, and prescriptions; patient engagement programs; and consumer engagement analytics. The company also provides domain expertise, market insight gained from serving 25,000 pharmacies, and proprietary SaaS technology that integrates with customer workflow. The company’s rules-driven OmniLink engagement platform improves vaccination rates, therapy adherence, and post-encounter follow-up, while its Fusion-Rx provides all-channel refill and pick-up reminders, manages refill requests, and offers an inbound IVR with automated attendant and voicemail. CEO John King is an industry long-timer going back nearly 30 years, starting with Shared Medical Systems. Thanks to OmniSys for supporting HIStalk.


Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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This seems to hit a lot of timely trends. SteadyMD raises $2.5 million for its online, concierge primary care practice. It runs eight practices, most of which are specialized (bodybuilding, LGBTQ, triathlon, etc.), but one of the practices addresses general health. SteadyMD patients meet their new PCP in a one-hour video visit, after which the company collects and stores all their medical records and makes the doctor available at any time via text messaging, phone calls, or video appointments. Membership costs $79 per month. The company says its doctors can prescribe, but doesn’t provide details of how that works.


Sales

  • Washington Regional Medical Center (AR) selects Streamline Health’s cloud-based, automated pre-bill coding analysis technology.
  • The Wyoming Department of Health chooses Medicity to power a statewide HIE that it hopes to eventually connect to that of neighboring states of Colorado and South Dakota, which also use Medicity.

People

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Glytec names Ed Furlong (Kyruus) COO.

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Robert Redfield, MD will become director of the CDC. A 20-year veteran of the US Army Medical Corps, Redfield has spent the majority of his career on HIV/AIDS research and clinical care.


Privacy and Security

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Finger Lakes Health (NY) is still recovering from a ransomware attack over the weekend that forced it to revert to paper-based processes and EHR backups.

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The 40,000 users in Australia of Telstra’s Argus healthcare secure messaging software are notified that their systems are vulnerable to outside attacks since the company always creates the same user account for remote access and then stores its static password in an unsecured text file. Telstra says hackers used the information to penetrate servers via Microsoft’s remote desktop protocol with full administrative access. One person who examined a breached server said it appears that medical information wasn’t stolen, with the hacker’s main interesting appearing to be using the servers to host dating scams and to buy items with stolen credit cards. I suppose Telstra is correct in calling its service “secure” even if its installation of it isn’t.


Other

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The threat of a negative patient Yelp review seems to hold more sway with physicians than educational campaigns encouraging them to reduce unnecessary prescribing of antibiotics. Physicians Working Together has launched a petition asking Yelp to remove negative doctor reviews.

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Danny Sands, MD, MPH assures his Twitter followers that the above fax from VNA of Boston to his practice announcing its transition from mail to fax is not an early April Fools’ Day joke.

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This contraption looks downright frightening, perhaps something that Michael Myers might have created for his Halloween activities as a Shatner mask replacement. I’m willing to bet the mug that the patient is so tightly clasping is filled with either calming tea or spirits.

A survey that asked consumers to name a famous female technology leader resulted in 92 percent drawing a blank and half the remainder naming Siri or Alexa, fueling the fire under the question of why virtual assistant voices are always female.


Sponsor Updates

  • Bernoulli Health publishes a new e-book, “Continuous Clinical Surveillance: A Business and Clinical Case for Creating the Foundation for Real-Time Healthcare.”
  • Optimum Healthcare IT publishes a new white paper, “Is Healthcare Preparing for a Cyberattack?”
  • LogicStream Health releases a new podcast, “Improving care: The role of patients, technology and the art of healing with Archelle Georgiou, MD and Patrick Yoder.”
  • MedData will host a job fair March 24 at its office in Grand Rapids, MI.
  • Meditech AVP Cathy Turner, RN joins the HIMSS CNO-CNIO Vendor Roundtable as co-chair.
  • EClinicalWorks publishes a new customer success story, “World-Class Care in a Small Town,” featuring Pecos Valley Medical Center.
  • National Decision Support Co. will exhibit at the National Comprehensive Cancer Network Annual Conference March 22-24 in Orlando.
  • Experian Health will exhibit at the MultiState Managed Care Meeting March 28-30 in Atlanta.
  • PerfectServe’s Michelle McCleerey presents at the Population Health Colloquium.
  • The Chartis Group publishes a new white paper, “Everyone is a Cancer Patient.”

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 3/22/18

March 22, 2018 Dr. Jayne No Comments

It’s been a wild week of post-HIMSS email madness, with most of the vendors that I asked to “give me a week to recover before we connect” having complied with my request. It’s a new strategy I tried this year and it seems to have worked, although a couple of companies did call or email the first business day after HIMSS.

You have to give them credit for working their leads, but one company’s contacts have bordered on the obnoxious – every two days with escalating language about our need to connect, and by both phone and email. You can bet that I’m not eager to connect with someone who doesn’t understand that people don’t always respond right away and that getting frantic about it isn’t going to build a potential business relationship.

Over the last two weeks, I’ve visited a couple of long-term clients to check in on their strategic planning for the next year. Organizations vary in how good they are at this process. Some that I’ve worked with do an outstanding job, with a major annual planning retreat each year and then quarterly or monthly follow-ups. They’re a joy to work with since they set their dates a year in advance to ensure everyone can attend and that agendas are productive, since they typically pull key provider stakeholders out of productive clinic time to meet their objectives.

Others are pretty bad at it, with last-minute attempts to pull people together and slapdash agendas. The worst don’t do any strategic planning at all and then wind up in a frenzy as they struggle to meet regulatory or other deadlines.

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I was contacted by one of these organizations this week, who is looking for last-minute help with clinical quality measures reporting which is due very, very soon, as in “nine days from now” soon. I have a handful of groups reach out to me every year and all are in the same dire straits. One version of the tale of woe has the person who used to be responsible for it leaving the practice, out on medical leave, or something similar. Another version has someone running the reports regularly, but not telling anyone the numbers are bad until the end of the year and it’s too late to correct workflows. When the physicians find out, they go ballistic and I get the call. The third version has a group who knows their numbers are bad and workflows are problematic, but wants someone to “move” the data because it’s all somewhere in the EHR but just not in the right fields for reporting tools to pick it up.

I’ll help the first group as much as I can, but the rest are on their own for this reporting cycle. I’m happy to contract with the latter two to try to remediate them for next year, but I’m not going to tackle their dumpster fire (which incidentally was added to the Merriam-Webster dictionary) this year.

I enjoy reading posts by the rest of the HIStalk team, especially those that mention startups. I was baffled, however, by this piece sent to me by a reader, where startup SteadyMD refused to comment on $2.5 million in funding. Maybe they’re going for an “International Man of Mystery” vibe, but as an industry follower, it seems unusual.

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In the “truth is stranger than fiction” category, I ran across this NPR piece about a reporter who had an interesting experience while working on story featuring Theranos. I’ve heard of people going off the rails during an interview, but the alleged pulling of a fire alarm to force the evacuation of a pharmacy and stop the interview is a new one.

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April 16 marked Match Day, where tens of thousands of medical students are herded into auditoriums to learn their fate for the next three to five years in front of classmates and loved ones. It’s a variable experience, with some people whooping for joy and others seeing their dreams crushed. Many of us have mixed feelings about it. My medical school had a keg delivered to the auditorium lobby, so you were either celebratory or partially anesthetized by the time the envelopes were handed out.

This year’s Match set a new record, with over 37,000 applicants participating. The match results are always telling as far as physician workforce and the popularity of specialties among US medical school graduates. Programs filling with more than 90 percent US grads: interventional radiology, orthopedic surgery, integrated plastic surgery, radiation oncology, neurological surgery, and otolaryngology. The three main primary care specialties were in the “programs that filled with less than 45 percent US grads” category: family medicine, internal medicine, and primary pediatrics. The fact that US grads don’t want to go into these specialties should be very telling. Congrats to my neighbor who matched in a highly competitive specialty, even though he will be wading through lots of snow for the next six or seven years.

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The highlight of my week was being on a conference line today with the funniest hold music I’ve ever heard. UberConference allows account owners to select their hold music, with one of the options being a song about being stuck on hold on a conference line. I’m sure it might have the potential to become annoying, but today it was just what I needed after having spent hours and hours on the phone yesterday. The worst hold music I’ve experienced was a current events news program that unfortunately was giving updates on a mass casualty situation that didn’t set the stage for a productive call, since participants were still in shock from what they had been hearing. The second-worst was music sounded like it was better placed in an adult film.

Apparently I’m not the only person with an interest in hold music, because a quick Internet search brought up several articles. I had forgotten the quirky Cisco default hold music – if you’re looking for an hour-long recording to jog your memory, you can find it here. I got my hopes up for an article that claimed to have 11 recordings of terrible hold music, but the links were broken so I missed out on that particular hall of shame.

Email Dr. Jayne.

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