Readers Write: Hospitals Move to Define Role of Secure Texting in Clinical Alarm Management

Hospitals Move to Define Role of Secure Texting in Clinical Alarm Management
By Todd Plesko

In 2010, The Joint Commission identified improvement in staff communication as a National Patient Safety Goal. A recent Spyglass survey found that 67 percent of hospitals, despite forbidding the practice, report that nurses are using personal smartphones to support clinical communications and workflow because they are dissatisfied with the options provided by hospital IT.

Of those exchanging data, 80 percent of the messages are not secure nor HIPAA compliant. Hospitals found guilty of a data breach can be fined $1.5 million per incident, so it’s not surprising that hospitals are acting swiftly.

There are more than 70 vendors today competing to solve this need. They are primarily segmented by the markets and users they are targeting; e.g. physician-to-physician, physician-to-nurse, physician-to-patients. These single-function secure text messaging apps were initially an attractive fix to HIPAA anxieties because they are cheap and quick to implement, but their myopic view of communications often contributes to the burgeoning problem of alert and alarm fatigue.

As of July 1, hospitals seeking accreditation from The Joint Commission are required to prioritize clinical alarm safety. Even though the new National Patient Safety Goal recommends that hospitals begin with the largest offenders – patient monitors and medical devices – forward-thinking hospitals are taking a closer look at the full gambit of interruptions experienced by front-line nurses and asking how solutions designed to address alarm fatigue will impact overall clinical workflow.

Alarm fatigue is rooted in more than just patient monitors and medical devices. It is the result of multiple systems communicating alarms, alerts, text messages, and phone calls simultaneously without regard to priority or urgency. Really, “interruption fatigue” much more accurately describes today’s care environment.

Hospitals have traditionally viewed alarm fatigue and secure text messaging as two unrelated pain points with separate solutions. This has resulted in an accidental architecture embodied by multiple solutions with overlapping functionality that have become increasingly difficult for hospital IT and users to manage.

Single-purpose integrations often lack sophistication and the intelligence necessary to serve as the traffic cop between multiple systems that compete for attention, interrupt workflows, and contribute to alarm fatigue. They are concerned with the singular goal of delivering the alarm, alert, or text message they were designed to transmit.

Consider that most clinically relevant communications originate from a patient event: a nurse call alert, a smart IV pump, a patient monitor alarm, a bed exit, critical lab, or stat order alert. When a clinician is texting about a patient, they must ensure that the subject of the conversation is properly identified, an important feature that single-function texting apps are incapable of providing automatically. All text messaging apps targeting healthcare are secure, but few are centered on the patient and their role in the overall communications workflow.

If a healthcare provider organization is going to be successful with patient-centric text messaging, then this is only possible with an enterprise platform that delivers relevant information with patient context along with the alarm, alert, or text message that the recipient receives. Optimally, alarms and alerts would include a dynamically-generated list of possible staff members to call or message about the patient event to further enhance communications. Patient-centric messages need to be displayed properly based on priority level and integrated into the overall communications workflow to ensure that the recipient is able to identify and respond effectively to the most critical needs first.

Hospitals are beginning to recognize that identifying improvements in staff communications and managing the interruptions generated by alarms, alerts, and text messages are twin problems that should be addressed as a single project. A next-generation alarm safety and event response platform is required to support this level of clinical collaboration.

Todd Plesko is CEO of Extension Healthcare of Fort Wayne, IN.

Readers Write: Navigating EHR Disillusionment: Strategies for Maximizing Value

Navigating EHR Disillusionment: Strategies for Maximizing Value
By Joel French

EHRs are a necessary but small component of what provider networks require to financially prosper in competitive markets being rapidly transformed by narrow networks, contracting reimbursement rates, and risk-bearing payment arrangements. As digitization proliferates, acute and ambulatory providers have become more vocal with EHR criticisms, including a lack of interoperability, workflow disruptions, and adverse impact to physician productivity. Many physicians now view themselves as data entry clerks.

Research from the American College of Physicians, Deloitte, and Physician’s Foundation finds that physicians have mixed opinions on EHRs, with significant downside sentiment. In the Deloitte study, 75 percent of physicians say EHRs are not cost-effective and do not save time.

One might assert the US health industry is suffering from Gartner’s Trough of Disillusionment regarding EHRs, defined as the period when “interest wanes as experiments and implementations fail to deliver.” This disillusionment exists because individual and organization expectations of EHRs exceed what they were actually designed to do. History abounds with examples of beliefs that were widely (if not universally) viewed as true, only to be later disproved by practical experience or fuller knowledge.

The point of view that integrated EHRs should be central to a health systems’ competitive strategy is one common view that is easily disproved by examining this assertion under the lens of basic business logic. By definition, a competitive advantage gives an organization an edge over its rivals and an ability to generate greater value (value is generally expressed in terms of market share growth, profitability, or enterprise value). The more sustainable the competitive advantage, the more difficult it is for competitors to neutralize the advantage.

As it relates to EHRs, once most or all hospitals in a geographic market have implemented such a tool, that tool itself ceases to be a competitive advantage. It should be better understood as a fundamental business input or asset, not materially dissimilar to facilities, medical equipment, or business licenses. Table stakes, as some might say.

Executives who have invested in EHRs hoping to derive investment returns above their cost of capital must first come to grips with the following truth: EHRs were designed to solve specific problems within the confines of a health system, but nearly all incremental revenue and contribution margin opportunities originate outside health systems in care communities. Trying to retrofit or adapt EHRs designed for use inside the walls of an enterprise for use outside the walls and across a community is fraught with risk and tantamount to believing the world is flat.

In 1837, Hans Christian Andersen wrote a fairy tale, now widely known, called “The Emperor’s New Clothes.” The metaphorical point applies to any situation wherein the overwhelming majority of observers willingly share in a collective ignorance of an obvious fact, despite individually recognizing the absurdity. The notion that implementing the same EHR as your competitors or peer group would somehow provide a sustainable competitive market advantage is completely devoid of classical business logic any first semester college freshman understands.

Today, an increasing cackle of honest voices are murmuring that the Emperor is naked. Those voices will only get louder as more organizations experience bond rating downgrades or executive removals attributable to expensive and unsuccessful EHR experiences.

To be sure, EHRs are necessary and are typically superior to the analog predecessors they replaced. They can be effective tools for clinical documentation, intelligent alerting, retrieval of patient data, and order entry/results return within the setting for which they were intended – the hospital or the clinic. Their deficiencies are exposed when care teams need to coordinate across not just physical settings, but differing organizational boundaries.

The migration to value-based care is accelerating, requiring fundamentally news ways of working to increase revenue while simultaneously keeping populations healthy. Nearly all at-risk payment models – such as episodic bundling, avoidable readmission penalties, Medicare Shared Savings, and ACOs – require better orchestration of care transitions across organizational boundaries. Successful health systems in the new health economy must therefore utilize technologies to integrate electronically and economically with scores of market trading partners, many of whom will have heterogeneous technologies and fragmented corporate ownership.

To grow, health systems must exploit all their channels – not just employed physicians, but also independent providers and other stakeholders – in order to access new referral sources, effectively coordinate care for patients with chronic conditions, and reduce unit costs. There are key EHR deficits critical to health system business objectives. These will require supplementary tools to bridge functionality gaps.

With average revenue from inpatient admission volumes down 4.9 percent in 2013, health systems need a technology strategy to support outpatient revenue growth. Health systems will live or die based on their ability to find technology solutions beyond the EHR, enabling them to uncover the economic value of independent providers in their communities by delivering differentiated value to those practices.

Introducing a network layer that smartly aligns the hospital’s capacity with the community’s demand for services is not only possible, but necessary. Today’s cloud-based tools for functions such as referrals, scheduling, and analytics can create attractive investment returns against EHR cost centers that some have come to view as permanent sink holes.

These tools extend the life of EHRs and introduce accretion by supplying what they lack – the ability to quickly grow outpatient volume, curtail network revenue leakage, and lift contribution margins. Integrating these tools with EHRs adds new value to the EHR, potentially creating the investment returns originally hoped for at the time of purchase.

The industry is still a long way from experiencing Gartner’s Plateau of Productivity with EHRs, but progressive health system executives are realizing limitations of EHRs and are increasingly turning to complementary cloud technology solutions that complement them and unlock value. Health systems that survive and thrive will be those that innovate to meet industry demand, which at this point requires thinking beyond EHRs. 

Joel French is CEO of SCI Solutions of Campbell, CA.

Readers Write: Driving Interoperability by Putting People at the Center of Health Technology

Driving Interoperability by Putting People at the Center of Health Technology
By Joseph Frassica, MD

During a recent earthquake in Charlottesville, VA, people heard the news of the earthquake long before they actually felt the tremors. In healthcare, even getting information to travel across departments in a hospital, or from a hospital to a primary care physician, can sometimes be challenging.

Many healthcare organizations present “interoperability” as the silver bullet that will resolve an organization’s data problems. But how can the industry implement effective, interoperable solutions that allow clinicians to get the information when they need it most, and no matter where they are?

I see three key steps the healthcare industry must take in order for information to travel securely and seamlessly to improve interoperability:

1. Embrace collaboration. As a first step, the healthcare industry – including hospitals, specialists, practice groups, vendors, home health agencies, and so on – needs to work together to provide the best possible care for patients. For too long, we kept our blinders on and treated patients when they entered into the hospital domain. Instead, the industry needs to change its mindset to think of the patients’ journey throughout the health continuum and work with other caregivers to make that process seamless. Accountable care models are already helping usher in this important change.
2. Encourage openness. Vendors of all types and sizes must work toward openness and subscribe to open standards. Vendor-agnostic and flexible technologies allow critical patient information to travel faster and get where it’s needed. By embracing open standards wholeheartedly, the industry can begin to lay the foundation necessary to drive innovation in healthcare technology and in patient care. Open standards can enable providers to share EMRs securely and can also provide greater access and insights.
3. Think beyond the EHR. Hospitals and health systems have made big investments in getting their EHRs up and running, and the technology is important for modernizing health care. But EHRs are not the be-all and end-all of patient data. They barely scratch the surface. To improve population health, healthcare organizations need to think beyond data collection and more about how this data can be used to improve patient outcomes across the health continuum. Healthcare systems need to think about how this data can be analyzed to present a more comprehensive, complete, and integrated picture of a patient and their medical history. Providers can then begin to use this data for predictive analytics, which will enable them to identify and manage trends across a population. By analyzing this data, physicians can make more confident diagnoses and develop preemptive treatment plans.

As healthcare becomes more and more connected, the amount of data and information entering the healthcare picture will only increase, and will become even more critical to realize the promise of interoperability as time goes on. By taking steady steps toward interoperability, the healthcare industry can fully liberate and share data seamlessly, giving physicians the quality insights they need to predict, prevent, and treat disease with better results.

Joseph Frassica, MD is CMIO/CTO, Patient Care and Monitoring Solutions, of Philips Healthcare.

Curbside Consult with Dr. Jayne 10/27/14

In this week’s Monday Morning Update, Mr. H mentioned the UberHEALTH promotion where customers could use the Uber app to summon a nurse to administer a flu shot. The idea came from John Brownstein, a Harvard epidemiologist who saw the mismatch between importance and convenience of getting a flu shot. After the success of the program, he feels it might be a possible delivery model for basic preventive care as well.

Given the ebb and flow of my happiness as a CMIO of late, I decided to run the math and see what it would look like to take to the road.

Although as an Uber promotion the nurses had a driver, I could certainly drive myself. That would cut costs right there. I’d be seeing fewer patients each day, which would actually lower my professional liability insurance premiums. I wouldn’t be paying rent or utilities either.

I have a friend who has a retainer-based practice and does only house calls, so I know that I’d have to trick out a decent-sized vehicle that could handle vaccine and specimen storage, various equipment, and more, but it would still be cheaper than paying for office space.

EHR costs would be about the same, although if I ran it as a cash practice they would be significantly less due to the savings in billing services, audits, etc. I went back and forth thinking about a cash practice. Looking at the percentage of cash-pay patients I see at a local urgent care, it may be more realistic than one would think. There are increasing numbers of patients with high-deductible health plans, which may make a reasonably-priced cash practice very attractive.

Having limited equipment would actually help to keep costs down. There’s no temptation to order x-rays because it’s convenient if you don’t have a machine.

Several countries in Europe offer house calls as part of standard medical care. One of my medical school classmates who lives in Germany recently had a baby and was telling me about her benefits. Rather than cutting services as payers do here, plans offer generous coverage and even things we wouldn’t think about. She was able to get “homemaker” services to perform light housework while she recovered from her delivery and had home visits from a lactation specialist and a pediatrician with very little out-of-pocket cost.

Her family physician actually takes “first call” at night, alternating with other physicians, rather than screening the calls through an answering service. My friend asked her family doc how he liked that. He said the patients are respectful because they know they’re waking the doctor up and they only call if it’s an emergency. Because he’s the one on the phone with them, it’s easier to negotiate an office visit the next day or even a house call, rather than potentially just sending everyone to the emergency department.

It’s certainly not inexpensive to deliver care this way. Coverage is funded by a flat percentage of each worker’s income that is paid to a non-profit coverage fund. It’s mandatory, but due to the flat percentage, it varies by income, with higher wage earners paying more. Although most Americans would balk at paying 8-10 percent of our gross income individually for healthcare, when you do the math and look at what employers are paying, the cost of individual insurance, and the level of service, it seems like a contender.

Although she’s a physician, my friend isn’t licensed in Germany and works part-time as a medical editor. She did mention that highly compensated employees can opt out of the requirement and purchase “private” coverage from a for-profit plan, but she doesn’t personally know anyone who has.

My friend isn’t an expert on healthcare finance, but that model of care brings up some interesting concepts. She didn’t have a lot of feedback about EHR use among physicians other than to say that they’re significantly less stressed out about it than most of her friends in the States.

I’d love to hear from readers that have deeper knowledge on those topics or who have experienced that type of health system first hand. I’d also love to hear from providers in the US who have incorporated health IT into either mobile or direct/cash primary care practices.

In the mean time, I’m going to start shopping for a vehicle worthy of a diamond-plate accessorized vaccine refrigerator.

Got a sweet ride for patient care? Email me.

Email Dr. Jayne.

Morning Headlines 10/27/14

Cerner Q3 2014 Results – Earnings Call Transcript

In its Q3 earnings call, Cerner representatives address its recent Siemens acquisition, the upcoming DoD EHR deal, and its goal of having “the most open EMR.”

New York-New Jersey Quarantines Fuel Ebola Debate

After a doctor returning from Guinea is diagnosed with Ebola in New York, the state governments for both NY and NJ enact a mandatory 21-day quarantine order for any US aid workers returning from the affected areas. On Friday, a non-symptomatic nurse returning through Newark Liberty International Airport was involuntarily detained and is now being held under quarantine at Newark University Hospital.

FDA Approves Two Faster Ebola Tests

Two new Ebola tests that reduce the time it takes to run an Ebola screening from four hours down to just two hours have been approved for use by the FDA.

Salesforce to make big push into healthcare industry

Reuters reports that Salesforce will begin pursuing sales in the healthcare market, with a formal announcement expected in November.

Monday Morning Update 10/27/14

Top News

From the Cerner earnings call:

• Bookings hit an all-time Q3 high at $1.1 billion and backlog increased to $9.34 billion.
• The company predicts that its margins will drop from around 25 percent to the low 20 percent range due to the Siemens acquisition, but expects them return to normal by 2017.
• Cerner expects the Siemens acquisition to close on February 2, 2015.
• Adjusted EPS was $0.42 per share. The company expects a post-Siemens earnings growth of 27 percent. I’m not much of a stock analyst, but that seems to indicate an EPS jump to around $0.53, and with 341 million shares out, that means the acquisition will add $38 million of profit per quarter or around $150 million per year, meaning the acquisition will pay for itself in no more than eight years. I expect it will be perhaps half that time given the opportunity to upsell and convert existing Siemens customers. Cerner would have to make as many mistakes as Siemens did to mess up this deal given the fire-sale price they paid.
• The company says it is committed to “having the most open EMR.”
• Cerner says best-of-breed registry suppliers aren’t getting value because they haven’t aggregated clinical and financial information across systems, leading some of them to look to Cerner’s offerings.
• The company expects the DoD EHR selection to occur in the first half of 2015 and the contract to be signed in the second half.
• Cerner observes that Siemens offers to the global market “relatively low-end solutions” that “played at a little bit of a lower end in terms of scalability,” giving the company a chance to put Millennium in place outside the US.
• President Zane Burke suggests that non-Soarian legacy Siemens users (Invision, MedSeries4) have a three- to five-year horizon (“horizon” being related to “sunset.”)
• CFO Marc Naughton explains the Soarian opportunity: “When you look at a Soarian client, their clinical solutions were not very broad. They were focused on EMR orders and a very core set of solutions. All of those clients are paying a third party — in many places a niche supplier — a fair amount of money for their ancillary solutions. One of the key rationales for this business, obviously, and the reason we want to retain that client base is, like for like, exchanging Millennium for Soarian. We have a lot of additional solutions we can sell onto that base.”
• Zane Burke stated, “I don’t see Meaningful Use driving any buying behavior today.”
• Burke says that population health could be bigger market than EHRs.

Reader Comments

From Tony M: “Re: Psychology Today article. Says EHRs are a farce.” A sleep medicine doctor writes a not very convincing anti-EHR piece that still manages to make a few good points. He wanders around in fretting (usually anecdotally) about health vs. healthcare, privacy breaches in healthcare and other industries, wasted physician time inputting EHR information, and lack of interoperability. Where he misfires is in failing to identify the real problem: EHRs drive billing (I assume he’s not against billing for his services) and therefore reflect the requirement of those who write the checks, not those who send the invoices. He takes a turn toward the bizarre in his concluding recommendation: give taxpayer money to public health schools to create non-profit EHR companies that will license EHRs from “civilized countries that have worked cheaply and effectively for decades.” Hopefully he is sincere about the “working cheaply” part since he would be doing just that in running an EHR that works in Denmark or Australia – unless he launches an all-cash practice, he’s not going to see a dime of revenue. It is nearly always the case that those complaining about the clinical intrusion of EHRs are confusing the symptom with the disease and the disease isn’t easily cured – the US healthcare system is a world-class, special-interests disaster and EHRs were designed to support it effectively. Doctors are smart but were unwisely obedient over the past few decades – they turned healthcare over to insurance companies, government, and profitable non-profit healthcare systems without a peep, but now misdirect their ire toward whatever’s sitting right in front of them rather than the far more complex hole they compliantly helped dig themselves into.

From Moderated: “Re: anti-EHR comments. I think we’ve heard enough of the same parroting anti-EHR crowd, both about THR and otherwise.” It’s actually a crowd of one. The same poster users a variety of phony names –  Not Tired of Suzy RN, Jenny Dimento MBA, Gopal Singh MD, Keith McItkin PhD, and several others. Sometimes I approve his or her comment if it adds value or is entertainingly strident, but often I delete it because I agree that the incessant “bring back paper charts” droning gets old.

From Country Coder: “Re: EHRs and Ebola. Everybody is glomming on with their uninsightful insights. Anything to get your name in the papers even if it’s not related — I’m calling it the Tori Spelling effect.” Tori Spelling has zero chance of getting Ebola, but that doesn’t stop her from turning a case of bronchitis into possible Ebola infection as she coincidentally shows up at Cedars-Sinai right before her new reality show premieres. The TV rags claimed “quarantine,” but she was really just put with other feverish, coughing patients until they decided to admit her for some reason, just in time for her to tweet out a dramatic message complete with photo. I would bet money she uttered the word “Ebola” enough times to make sure she wasn’t just sent home where the cameras aren’t. She pulled the same stunt a couple of weeks ago in falsely claiming she was pregnant in a teaser for the new show. I can never figure out how celebrities can “check themselves” into a hospital while everybody else who is really sick gets sent home because their insurance won’t pay for an admission.

HIStalk Announcements and Requests

The vast majority of poll respondents don’t think the names of Ebola patients should be publicly announced. New poll to your right or here: what is the weakest link in diagnosing Ebola in the ED based on travel history? (I say “travel history” specifically since unfortunately in the absence of such history, no immediate and accurate diagnostic method exists). Vote and then click the “Comments” link to pontificate further.

Welcome to new HIStalk Platinum Sponsor Healthgrades. The Denver-based company’s online provider database – searchable by disease, condition, or procedure – is used by a million people per day who are making trusted, informed decisions about their care in choosing the right provider, more than half of whom follow up by scheduling a physician appointment. The company just enhanced its free physician search to let consumers choose factors that are important to them, such as experience, the quality of the hospitals in which they practice, and patient satisfaction. It  also offers services to hospitals that include business intelligence, marketing, and clinical communication solutions that increase consumer and physician engagement and improve service quality and utilization. I interviewed President Jeff Surges a few weeks ago, who told me, “We’re going to be releasing a lot of data and analytics about our ratings in the fall and using very expressive ways to show how our methodologies can partner with quality and outcomes within a hospital.” Thanks to Healthgrades for supporting HIStalk.

I always cruise YouTube to research new sponsors and found this recently posted 15-second Healthgrades TV commercial.

Listening: new from Brooklyn-based The Budos Band, instrumental Afro-Soul that sounds like sweet, funky 1960s horns and wah-wah guitar without the vocals — think the opening theme from “Hawaii Five-0” or “The Horse” by the underappreciated Cliff Nobles – although it sometimes moves into psychedelic rock territory with molten guitar and a smoke-filled room backbeat. They’re on Daptone Records along with the equally magnificent and musically similar Sharon Jones and the Dap-Kings. I’ll also be listening to Cream (and possibly West, Bruce & Laing and Manfred Mann) in noting the death of bassist Jack Bruce at 71 on Saturday.

Last Week’s Most Interesting News

• ONC loses its two highest-ranking officials as HHS transfers National Coordinator Karen DeSalvo, MD to acting assistant secretary for health and Deputy National Coordinator Jacob Reider, MD announces his resignation. COO Lisa Lewis, whose non-medical, non-technical background is federal government administration, is named acting national coordinator.
• HIMSS moves its 2019 convention from Chicago to Orlando after a squabble triggered by a guarantee given to RSNA that it gets the lowest available Chicago hotel room rates.
• Details of the treatment given to Ebola patient Thomas Duncan by the ED of Texas Health Presbyterian Hospital Dallas show several inconsistencies with earlier reports, with contributions to the missed diagnosis including that a nurse’s failed to follow policy in telling the ED doctor about the patient’s travel to Africa, the doctor missed the nurse’s travel note in a nearly empty Epic patient record, and the patient provided conflicting history and symptoms.
• HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program to move providers to value-based, patient-centered, coordinated health services, with health IT playing a key role.
• The move away from document-based EHR information exchange to API-driven interoperability starting with Meaningful Use Stage 3 gains momentum as ONC and industry groups announced support for the change.
• A survey of 14,000 RNs finds widespread dissatisfaction with EHRs and the IT departments that help choose and support those systems.

Webinars

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

Imprivata put on an excellent webinar last week on electronic prescribing of controlled substances. We had a lot of engaged attendees, but if you weren’t able to participate, the  YouTube video contains the complete 49-minute webinar, including the Q&A. The presenters cover the DEA rule, which requires EMRs to be certified and providers to use two-factor authentication (along with other technical requirements). New Yorkers should be especially interested since the I-STOP act requires EPCS starting in March 2015. HIStalk webinar questions can be directed to Lorre.

Acquisitions, Funding, Business, and Stock

Small practice software vendor Kareo lands $15 million in funding, raising its total to $47 million.

Cambia Health Solutions, which has held a few health IT investments in its portfolio of companies, is creating a collaboration space that it hopes will draw healthcare startups and providers to Seattle to launch pilot projects. It won’t be an incubator or accelerator – which the company says are hard to implement in healthcare – but will “raise all the boats in the Puget Sound market around healthcare.”

A Reuters article says that Salesforce will make a big push into healthcare, hoping to create a $1 billion annual business despite the lack of success it and other technology companies have in similar attempts. The company’s healthcare head, whose background is as a drug company CIO, says they see a growth opportunity in care coordination, patient engagement, and analytics.

Government and Politics

The states of New Jersey and New York an involuntary 21-day quarantine on healthcare workers returning from West Africa via Kennedy and Newark Liberty International Airports, even those who are free of Ebola symptoms. The “just to be safe” actions in which spacesuit-wearing workers quarantine and burn everything touched by people guilty only of a history of travel aren’t exactly calming a media-frenzied populace that is much better at being illogically scared than at understanding science. “We are no longer relying on the CDC standards,” said New Jersey Governor Chris Christie, who along with New York Governor Andrew Cuomo made their decision without consulting New York City’s health department. The first person detained, a nurse returning from work for Doctors Without Borders, says Newark airport officials treated her rudely, barked questions at her, reacted happily in claiming she had a fever that she was later found not to have, and forced her into an unheated tent wearing paper scrubs (rudeness, incompetence, and lazy union indifference were my strongest memory of my one international arrival at that airport, so I’m not exactly shocked.) She’s tested negative twice for Ebola but New Jersey is still locking her up for the full 21 days. She says healthcare workers are being treated like “criminals and prisoners.”

Good luck containing the outbreak to Africa if US-based aid workers face detention in return for helping there. If possible exposure is reason enough to lock people away, are all the Bellevue doctors and nurses going to be be quarantined for three weeks? Farzad Mostashari says it best: “Politicians suck at making public health decisions, especially when the public has lost their mind.” I’ll say it again: fast identification of potential Ebola carriers will be impossible if and when it starts spreading within US borders and the travel history becomes worthless, so someone better come up with a fast, early diagnostic tool since we can’t lock up everybody up for three weeks just because they have a fever.

Update: in timely news, FDA just approved fast-tracked tests that can detect Ebola in one hour, which is a huge development with all of this hysterical Dark Ages quarantine nonsense. Salt Lake City-based BioFire Defense, a University of Utah spinoff, already won a $240 million defense department contract to turn its FilmArray product into a biological warfare detection system. It analyzes saliva or blood for genetic markers. The test has already earned FDA approval for respiratory and GI conditions. The instrument costs $39,500 and the tests are $129 each. Government comments suggest that the Ebola test may already be in use in Africa. I’m not clear from the product information if there’s a lag time between exposure and detection, which would be important in using it to detect pre-symptomatic infections.

Meanwhile, in New Jersey, New York, and everywhere else, use of the vaccine that protects against a far greater virulent killer – influenza – is optional (Governor Christie effectively vetoed a New Jersey bill earlier this year that would have required healthcare workers to get a flu shot, although he does urge everyone to get one). Contagious outbreaks can be contained only through herd immunity, meaning you need a critical mass of the overall population to be vaccinated to stop the spread and protect the unvaccinated. I got my flu shot yesterday – you’re welcome. Not making the headlines among the Ebola hype is that the first child of the 2014-2015 US flu season died the week of October 4; over 100 babies and up to 50,000 people overall died of influenza in the 2013-2014 season, although public health reporting tools have overlap between influenza and pneumonia that probably throws the count off.

HHS posts Karen DeSalvo’s bio page for her new job. I thought of another reason HHS might have moved her into the position. Her predecessor, Wanda Jones (who was also in the “acting” role) holds a public health doctorate but isn’t an MD — the Assistant Secretary for Health has always been a medical doctor, at least was in recent years. Another HHS problem: the US has had only an “acting” Surgeon General since mid-2013, when the NRA stalled the appointment of the President’s nominee, Vivek Murthy, MD, MBA because he has labeled guns as a public health problem. Acting Surgeon General Boris Lushniak, MD, MPH has kept a low profile during the Ebola scare, so perhaps HHS wanted to have an MD who is credible, visible, experienced in actually practicing medicine, and free of political baggage. Whether the selection reflects HHS’s placement of ONC in its food chain is up for speculation.

Other

The family of a 12-year-old New Mexico student accused of shooting two of his classmates sues University of New Mexico Hospital after it told them that at least eight people inappropriately accessed his medical or mental health records.

Uber runs a one-day promotion called UberHEALTH in which customers in Boston, New York, and Washington DC could tap an app button to have a flu shot administered in their homes at no charge. The idea was suggested by a Harvard epidemiologist, who adds that “the model of delivering healthcare by car service could work to provide basic preventive care.”

A fascinating New York Times article profiles the decades-long work of psychologist Ellen Langer, whose experiments suggest that aging and the course of life-threatening diseases are influenced by how old the individual feels as triggered by their surroundings and the perceptions of others. In other words, to some extent you really are as old as you feel.

Partners HealthCare CEO Gary Gottlieb announces that he will resign with five years left on his contract to run the Partners in Health non-profit, just as his current employer faces unprecedented scrutiny of its expansion plans and its high pricing. He says he will take a pay cut from $2.6 million to $200,000 and will leave without a golden parachute.

Weird News Andy finds this story infectious, as scientists in China find a virus-killing penicillin in honeysuckle plants. WNA admits that he rarely sees bees and hummingbirds with the flu (although they possibly flew up the flue, he quips) but questions whether his employer will allow proof of honeysuckle tea consumption instead of a flu shot.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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News 10/24/14

Top News

 

HHS Secretary Sylvia Burwell transfers National Coordinator Karen DeSalvo, MD, MPH, MSc to the position of acting assistant secretary for health — it oversees public health, including the Office of the Surgeon General — in response to the Ebola threat. DeSalvo replaces Wanda Jones. ONC COO Lisa Lewis (above) is named acting national coordinator, effective immediately. Ms. Lewis’s background is in grant management for ONC and FEMA, so her non-clinical, non-technical experience will contribute to ONC’s identity struggle in a post-Meaningful Use world. I would expect HHS to launch a search for a permanent and well-credentialed national coordinator quickly since its internal personnel stores have been recently depleted (assuming that DeSalvo’s move is permanent, which isn’t the stated case so far, which otherwise means Lewis may be keeping the seat warm for some time).

Jacob Reider, MD would seem to have been the obvious choice for interim national coordinator since he is deputy national coordinator, but he confirms with me that he has resigned, having promised to his family several weeks ago that three years of commuting to DC was enough. That leaves only Jodi Daniel and Kelly Cronin from Farzad’s 10-member team of a year ago, at least barring any additional announcements.

Reader Comments

From Frank Poggio: “Re: Karen DeSalvo reassigned from ONC. If this does not signal the end is near for the MU fed program, I do not know what would. She was there for maybe six months, came up with the grand revelation that interoperability is a bus, issued a voluminous dissertation on what was wrong, then headed for the hills! Can’t wait to see ONC /DHSS press releases on what a great job she did.” ONC was all over the Ebola issue even though the EHR turned out to be non-contributory at THR, so DeSalvo’s interest and Katrina-related public health background put her in the right place at the right time. Physicians with practice experience and an MPH from a decent school will find many job opportunities as the industry matures from encounter management to population management. I think ONC’s best purpose once they’ve either handed out all the MU money or caused providers to lose interest in receiving it would be to (a) retool EHR certification to encourage interoperability and issue standards accordingly, and (b) run with the idea of the healthcare IT patient safety center if they can get Congress to fund it. They got EHRs out in the field, now it’s time to focus on using them for patient rather than provider benefit.

From The PACS Designer: “Re: ultrasound emergency wireless app. Samsung has demonstrated an ultrasound wireless application for emergency situations. A test showed that life saving could be achieved through the immediate sending of ultrasound images to emergency departments from ambulances.” That’s a good reminder that sometimes creating new data elements isn’t as important as moving the existing ones around more effectively to increase their value to a wider audience.

From Barry Black: “Re: Wellogic. Alere has divested the former company that was Alere Accountable Care Solutions.” Alere acquired Wellogic, founded in 1993 in late 2011. I interviewed President and CEO Sumit Nagpal a year ago. Alere ACS offers a PHR, EHR, HIE, decision support, analytics, and wellness and health coaching platforms. The company provided this response:

Based on strategic review by a leading consulting firm, Alere made a decision to refocus its energies on its main business market — diagnostics. As a part of this strategic refocus, Alere chose to divest certain assets, including those in connected health and health management. Alere ACS was the cornerstone of the Alere connected health strategy, and during its Alere tenure, enjoyed great investment that were mutually beneficial to Alere and Alere ACS — including tens of millions of dollars of enhancements to its core HIE platform. Alere ACS has now successfully separated from Alere into a new entity that will operate independently. This new entity has received a significant commitment of support and capital that will ensure continued operations and a sizable R&D investment for short- and long-term success. The new unit will continue to focus on the connected health market, including integrations with various diagnostics, mobile devices, and home monitoring opportunities. The new entity is financially robust and is armed with the necessary resources to achieve and support better healthcare and financial outcomes for the healthcare system. Executive leadership, engineering, and professional services  remain unchanged.

From Lazlo Hollyfeld: “Re: non-competes. No rank-and-file employee should be subject to these agreements, and certainly not for two years.” Jimmy John’s, which is my least-favorite sub chain next to Quizno’s and not in possession of any obvious meat and bread secrets, slips a two-year non-compete clause into its employment agreement that prohibits its $8 per hour sandwich makers and delivery drivers from working not only at competing sub chains, but for any business located near one of its locations that makes 10 percent of its revenue from sandwich sales. Lawyers in a class action suit say the chain’s 2,000 locations mean that an employee who quits can’t work in an area covering 6,000 square miles. It’s like every non-compete that claims to cover non-management employees: a load of repressive corporate crap dreamed up by paranoid management that wouldn’t withstand five minutes of scrutiny in court, existing only because non-management employees don’t have the time and money to challenge it.

From Deanna: “Re: Plato’s Cave. Made me think of you and why your contribution to HIT is so much better than anyone else’s. You have been outside the cave.” The outgoing editor of The Wall Street Journal’s CIO Journal says he left journalism to work for Oracle because “journalists are at least twice removed from the essence of what they write about … I also don’t want to watch technological evolution while imprisoned in a cave, forced to take someone’s word for how it’s made and how it’s used. I want to observe it for myself.” Diligent writers often do a good job covering complicated subjects of which they have zero first-hand experience for experts who live it every day, but I get annoyed when they get lazy and just dutifully reword press releases or stray over that already generous line and start editorializing or delivering podium speeches based entirely on their cheap-seats view, like a couch potato sports fan yelling instructions to a professional football coach or a secluded porn watcher providing relationship advice.

From Clinic EHR Director: “Re: Epic staff rates. Most of the information out there is overpriced, inaccurate, or both. A friend put together a survey and will publish it free. I would love it if this could be made available to as many people in the industry as possible.” The Epic salary survey is here and the results will be published here.

From P.O. Garth: “Re: HIStalkapalooza. Just curious what night it will be?” This might set the record for the earliest inquiry about an event that’s still almost six months away. HIStalkapalooza will be Monday, April 13, 2015. It will be the best HIStalkapalooza, the last, or both since I’ve decided to take the planning out of a single sponsor’s hands and instead run it myself with the help of Lorre and Jenn and the financial support of five sponsors yet to be chosen (let me know if your company is interested – you’ll get lots of exposure and invitations). Last year was the breaking point for me since ticket demand far exceeded supply and people I wasn’t able to invite got personally rude even though I spend months every year from late summer to spring sweating details for no personal benefit, leading me to swear that I was done with it. For Chicago, the facility, band, and menu are all under contract – it should be pretty great. If it’s the last one, it will at least be legendary.

HIStalk Announcements and Requests

This Week on HIStalk Practice: the DoD’s DHMSM RFP deadline is pushed back — again. Qualis Health achieves MU goal. Jerry Broderick suggests three questions to ask before joining an employed physician network. Tennessee Primary Care Association implements new pop health/analytics tools. HP interviews Rob Tennant, SVP of government affairs, MGMA. Modernizing Medicine co-founders win leadership award. Check out the HIStalk “Must-See” Exhibitors Guide for MGMA 14. Thanks for reading.

This week on HIStalk Connect: Doctors Without Borders is developing an SMS-based Ebola screening tool to engage with the local West African population. HealthTap announces that it has created a national telehealth platform that will provide virtual visits for $44 per session. XPRIZE announces 11 finalists in the Nokia Health Sensor Challenge.

Listening: new from Cold War Kids, bluesy indie rockers from Long Beach, CA.

Webinars

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

Acquisitions, Funding, Business, and Stock

NextGen parent Quality Systems reports Q2 results: revenue up 9 percent, adjusted EPS $0.13 vs. $0.22, beating revenue expectations but missing on earnings. Above is the one-year QSII share price chart (blue, down 39 percent) vs. the Nasdaq (red, up 13 percent).

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Cerner announces Q3 numbers: revenue up 15 percent, adjusted EPS $0.42 vs. 0.35, falling short on revenue expectations but meeting consensus earnings. Above is the one-year CERN share price chart (blue, up 6 percent) vs. the Nasdaq (red, up 13 percent). The breathy reports of $XXX billion of healthcare IT startup investment hide the fact that most of the publicly traded HIT vendors aren’t exactly killing it on Wall Street, which the irrationally exuberant cheerleaders will spin as evidence of the changing of the guard rather than the historically difficult HIT business climate.

Patient self-service app vendor Phreesia raises $30 million in funding.

North Bridge Growth Equity becomes a majority stake owner in patient encounter platform vendor Ingenious Med with an undisclosed financial investment.

Sales

Logicworks will host the Massachusetts Health and Human Services Virtual Gateway portal.

Wyoming Medical Center (WY) selects Wolters Kluwer’s ProVation MD Cardiology for structured reporting and coding in it catheterization labs.

DeKalb Medical  (GA) selects Connance’s Patient-Pay Optimization program to improve productivity and improve patient experience.

People

MModal names Scott MacKenzie (Experian Health) as CEO and board member.

Health Data Consortium, the group that runs Health Datapalooza, names Chris Boone, PhD (Avalere Health) as executive director.

HDS hires Bradley Johnson (Caradigm) as senior executive of business development.

Announcements and Implementations

Strata Decision launches cloud-based StrataJazz Continuous Cost Improvement to help providers reduce waste and inefficiency.

Greythorn launches a healthcare IT salary survey and will donate $1 for each survey completed to Autism Speaks Foundation.

Long-term care EHR vendor HealthMEDX announces its iCare POE mobile care management system.

Valley General Hospital (WA) goes live on Medsphere’s OpenVista.

HSHS Medical Group (IL) launches a pilot that will test the use of Apple Watch, due out next year, in its medical home program.

Government and Politics

HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program to move providers to value-based, patient-centered, coordinated health services, saying that healthcare IT will be a key component. Among the suggested strategies is daily review of EHR quality and efficiency information. Specifically listed is secure, standards-based, bi-directional communication with other providers.

Three industry notables (Dean Sittig, David Classen, and Hardeep Singh) propose in a JAMIA article that ONC’s planned HIT Safety Center (a) create a post-marketing HIT patient safety event surveillance system; (b) develop policies and procedures for investigating those events; (c) design random safety assessments of large providers; and (d) advocate HIT safety. The surveillance function would look at system failures, inadequate design, improper user configuration or usage, interface problems, and missing or unimplemented safety-related features. I would be happy if someone would just implement an easy way (on-screen button?) for providers to communicate safety concerns directly to vendors with a CC: to a safety center. Several organizations (some of them governmental) claim to have such a system, but none get significant use because end users don’t know about them or aren’t willing to complete a pile of paperwork that doesn’t benefit them directly.

The Department of Homeland Security is reviewing possible cybersecurity flaws in medical and hospital devices (including IV pumps and cardiac devices) that could make them vulnerable to hackers, stating its intention to work with vendors to correct software problems.

Other

HIMSS will move its 2019 convention from Chicago to Orlando in a dispute over hotel room rates, citing its unhappiness that the RSNA conference obtained a “favored nation” clause that guarantees it the lowest room rates for events held from April through November. I surveyed readers in early 2013 about their preferred HIMSS conference cities and Chicago finished near the bottom, with only 6 percent choosing it as their favorite — New Orleans, Atlanta, Dallas, San Antonio, and Boston did as poorly or worse, while San Diego, Las Vegas, and Orlando topped the list. Chicago is easily my least-favorite convention city (even though I like visiting it otherwise) due to overpriced and indifferent hotels, surly union workers, poor public transportation to McCormick Place, and the near-certainty of cold, dreary weather in April (which of course exhibitors love since it keeps attendees inside looking at booths). HIMSS scratched its home city’s back by holding the conference there in 2009 after pushing the usual date back several weeks to avoid blizzards (which didn’t work), pulled the conference out again because of union-driven high costs of exhibiting at McCormick Place, and then ill-advisedly decided to return in 2015. Too bad their squabble comes too late to move HIMSS15 somewhere else.

Interesting: scientists nearly 10 years ago came up with an Ebola vaccine that was 100 percent effective in protecting monkeys, but the $1 billion plus cost of bringing a drug with minimal sales potential to the US market sent it to the shelf, where it remains.

A Diagnosis article by the aforementioned Dean Sittig and Hardeep Singh, along with Divvy Upadhyay, looks at the treatment of Ebola patient Thomas Duncan at Texas Health Presbyterian Hospital Dallas, reviewing the patient’s record to find several discrepancies in THR’s announcements:

• The patient presented with a temperature spiking to 103 degrees, dizziness, GI symptoms, headache, and a self-reported pain score of eight on a 10 scale, contradicting hospital reports that his initial symptoms weren’t severe.
• The nurse documented his recent travel to Liberia.
• The ED doctor prescribed Tylenol and antibiotics (the article didn’t question why he or she prescribed antibiotics for vague symptoms that could be non-infectious or viral, but antibiotic overuse and resistance is a topic for another day).
• The authors speculate that the ED physician chose predefined phrases from EHR-suggested drop-downs that misled caregivers who read the notes later.
• They also speculate that the hospital is located next to a high-immigrant population area that a county commissioner termed “a little Ellis Island” that could have caused employees to miss the red flag of “a black man with a foreign accent who reported he came from Liberia and presented with serious ‘flu-like’ symptoms to an ED which reportedly had received CDC and county health department’s guidance as early as July 28th, 2014.”
• The article points out that clinicians often misdiagnose or miss common clinical conditions and it’s not the EHR’s job to replace their critical thinking and history-taking skills.
• It adds that doctors tend to ignore nurse-generated documentation, both on paper and in the EHR. Sad, but true.

THR previously submitted to Congress a timeline of Thomas Duncan’s ED visit with some interesting items:

• Triage didn’t start until an hour after the patient’s arrival at 10:37 p.m. – he was sent to the waiting area (in contact with everybody else there) and wasn’t taken to the treatment area for for nearly 90 minutes.
• The ED physician accessed the triage nurse’s report at 12:27 a.m., but the travel history question hadn’t been asked yet since it wasn’t the triage nurse’s responsibility.
• The patient first reported his travel history to Liberia in a 12:33 a.m. question from the primary ED nurse, but she didn’t pick up on the importance of his answer and ignored the EHR prompt to verbally relay it to the ED doctor (big-time fail there).
• Audit logs show that the ED doctor reviewed the Epic sections that included the patient’s travel history several times between 12:52 and 1:10 a.m. Remember that at that point, the EHR should have been basically a single screen of information since all that had been documented  was triage, the primary nurse’s initial workup, and a few vital signs. Specifically in Epic, the authors say, that includes screens for: ED lab results, Visit Navigator, related encounters, flowsheet, allergies, home meds, and ED patient history, all of which should have been pretty much blank.
• The doctor later reviewed the patient’s history in which he said he was a “local resident,” had not been in contact with sick people, and had not experienced GI symptoms (contradicting the triage nurse’s recording of his chief complaint – in other words, the patient gave incorrect and misleading information for some reason).
• The ED doctor discharged the patient with a diagnosis of sinusitis (not sure where that came from) and abdominal pain.

My conclusions: (a) Epic worked as it should have although the ED doctor still missed crucial information despite spending a lot of time looking at what should have been minimally populated Epic screens and possibly not the patient himself; (b) the hospital should have been asking travel questions at triage, which THR has since required; (c) the ED nurse missed an obvious red flag and broke hospital policy by documenting in the EHR but not reporting the travel information verbally; (d) the ED doctor either missed what should have been plainly obvious travel information or failed to note its relevance; (e) the patient told the ED doctor a very different story than he had told the nurse previously, eliminating or changing information that would have put the ED doctor on alert. All of this points out how unprepared the hospital was for detecting possible Ebola patients despite public health warnings, along with their lack of urgency to put new policies in place. My bigger conclusion: hospitals are not good at all with issues related to public health, and public health departments don’t seem to have the influence to drive sound infectious disease policy out of their ivory towers to the front lines.

BIDMC CIO John Halamka, MD proposes that clinical documentation, which was designed for billing rather than care coordination, be redesigned around a team-based, story-oriented structure that eliminates redundancy, inaccuracy, and copied-pasted text that doesn’t convey (or even hides) the patient’s story. It resonates with me because I’m getting increasingly frustrated that EHRs are superior to paper in every way except that one – the tendency to generate a lot of worthless but structured information that masks the sometimes obvious issues, meaning those EHRs make care worse instead of better. It’s time to reclaim the EHR from administrators, bureaucrats, CMS, and malpractice attorneys and give it back to patients and clinicians. Halamka writes on his blog:

Imagine if the team at Texas Health Presbyterian jointly authored a single note each day, forcing them to read and consider all the observations made by each clinician involved in a patient’s care. There would be no cut/paste, multiple eyes would confirm the facts, and redundancy would be eliminated. As team members jointly crafted a common set of observations and a single care plan, the note would evolve into a refined consensus. There would be a single daily narrative that told the patient story. The accountable attending (there must be someone named as the team captain for treatment) would sign the jointly authored Wikipedia entry, attesting that is accurate and applying a time/date stamp for it to be added to the legal record.

After that note is authored each day, there will be key events — lab results, variation in vital signs, new patient/family care preferences, decision support alerts/reminders, and changes in condition.

Those will appear on the Facebook wall for each patient each day, showing the salient issues that occurred after the jointly authored note was signed.

With such an approach, every member of the Texas care team would have known that the patient traveled to Dallas from West Africa. Every member of the care team would understand the alerts/reminders that appeared when CDC or hospital guidelines evolved. Everyone would know the protocols for isolation and adhere to them. Of course, the patient would be a part of the Wikipedia and Facebook process, adding their own entries in real time.

A study of ICU patient alarms finds that each occupied bed generates 187 audible alarms per day, many of them false alarms related to arrhythmia. It suggests that hospitals reduce alarm fatigue by reviewing their alarm settings and consider changing some alarms from audible to text messages.

A woman who tried to kill herself by gouging out her eyes with a pencil sues LA-USC Medical Center, saying that one of its nurses took a picture of her and shared it with a friend who then posted it on a shock website.

Weird News Andy fiddles around with this story, in which a concert violinist plays his instrument on the operating room table as neurosurgeons implant a “brain pacemaker” to correct his otherwise career-ending tremors. The surgery team monitored the patient’s movements via a three-axis accelerometer as he played and they inserted electrodes into his brain to make sure they hit the right spot. It worked: three weeks later, he was back on stage with the Minnesota Orchestra.

Sponsor Updates

• Yale New Haven Health System (CT) implements SSI Group’s Audit Management solution.
• Predixion Software CEO Simon Arkell is named “Outstanding CEO” for a mid-sized company by the Orange County Technology Alliance.
• PerfectServe President and CEO Terry Edwards writes a blog post called “Prioritizing Communications to Improve Care Coordination.”
• AOD Software and Imprivata partner to provide a secure communication platform for the senior healthcare market.
• Medical Economics names ADP AdvancedMD, Allscripts, Aprima, CompuGroup Medical, e-MDs, eClinicalWorks, GE Healthcare, Greenway, Kareo, McKesson Specialty Health, NextGen, Optum, Quest Diagnostics, and RazorInsights to its “Top 50 EHRs” list.
• MedAptus will integrate Entrada’s dictation recording technology with its Pro Charge Capture solution.
• Truven Health Analytics introduces Interactive Reporting, which helps health plans analyze account-specific cost, use, and quality.
• Perceptive Software will introduce Medical Content Management at RSNA 2014.

EPtalk by Dr. Jayne

I’m always excited to receive reader mail, although I’m terribly behind on answering it. I have a couple of blogger / author friends and am convinced HIStalk has the best readers out there. That was proven this week when several of you wrote offering advice for my friend’s oncology RFP conundrum. I appreciate the input and have forwarded your thoughts.

Weird News Andy weighed in on last week’s discussion of mood-altering wearables, sharing that it “depends on who is wearing them and what else they are wearing. Mrs. Weird has an effect on my mood no matter the other variables.” I hadn’t thought of wearables in that context when I was writing last week, but that’s an important point. Despite the mass integration of technology in all facets of our lives, I still don’t understand people who wear Bluetooth headsets constantly, let alone people wandering around with Google Glass in social situations. I wonder how much we miss of the world around us because of our devices.

Reader Foie Gras wrote about this year’s Clinical Informatics board certification exam: “Thanks for your description of last year’s experience. I took the exam this past week and I want a do-over! I feel like I studied very very hard, reviewed the AMIA course, took lots of notes, and am experienced in the field, but there were definitely questions on the test with terms I did NOT know and even on some of the topics I’d studied up on. I felt they asked a very nuanced question that I just couldn’t feel comfortable with. A bit frustrating after quite the marathon and sprint of studying. Here comes the two-month wait. I really don’t want to have to study for that thing again (although yes, I learned a ton studying for it and it was really enjoyable at times.)”

I heard similar feedback from other colleagues who sat for the exam this year. Preparing for board certification can be arduous, but being able to find some enjoyment in it says something about the personality traits of those who stay in medicine. I share the frustration about some of the terminology (particularly eponyms) used on board exams. If it walks like a duck and quacks like a duck, and actually is a duck, is the fact that it’s a Baikal Teal vs. a Carolina American Wood Duck really relevant if the question is asking how many feet it has?

I enjoy leisure reading much more than I enjoy reading CMS regulations or (heaven forbid) the Federal Register, so I was excited when a colleague left a copy of “Doctored: The Disillusionment of an American Physician” on my desk. Sandeep Jauhar is a New York cardiologist. I was familiar with his first book, “Intern.” The sequel was a pretty quick read and explores several healthcare dynamics from the last two decades: the fall of fee-for-service reimbursement, providers who order diagnostic testing for their own enrichment, and fragmentation of patient care.

Although I haven’t had to deal with some of the scenarios he encountered after leaving fellowship, I’ve experienced enough of them to share some of his feelings of disillusionment. In addition to being about the “mid-life crisis” facing medicine since the creation of Medicare in the 1960s, it also covers his own mid-life crisis, which makes some sections a little difficult to read. Still, I appreciate his candor and his willingness to stick his neck out as he shares his story.

I’m used to getting a variety of mailers and postcards from vendors and recruiters, particularly around HIMSS and other conferences. I was surprised this week to get a recruiting postcard from Uncle Sam. I’m sure the mailing was set up weeks ago, but the statement “because of the wide scope of the Army’s activities, you may have the chance to see and study diseases that are not usually encountered in civilian practice” to be very timely. Some of my best friends are currently or have been military physicians. I am grateful for their service and for the sacrifice of everyone serving in all branches of the military. Veterans Day is approaching, so make plans to thank your colleagues, neighbors, and family members who have served.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 10/24/14

HHS reshuffles amid Ebola crisis

Karen DeSalvo, MD leaves her post leading the ONC to take over as HHS’s acting assistant secretary for health. Interim national coordinator Jacob Reider, MD also announces he will leave ONC in the coming weeks, leaving ONC COO Lisa Lewis to take over as the new acting national coordinator.

HHS Secretary announces $840 million initiative to improve patient care and lower costs

HHS announces $840 million in new grant money that will be used to help provider organizations implement the tools needed to create more coordinated, integrated health systems.

Wikipedia and Facebook for Clinical Documentation

John Halamka MD, CIO of Beth Israel Deaconess Medical Center, calls for clinical documentation, which was designed to support billing needs, to be redesigned as an interdisciplinary communication tool.

Cerner Reports Third Quarter 2014 Results

Cerner reports Q3 results: revenue is up 15 percent to $840 million, adjusted EPS $0.42 vs. 0.35.

Morning Headlines 10/23/14

U.S. government probes medical devices for possible cyber flaws

Reuters reports that the Department of Homeland Security is quietly investigating cybersecurity flaws found in medical devices that government officials suspect could be exploited by hackers.

The Comparative Value of 3 Electronic Sources of Medication Data

A study measuring the accuracy of home medication list data sources compares the actual home medication lists for 858 patients with the data found in the hospital’s EHR, the local HIE, and a commercial ePrescribing network. Researchers found that the EHR had 80 percent of the patient’s home medications accurately listed, while the commercial ePrescribing network had 45 percent, and the local HIE had 37 percent.

Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in US Hospitals

The CDC updates its Ebola personal protective equipment guidelines to specify that no skin should be exposed, and that repeated training with demonstrated competency on infection control standards should be conducted prior to caring for Ebola patients.

HIStalk Interviews Victoria Tiase, RN, Director of Informatics Strategy, NewYork-Presbyterian Hospital

Victoria Tiase RN, MSN is director of informatics strategy of NewYork-Presbyterian Hospital of New York, NY.

Tell me about yourself and the hospital.

I work as the director of informatics strategy at NewYork-Presbyterian Hospital. The position reports directly to our CIO, Aurelia Boyer.

My background is a nurse. I’ve been at the institution for almost 20 years. I did my graduate work in informatics at Columbia University. 

My role in the IT department consists of consulting from an informatics point on various projects and initiatives throughout the department and organization. I also serve as the liaison to state and federal initiatives that pertain to health IT, which as you know over the past seven or eight years have really expanded. I work very closely with Greater New York Hospital Association and HANYS and other organizations as well as our internal government affairs department as it relates to health IT.

Is the hospital still using both Epic and Allscripts?

The hospital uses Allscripts. One of the physician organizations that is affiliated with the hospital uses Epic, but not the hospital.

Are you using other Allscripts products?

We use Allscripts SCM and Allscripts Pharmacy. In addition, we have a couple of their care coordination products, Allscripts Care Management and Allscripts Care Director. In addition, our ambulatory areas use the ambulatory SCM product. We also use their ED product in our emergency rooms.

You’ll be presenting on care coordination at  the Digital Health Conference in November. What’s the role of technology?

I see it playing a huge role. It remains to be seen how the technology will be used in the care coordination arena. I think we’re basically sticking our toe in the water at this point.

Most specifically, what I’m going to be speaking about is our involvement in the New York Digital Health Accelerator program last year. It was a partnership between New York eHealth Collaborative and the Partnership Fund for New York City. They initiated a program last year where they find health IT startups that might already have some involvement in New York City and/or are interested in relocating and moving to New York City. They partner them with area hospitals for a mentoring perspective and the hospital has the ability to pilot that company’s technology if interested.

We participated last year and we just kicked off this year’s program, so we’re now in Year 2, but I’m mostly going to be speaking to our experience last year. We were paired with a company called ActualMeds. They have a loosely called medication reconciliation solution. However, the use that we found in speaking with the company and working and mentoring with them last year was that we have community health workers in a number of our programs up here in our Washington Heights area. They go into the home, they have a close relationship with the patients, and are helping us with that care coordination aspect in the community.

Prior to working with ActualMeds, we had the community health workers collecting information on paper while they’re in the home with the patients. They’re bringing that information back to our clinics and our program coordinators. It’s our way of gathering that information about the patient, which is so important for the continuity of their care once they leave our inpatient or outpatient clinics — what goes on at that point in time and how can we collect that information. 

Using the ActualMeds technology, we had our community health workers for the first time using a tablet device to collect medication information from the patients in their homes. They are looking at the medications, talking with the patient, and entering the information in an electronic fashion. It is easier for our clinicians to look at that and then integrate that into the care of the patient when they are seen for their next visit.

It was a great learning experience for us because there’s this idea that health IT is going to help us do all of this care coordination. How do we break that down? How do we test and pilot and ensure that that will definitely make a difference? How do we do it in the best way possible?

We had a lot of learning experiences from just even understanding if our community health workers can use a tablet. There were so many things that we assumed and a number of assumptions that were proved wrong. It’s just some of the basic mechanisms of just operating a tablet. Then there’s understanding the operating system, understanding how to use a browser, understanding how to use an app. So many interesting findings came out of that work. I think it’s important for us to work with our players in the community and understand how technology can best meet those needs.

Are the startups you’re working with connecting to your Allscripts system?

They are not connecting. I assume you mean interfacing. No, they are not interfacing at this time. These are really just usability pilots. We’re continuing to work with ActualMeds. I think eventually down the road, we would love to have some use cases for patient-generated data in electronic medical records. We are certainly not there yet. That is a big topic in HIT.

Are you doing anything to allow patients to be more involved in the process?

We have a homegrown portal in which our patients have the ability to see the information on their visit. We have also just started some pilots on the inpatient side, where we are working with patients to see the medications that they are to be given and have been ordered for them on the inpatient side. We’re allowing them to document their pain level.

We are definitely doing some pilots in that area. We’re very interested in how that would work. Then as I mentioned, I think the trick is how you legally incorporate and safely incorporate patient-generated data into the electronic medical record.

I always wondered why hospitals don’t give patients their own version of the medication administration record so they can follow their therapies. What did you learn from the experience of patients seeing their medication schedules? Did they find opportunities to correct what otherwise would have been a mistake?

Absolutely. We’re finding a huge satisfaction from the patients in knowing what medications are being ordered for them and what medications they’ll be receiving. That’s where we’re finding the value. 

It gives the patient the ability to ask questions, which I think is important. A lot of times, they don’t have the information in front of them, or they’ve been given the medication at a time that is not during rounds, so then they forget when the physician comes in for rounding or the team comes in for rounding. It’s like, oh my goodness, I wanted to ask you something about the medication — I forget what it was. Here they have it right in front of them. The satisfaction piece is the part that we were most pleased with.

Was that transparency threatening to nurses who might get called out for factors beyond their control for not being on schedule with meds or maybe even missing meds occasionally?

We did not find that. We did not receive pushback from our nurses. I don’t have results that we measured, but I think it takes the opposite effect. That makes me feel like, especially as a nurse, like, the patient knows what they’re going to be getting, when they’re going to be getting it. That way, they’re not going to be calling me every five seconds and saying, “Where’s my med, where’s my med, where’s my med?“ 

I think it actually would have the opposite effect. That is my hypothesis, but that isn’t something that we’ve measured per se. I’d be surprised if it was the other way around.

What are you doing with population health and analytics?

There’s certainly a lot in those areas. I guess our initiative that is farthest along is in our patient-centered medical home arena. Our ACN clinics have all achieved PCMH status level 3. We have a number of dashboards and tools that our providers use to see which are our diabetic patients — diabetes is one of our PCMH diseases — and how many of them have an A1C that’s of a particular level, when was their last visit, when was their last foot exam, eye exam. We certainly are doing a lot of work in that area — targeting our diabetic patients, our CHF patients, and also our asthmatics. Those are the big diseases we’ve been targeting.

How is the hospital doing with Meaningful Use?

We are doing great with Meaningful Use. That’s one thing that I work on very closely. I’ve spent most of today working on that, in fact. 

We’re in a great position with Meaningful Use and have certainly met it in the past few years. We are about to attest for Stage 2. Our learning there is that it certainly is a lot more time-consuming. It takes a lot of thought and it takes a lot of resources. It’s a project to not take lightly to make sure you’re doing it in a meaningful way and not just trying to check the boxes.

How about interoperability?

How about it? [laughs] Our nation is on a 10-year plan. Hopefully we’ll be seeing it soon. [laughs]

Meaningful Use, again, it’s just sticking the toe in the water. It’s a really small piece of what needs to be done. But I think we’re headed in the right direction.

I think for those that are attesting to Meaningful Use, you’ve now got some of the standards in place. A small amount, but you’ve got LOINC and SNOMED, so we’re starting to move in the right direction. I think there’s a lot more work to do. But it’s a place that we need to go. I think the CCD is a start. But as you’re seeing in the Times and other publications, we’ve got a ways to go.

What are the biggest issues and opportunities in nursing informatics?

Patient engagement is the biggest one in my mind. Nurses are in a unique position to be the discipline that leads efforts for patient and family engagement. There are some huge opportunities there. Nurses are already engaging the patients, already educating the patients. I think there’s great opportunities to use nursing and health IT to move that forward. That is one huge opportunity.

The second piece involves mobility and inefficiencies for nursing. We’re already seeing with medication barcoding and handhelds. Finding ways to use health IT and informatics and using the data as well in order to create more efficiencies for the nurses. We’re really looking at that.

We are very passionate at NewYork-Presbyterian about creating efficiencies for our nurses. Creating efficient workflows for them. We know they’re busy. We know there are a lot of tasks. How can we make their lives easier in caring for the patients in the best way possible?

That also includes providing real-time data to both the bedside nurses and the nurse managers. How can we get real-time data to them on their metrics on the number of patient falls and the other metrics that they might be tracking on their particular units? How can we get that data in their hands real time so it’s actionable? 

Those are some of the big opportunities for nursing. There’s a lot of opportunity and a lot of work to do.

Do you have any concluding thoughts?

I know it’s an overused term these days, but I think engaging the patient in their care and partnering with the patient is going to be important moving forward. Engagement is not only on the patient side. The patients and family are in a place where they’re ready to participate. We also need to foster that engagement on the clinician side, getting the providers ready for that engagement.

There’s going to be a lot more information flowing from the patients in the near future. Being ready to provide that information to the clinicians in the small snippets or nuggets that will help them to take the best care of the patient is going to be an important area to focus on. I’m envisioning this influx of data from the patients and what are we going to do with it and how we’re going to make it meaningful for the providers to help the patients in the best way possible.

Morning Headlines 10/22/14

Obama’s Ebola czar declines to testify

Newly appointed Ebola czar Ron Klain declines a request to testify before the House Oversight Committee over the government’s Ebola response thus far. The hearing, scheduled for Friday, will be just his third day on the job.

NCCN Chemotherapy Order Templates to be Integrated into Epic’s Electronic Health Record

Epic will integrate the evidence-based chemotherapy order templates from the National Comprehensive Cancer Network into its Beacon oncology product.

Athenahealth to expand at Ponce City Market

Athenahealth will expand its Atlanta, GA offices, adding 20,000 square feet immediately, with plans to add an additional 40,000 square feet in 2016.

News 10/22/14

Top News

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

Announcements and Implementations

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

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

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

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

Sales

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

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

People

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

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

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

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

Research and Innovation

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

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

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

Other

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Curbside Consult with Dr. Jayne 10/20/14

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: The Elephant in the Room: Provider Validation

The Elephant in the Room: Provider Validation
By Miranda Rochol

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

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

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

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

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

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

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

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

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

Morning Headlines 10/21/14

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

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

Healthcare IT Leaders Embrace Federal Interoperability Plans

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

New Affordable Care Act initiative to support care coordination nationwide

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