Monday Morning Update 9/1/14

August 30, 2014 News 4 Comments

Top News

CMS basically kills the comatose Meaningful Use program by publishing a rule that leaves the 365-day attestation period for 2015 unchanged, meaning hospitals must be ready to start in the next four weeks. The rule, released late in the afternoon of a Friday holiday weekend, ignores widespread recommendations to allow providers to attest for any three-month quarter of the year. The only benefit to providers is that Stage 3 is moved back a year to January 2017 and an extension of time for using 2011 CEHRT. The program has gotten so complex that I’m not sure anyone really understands it. Leave a comment with your reaction to the new rule, assuming you even care.

Reader Comments

From DrM: “Re: Apple’s privacy policy change for HealthKit. This is actually broader than just selling data. It extends to providing HealthKit data to any third party for any purpose other than providing health and/or fitness services, and even then they must obtain user consent. This precludes many secondary use scenarios, possibly even ones that might be beneficial to the user. I’m guessing this change was driven by their discussions with large healthcare organizations who likely told them that if they allow others to monetize or reuse that data, they won’t be putting their patients’ data into HealthKit and wouldn’t ask their patients to do so, either. Apple has a number of other hurdles to overcome to make their technology work for healthcare, but this would have been a quick deal-breaker for many if not most organizations.”

From Frogger: “Re: Castlight Health. I’m M&A trained and Castlight was a loser from the get-go. The who’s who of investors, big-name healthcare people, and investment bankers involved were desperately trying to save their investment with a much-publicized marketing campaign of an IPO. However, many of my colleagues with healthcare investment backgrounds (including me) can’t figure out what’s so attractive. It will be sure to die if Todd Park gives it CPR like Healthcare.gov, which is still being propped up by taxpayer dollars. Left on its own, it would perish by Christmas and still have 15 million uninsured, which was the CBO projection even if it had gone according to plan.” I dug through SEC documents trying to figure out how many CSLT shares Todd owns or if he’s sold them, but couldn’t find his name anywhere other than on the list of the shareholders of Maria Health that morphed into Castlight. He wasn’t a company executive, just a co-founder, so maybe his shares are held under a corporate name. I would think he had to divest to work for the White House, but I don’t know for sure.

From The PACS Designer: “Re: Windows 9. The Microsoft Threshold project, now known as Windows 9, has been rumored to be moved forward from 2015 to a possible launch in late September. It will be interesting to see how it will be sold considering how many users are still on Windows XP.” Everybody knows that every other major version of Windows is bad, which obviously includes the terrible decisions made about the user interface of the poorly-adopted Windows 8, such as the default Metro tile interface even for non-touchscreen desktops, the bizarre Charms bar, and the unintuitively hidden red X to close an open window. Let’s hope Microsoft doesn’t break the streak by rushing out a partially baked Windows 9. Rumors suggest that a Win 9 upgrade will cost somewhere between nothing and $20. I’ll add this: I’m on Windows 8.1 and I like it a lot since updates made the non-tile display standard. I’ve had no problems at all, and even its native Bitlocker encryption works flawlessly and invisibly. Individual Win XP users should definitely get off that creaky platform, especially since Microsoft will supposedly offer a great deal to move to Windows 9.

Reader Comments about HIE Costs

From an HIE president: “We partnered with the state’s department of health for important services that include public health feeds for Meaningful Use. When providers are forced by regulation to use the HIE, there’s no charge for access. However, those services are subsidized by the all-in participant fees, which are on average less than one-tenth the number you mentioned. Yes, our HIE hopes to make our services so valuable that everyone will use them, but since we are governed by providers that both set and pay the fees, I wouldn’t consider it milking for profit. Certain vendors have been speaking negatively about HIEs for years, telling customers, ‘You don’t need them – just buy my [incredibly expensive] software.’”

From an EHR vendor: “One state we work in was territorial. We were told that practices had to submit data via the HIE instead of directly to the state. The HIE moved very slowly and the state demanded more upfront data cleanup by the EHR, such as changing ‘Road’ to ‘RD’ or whatever. I think the state was threatened by the HIE’s approach and wanted to punish someone for it. Then there was a problem that the HIE wouldn’t talk to the state about, so the state called us, then the HIE blamed their HIE platform vendor and the state, the state blamed us and our clients, and our clients blamed us, all while the vendor didn’t respond. That vendor finally fixed the problem without any explanation or apology.”

From an EHR vendor: “I have really not found an HIE with a sustainable business model. They inherently believe they are providing value and believe that providers should line up and pay for it. I have not found that to be the case. We are finding more success in purpose-driven connections that generally bypass HIEs, partially due to their limitations in dealing with sensitive data and consents.”

From a hospital CIO: “The point of being held hostage is longstanding. I tried to make the point to the state HIE leaders that if you want to charge my organization, you need to do something I can’t do or do it more effectively. I had already automated interfaces to reference labs and e-prescribing, items the HIE was trying to sell me as added value. I told them they should remove my need to maintain never-ending state reporting changes in return for getting my ADT information, but they couldn’t seem to grasp the concept. They saw the health system’s participation in an HIE as an obligation.”

From a hospital: “The state HIE has told us repeatedly we need to pay full participation costs when we only need to send immunization data. This would have been around $675K annually. We have refused since there’s no reciprocal benefit to us. I know several of the state’s largest health systems are united with us in refusing to pay. The way to statewide HIE connectivity is through regional HIE collaboration.”

HIStalk Announcements and Requests

A third of poll respondents say their provider organizations are taking new security steps after the Community Health Systems breach. New poll to your right or here: how much impact will drug chains such as Walgreens and CVS have on healthcare in the future?

The HIStalk site had some malware added via SQL injection Friday afternoon. Sucuri, my excellent malware monitoring and remediation service, detected and removed it quickly, but it takes quite a while for the online services (especially Google Safe Search) to catch up and stop showing the “blocked” warning. It’s surprisingly challenging to keep the hackers out, even with a dedicated, hardened server with updated software. HIStalk, for example, has had 31,000 malicious access attempts blocked by yet another tool I use. After this incident, I’ve one more layer of security, a virtual proxy firewall that blocks several kinds of attacks.

The silver lining of the malware problem is that I found a great secure password management tool: LastPass. It will detect and store your Web-based passwords as you log in (encrypted on the web) and give a single-click access to any of them across multiple devices, including the iPhone. I updated my sites with new, complex passwords that I don’t have to remember – I only need to recall the master password that opens the LastPass web page in Firefox. You can even create a shared folder to share passwords with family members with real-time updates. It’s free, amazingly, and the premium version with extended mobile support is only $12 per year. It will change your life.

My idea for the HIMSS conference: Chicago’s not Black Rock City, but let’s go Burning Man and erect a giant figure of The Man (maybe he could look like Steve Lieber) that will be ceremoniously burned Wednesday night as a clothing-optional emotional purging of the week’s triumphs and frustrations. Then on Thursday, The Temple (the exhibit hall) can be immolated as the 15 people who stick around until then cheer.

Last Week’s Most Interesting News

Apple updates its privacy policy to prohibit health app developers from selling user data.
The Department of Defense issues the RFP for its $11 billion EHR project.
The VA issues an RFP for a new patient scheduling system.
Premier announces that it will acquire supply chain technology vendor Aperek.
The White House confirms that Todd Park will transition from US CTO to a West Coast-based advisory role, where he will recruit technology talent for government work.
Oregon files a lawsuit against Oracle over its mothballed $240 million health insurance exchange.

Webinars

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.

September 11 (Thursday) 1:00 p.m.ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors. Registrants get a free electronic or paper copy of the book.

Announcements and Implementations

Philips announces the monitoring cost for its free Lifeline app for seniors — just $13.95 per month with no contract required. That seems like a good deal for independent elderly folks as long as they have a smartphone and keep it handy at all times.

Government and Politics

CMS’s Open Payments system is not only late going live, it also will exclude an estimated one-third of total payments drug and device manufacturers pay to doctors. CMS says physicians who are paid via contract research organization haven’t had time to verify the validity of their data, so it will be withheld from the September 30 go-live. System proponent Senator Chuck Grassley (R-IA) wasn’t happy with the news, saying, “CMS has had more than four years to figure everything out. It’s disappointing and irresponsible that so many basic questions are unresolved at this late stage.” CMS was supposed to release its rules for the system that reports payments for research, consulting, and gifts in December 2011, but didn’t get them out until February 2013. Adding to the site’s problems, CMS says the system’s operation will be interrupted at times from August 30 to September 5.

Vermont, which fired its health insurance exchange contractor CGI and brought it Optum to review the project, gets a black eye when Optum concludes that the state’s project ownership was lax and CGI didn’t feel accountable.

Technology

A ED doctor develops a smartphone app that can objectively measure whether a patient is experiencing genuine alcohol withdrawal. The patient simply holds the smartphone for 20 seconds, after which the doctor can tell if they’re faking it to get prescriptions. One of its developers is working on an app that objectively measure the redness of a patient’s face to determine whether rashes are getting better or worse. Of all the dopey medical apps out there, these seem like great ideas.

Other

AMIA will convene an invited group this week on “Harnessing Next-Generation Informatics for Personalizing Medicine.” I wouldn’t have named AMIA as the best organization to work on tailoring treatments to genomics and discovering the correlation between physiology and diseases and treatments, but at least they are looking ahead.

In Ireland, a large hospital’s laboratory will need to reinterpret and possibly redraw hundreds of blood tests when on of its systems crashes several times in August.

Executives of four private health systems that control 80 percent of the Phoenix, AZ market question whether taxpayers should pay around $1.4 billion to replace Maricopa Medical Center and other county health facilities. The executives say there’s no need to expand a tax district hospital when most patients are treated as outpatients and the existing systems have more than enough capacity. I’ll admit the building looks awful, as does most early 1970s architecture, where a lot of hospitals are trapped in time due to the sudden influx of Medicare money.

Siemens posted this pretty cool time lapse video of a trade show setup. I was in the HIMSS exhibit hall on setup days earlier this year and it was a madhouse of fast-moving motorized equipment, setup workers, employees in blue jeans, and mountains of shipping containers.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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4 Comments

Morning Headlines 8/29/14

August 28, 2014 Headlines Comments Off

Apple prohibits HealthKit app developers from selling health data

Apple has updated its privacy policy to prohibit developers that connect to its HealthKit API from selling health data to marketers. The announcement comes on the heels of rumors that Apple will finally unveil the iWatch during its upcoming September 9 marketing event.

Google’s Smith Is Top Candidate for U.S. Chief Technology Officer

The VP of Google’s secretive X labs is rumored to be a top candidate for next US CTO position, replacing Todd Park who recently announced that he would be moving on.

Greenway has completed its implementation of Walgreen’s pharmacy EHR, the largest centralized pharmacy EHR system ever deployed.

Making Science Fiction a Science Reality: 10 Finalist Teams Selected For $10 Million Qualcomm Tricorder XPRIZE

Qualcomm has unveiled the final 10 teams in its $10 million tricorder XPRIZE competition.

Comments Off

News 8/29/14

August 28, 2014 News 1 Comment

Top News

Apple updates its privacy policy to prohibit companies whose apps connect to its HealthKit platform from selling user data to marketing firms. The change comes just ahead of the expected announcement of new health-related iOS 8 capabilities, including Apple’s Health app. Deborah Peel, MD of Patient Privacy Rights reacted to the announcement by saying, “If Apple is really doing this, if they’re really saying to developers that you can only use the data for the specific purpose that app provides the user and that they can not share the data with anyone else without informed consent, that is the victory of victories. That’s what we’re seeking from all of the 100,000 of the companies that are now selling health data.”

Reader Comments

From Aruba Layoffs: “Re: Aruba Networks. Many talented people let go as healthcare technology spending is way down.” Wireless networking vendor Aruba isn’t healthcare specific. Both its revenue and earnings announced this week beat expectations, revenue is growing at 30 percent annually, and share price matches the Nasdaq at 25 percent growth in the past year. The company is, however, laying off 65 employees and moving 75 jobs to Oregon, India, and Ireland, but it sounds like that’s related to shifting resources to less-expensive locations rather than because of financial problems.

From Stephanie Reel: “Re: Star-Spangled Spectacular. I wonder if your readers would be interested in something that has everything to do with our nation, but nothing to do with our industry?” Baltimore celebrates the 200th anniversary of the National Anthem — written as Francis Scott Key observed the British bombardment of Baltimore’s Fort McHenry — with a week-long celebration September 10-16. It features visiting ships, a Blue Angels air show, a concert (Kristin Chenoweth, Melissa Etheridge, Denyce Graves-Montgomery, Kenny Rogers, Train, and the Baltimore Symphony Orchestra), festival villages, and of course fireworks. Stephanie is CIO for Johns Hopkins University and Hopkins Medicine – both campuses are worth a tour if you visit Baltimore for the celebration. You can bring the kids and take short side trips from the Inner Harbor to DC and Lancaster, PA along with seeing the Orioles play the Yankees that week.

From Jimmy John: “Re: HIPPA. I thought you would enjoy this magazine’s misspelling.” At least they were inconsistent from one line to the next amidst the click-baiting headlines – 50 percent right is better than none. They’re owned by HIMSS (or is that HIMMS?), as is the publication devoting 12 lazy paragraphs to a wandering, not-too-interesting story with the breathy “Generalissimo Francisco Franco is still dead tonight” style headline: “New HIPAA breach details remain vague.” The “new” breach occurred in June and details are “vague” because the reporter just cobbled together the story and quotes from wire reports.

HIStalk Announcements and Requests

School has started, so I sponsored some new DonorsChoose projects involving Teach for America teachers, doubling the impact of HIStalk readers since the Bill & Melinda Gates Foundation matched our contributions to fully fund them all. Teachers of DonorsChoose projects provide photos and updates, so I’ll have more later. What we as readers did:

Purchased headphones and whiteboards for Grades 3-5 of a highest-poverty school whose teacher is urging her students to take ownership of their education, accept leadership roles, and share knowledge in groups that include peer tutoring.
Bought 50 library books for a high-minority, high-poverty North Carolina charter school that has 100 percent college acceptance of its seniors.
Provided a listening center for a highest-poverty school in southern Kentucky, whose energetic English teacher is struggling with ninth graders who haven’t read a book in years, some of whom have learning limitations.
Bought six bilingual picture dictionaries for a middle school class of a highest-poverty school in New Orleans, whose large population of new students from Central America are working hard to learn English.

Meanwhile, I heard today from the teacher of a high school engineering class for which we bought a 3-D printer. He says he has had to redesign his lesson plans and projects for the better, the number of students in his classes has doubled, and he makes them think about, “How would you model that in the Replicator? What medium should we use?” He taught students the importance of scale and precision by having them create an iPhone case. He says, “I am overwhelmed with requests from the students about what is in the printing queue.”

This week on HIStalk Practice: Dr. Gregg shares a humorous take on voice recognition and “otto collect.” McGree Medical goes live on Epic’s Community Care EHR. HealthSpot prepares to install 100 telemedicine kiosks. Walgreens implements Greenway’s EHR in over 8,200 pharmacies. South Florida Medicine Director of PM Alyson Tiedeman shares her thoughts on managing IT across a large medical group. CarePoint Health System goes with eClinicalWorks for its medical practices. Results are in from the annual HIStalk Practice Reader’s Survey. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses health IT IPOs and speculates who the next batch of likely contenders might be. Peer60 analyzes the patient portal market and the varying levels of success health systems are having with each vendor’s offering. Skullcandy partners with USC to host a digital health innovation contest focused on encouraging development efforts at the cross section of health IT and music.

Encore did a great webinar Wednesday on “Enterprise Data – Tapping Your Most Critical Asset for Survival” that some registrants couldn’t view because of a GoToWebinar problem in its latest code update. You can watch it above or on YouTube. Jonathan Velez, MD (CMIO – Hartford HealthCare) and Randy Thomas (Encore) did a nice job and filled the 40 minutes with solid information.

Meanwhile, here’s a case study on how to be a crappy software vendor like GoToWebinar, owned by Citrix:

Don’t QA your new releases. Instead, outsource QA to your customers and then just roll them back to pre-broken versions when they call in problems.
Don’t notify customers of known problems, especially those that affect critical processes like viewing and recording webinars. Admitting failure will shake their confidence.
Instruct your support reps to quickly tell callers that their problem is a known issue. Everybody loves to hear it’s not just them.
Keep support callers on hold when they call the high-priority service number and play annoying messages throughout telling them how great support will be once they get through. This heightens their anticipation.
Propose illogical solutions, such as restarting a webinar already underway even though that would prevent anyone from seeing it. The support engineer will seem more skilled since no non-engineer would propose a similarly out-of-touch solution.
Ask customers to trust you in rolling back to old code versions, even when they have no way to verify that the change works (unless they have 100 friends willing to hop on an impromptu webinar to see if they can get in). You trust them to pay their bills, so the should trust you to release pretty good code.
Just give up, as did the person from Citrix who told me apologetically, “Maybe it’s time for you to find a new webinar provider.” This reverse psychology will make them want you even more.

I apologize if GTW’s bug locked you out of Wednesday’s webinar. The video above is perfect and worth watching.

Acquisitions, Funding, Business, and Stock

Craneware acquires Scottish patient access mobile systems vendor Kestros Limited, which has been selling primarily to NHS Trusts.

September 10 is a critical day for Castlight Health and its tanking share price: the lockup period ends and the pre-IPO shareholders will be able to sell up to 76 million shares, which closed at around $40 on IPO day in March but are now trading at less than $12. That’s a 70 percent haircut, but the company still has a $1 billion market cap on less than $30 million in annual revenue and huge losses. Maybe co-founder Todd Park can swing by on his new West Coast White House gig and apply Healthcare.gov-like CPR.

Sales

Robert Wood Johnson Health System (NJ) expands its relationship with NTT Data in selecting its Optimum RCM suite.

Kaweah Delta Health Care District chooses Access for electronic forms and patient signatures.

Marshfield Clinic (WI) standardizes on Client Outlook’s eUnity university image viewer and collaboration tool for its homegrown CattailsMD EHR.

Georgia Regents Health System (Augusta, GA-based GRHealth) signs a $400 million agreement to turn over its IT operation to Cerner, which it says will save it 15 percent of its operating costs annually and make its annual expense predictable. GRHealth operates Georgia Regents Medical Center and Children’s Hospital of Georgia. The system says all 132 employees will receive offer letters from Cerner. Cerner became interested in the arrangement last year when the system signed a $300 million clinical technology partnership agreement with Philips, indicating along with the Siemens acquisition that Cerner sees a future in merging IT systems with clinical monitoring.

Sunquest will expand its relationship with private pathology lab CellNetix to work on anatomic pathology workflow solutions.

People

Boston Software Systems promotes Steve Cohen to COO.

David Watson (Oracle) will be named CEO of the new California Integrated Data Exchange (Cal INDEX).

Announcements and Implementations

Walgreens the rollout of its Greenway Health EHR to all of its 8,200 locations, allowing its pharmacists to counsel patients and provide immunization and testing recommendations.

Aspirus Wausau Hospital (WI) announces an OR digital integration project that will feature a centralized OR hub equipped with touch-screen monitors that can display images from all devices and modalities. It will use Brainlab’s Buzz digital OR.

Sentry Data Systems announces its 340B Technology Backbone to help pharmacies manage their 340B drug purchasing programs.

Government and Politics

Bloomberg reports that Google executive Megan Smith is the top candidate to replace Todd Park as US CTO. Smith’s background is the Google X skunkworks lab, so unlike her predecessors Aneesh Chopra and Park, she has no healthcare experience. She is married to re/code technical reporter Kara Swisher, although they are separated.

Meanwhile, the White House confirms that CTO Todd Park will continue working for the White House after returning home to California, recruiting technical talent for government work in a new role of technical advisor. President Obama said in a statement, “From launching the Presidential Innovation Fellows program, to opening up troves of government data to the public, to helping spearhead the successful turnaround of HealthCare.gov, Todd has been, and will continue to be, a key member of my Administration. I thank Todd for his service as my Chief Technology Officer, and look forward to his continuing to help us deploy the best people and ideas from the tech community in service of the American people.”

Innovation and Research

XPRIZE names the 10 finalists competing for its $10 million Qualcomm Tricorder XPRIZE: Aezon (US), CloudDX (Canada), Danvantri (India), DMI (US), Dynamic Biomarkers Group (China), Final Frontier Medical Devices (US), MESI Simplifying diagnostics (Slovenia), Scanadu (US), ScaNurse (England), and zensor (Ireland.)

President Obama will champion ElectRx, a $79 million, five-year DARPA-run project to implant computer chips in troops and veterans to promote faster healing. The program’s manager describes it as “a closed-loop system that would work in concept like a tiny, intelligent pacemaker” to assess conditions and send electrical stimulation to induce healing. A related effort will detect mood changes associated with PTSD. I don’t know how they’ll deal with FDA approval.

Speaking at the American Legion National Convention in Charlotte, NC, President Obama said,

So we’re going to keep at this until we end this backlog once and for all. And as we do, we’re going to keep working to liberate you from those mountains of paper. We’ve got to move towards a paperless system — electronic health records that our troops and veterans can keep for life, and that could cut down on some of the bureaucratic red tape so that you’re getting the benefits that you’ve earned a little bit faster.

Technology

Korea-based medical wearables startup Ybrain raises $3.5 million in a Series A round. Its product isn’t the usual fitness tracker: the US-educated team has developed an electrical stimulation device that it says can combat the effects of Alzheimer’s when used at home for 30 minutes per day, five days per week. The company hopes to launch its service in early 2015.

Apple co-founder Steve Wozniak says he expects the company to create a market for wearables starting with upcoming announcements on September 9 that will likely include the iWatch. He says he expects fitness monitors to be involved and maybe an EKG display at some point, but in the mean time, he’s not a fan of the category:

I feel that wearables are a hard sell. They are go-betweens for your smartphone but are an extra piece and need special advantages that the smartphone doesn’t have, in my opinion. If they are just a Bluetooth go-between then it could wind up in the category of Bluetooth headsets: Fun to wear and show off for a day.

Discover magazine highlights three projects that owners of 3-D printers can perform to help people in need. Among them: use downloadable designs to print and assemble a prosthetic hand for someone who needs one, requiring around $50 in parts and 8-14 hours of printer time. The first e-NABLE conference will be held at The Johns Hopkins Hospital (MD) on September 28.

More on 3-D printing: in the UK, 12 NHS trusts are using 3-D printers to test implants before surgery to reduce cost and OR time, including bones for facial reconstruction surgery, hip replacements, and forearms. In China, surgeons implant a 3-D-printed vertebra in the spine of a 12-year-old cancer patient.

Other

Sharp HealthCare (CA) becomes the tenth of the 32 Pioneer ACOs to drop out of the program, saying that local wages rose 8.2 percent in San Diego but the Pioneer model doesn’t adjust payments accordingly.

Drug maker Bayer starts a healthcare accelerator for Europe-based companies, offering a 3.5-month program of mentoring, free office space in Berlin, and around $65,000 financial support, taking as much of 10 percent equity in return. The five startups chosen from 70 applicants are Cortrium (a device that measures temperature, activity, respiration rate, and EKG); PharmaAssistant (medication reminders via smartphone); Parica (vital signs analysis); FabUlyzer (measuring fat burned after exercise); and Cardimoni (checks heart rate and rhythm).

AMIA’s annual meeting will be held November 15-19 in Washington, DC. The early bird member registration fee of $795 ended Thursday, August 28, but it’s still discounted to $895 through October 23 (then $995). Keynotes will be Amy Abernethy, MD, PhD of Flatiron Health (I interviewed her last month) and National Coordinator Karen DeSalvo, MD, MPH, MSc. Ross Martin, MD will head up the talent show, which will provide a musically equipped stage and a house band for participants, who need only bring “additional instruments, props, and groupies.”

Cisco CEO John Chambers says the US and other developed countries will go bankrupt if they don’t fix their healthcare systems, adding that technology has a key role (although he seems to pay little attention to the caregivers on the other end of it):

The first thing that will happen is all devices on our bodies, in hospitals and in our homes will be connected. The second technological advance is video, which is the way people will prefer to communicate in the future. Video can connect any health care professional to any patient and to any specialist, all at tremendous speeds. You’ll be able to receive medical expertise 24/7. Health care applications will combine the technologies of cloud and big data, whether in the hospital or in your home. Video allows a different level of collaboration, and it offers security and privacy from your home. This is the Internet of Everything … in a typical hospital, there are nine to 15 different applications that were never designed to share information with each other. And without a common medical record that has the appropriate security and privacy built into it, moving data from one application to another is difficult … The end game should be connecting any patient to the best healthcare professionals in the world at any time, using video-driven, low-cost technology.

Greenway Health CEO Tee Green accepts his Ice Bucket Challenge, offering to make a donation to ALS Association for every employee who sends him a video of themselves doing the same.

Weird News Andy asks if Oompa Loompas were vegetarians because he never found them attractive: a study (of questionable scientific validity) finds that the healthy skin glow of people who eat high-carotenoid vegetables is more attractive than a suntan.

Sponsor Updates

Kyle Silvestro of SyTrue will participate in a panel discussion titled “How Cloud Based Solutions Allow for Improved Coordination of Care and Patient Satisfaction While Reducing Overall Costs of Billing”at the Radiology Business Management’s fall conference October 19-21 in Seattle.
GetWellNetwork CEO Michael O’Neil will facilitate a breakout session, “Interactive Patient Engagement and Activation Workshop: What’s in a Number?” and will present “ePatient Entrepreneur Story” at the Stanford Medicine X conference on September 4.
Craneware announces the appointment of Russ Rudish (Deloitte Touche Tohmatsu) to its board as non-executive director.
Emdeon launches its co-pay assistance program for retail pharmacies, Emdeon Easy Save.
AirWatch renovates and expands its former headquarters.
TeleTracking Technologies will launch multiple solutions at its client conference October 26-29 in Florida.
Sentry Data Systems shares how a Rand report clarifies the 340B program impact and provides steps to ensure its longevity.
NextGen announces that its ambulatory EHR V 5.8.1 has earned 2014 ONC HIT Cancer Registry Certification.

EPtalk by Dr. Jayne

Recent research at the University of Michigan finds that patients with low literacy and low comprehension of numerical concepts are less able to understand online lab results. The Internet survey of 1,800 adult patients looked at simulated diabetes results and whether patients understood if labs were within or outside of reference ranges. Less literate patients were also less able to determine when they should call their doctor, based on the data.

Researcher Brian Zikmund-Fisher is quoted as saying, “We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them.” At the other end of the spectrum, over three-quarters of patients with higher literacy skills could identify levels outside the reference range. He goes on to state the need for more research on the best ways to display lab data.

When we first started releasing lab results directly to patients, our physicians voiced concerns. Physicians wanted to hold the results until they could put a comment with them, as they had done in the paper world. Many of our physicians would mail the patient a copy of the test results with a handwritten “OK” or “great” or “double your Lipitor and see me for fasting labs in six weeks.” Our administration overruled the physicians.

Initially we received more phone calls about labs. Most physicians changed their behavior to start counseling patients about potential lab results at the time they were ordered or drawn to reduce the potential for calls.

That approach is fine when you’re counseling a patient on an existing diagnosis or if the labs in question are “maintenance” labs, although it adds a new dynamic to the visit that we don’t always have time for. Looking at other scenarios, I don’t think it’s the best approach when you’re dealing with a new diagnosis, particularly if it’s an emotionally charged one such as cancer or other potentially fatal conditions. I’d like to at least get to those patients on the phone first before they see the results on the patient portal.

Our results release in real time, so it puts the physicians in the position of “stalking” lab results in the evening and over the weekend, then frantically trying to get in touch with patients before they log on. An uncertain diagnosis is certainly stressful for the patient, but it also weighs heavily on the physician. Adding time pressure isn’t optimal for anyone, especially if the physician needs to consult with other members of the care team prior to talking with the patient.

National Health IT Week is almost upon us again, with the goal of raising “awareness of Health Information Technology’s power to improve the health and health care of patients across the nation.” When IT solutions are used to transform care and improve quality it can be a powerful thing, but when tools are employed without goals, accountability, or governance, it doesn’t make the world a better place. There are key themes for each day of the week:

Patient Engagement
Advancing Interoperability Through Meaningful Use
Advancing Interoperability Across the Care Continuum – Beyond
Advancing Interoperability Through Standards
Clinical Quality & Safety

I couldn’t help but notice that quality and safety are last on the list. I’m going to give ONC the benefit of the doubt and assume that they are building the week towards the most important aspect, but if that’s true, then it puts patient engagement towards the bottom.

Why do we seem to revere the means more than the ends? Email me.

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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Morning Headlines 8/28/14

August 28, 2014 Headlines Comments Off

Medtronic Buys NGC Medical To Expand Hospital-Services Offerings

Medtronic acquires Italian-based hospital services firm NGC Medical for $350 million. NGC Medical will be integrated into Medtronic’s hospital managed-services business.

Federal auditors sought documents related to troubled Md. health exchange launch

Auditos from HHS’s Office of the Inspector General are investigating the now fired Noridian Healthcare Solutions over fraud allegations surrounding the failed health insurance exchange it was contracted to develop for Maryland.

NIH issues finalized policy on genomic data sharing

The National Institutes of Health issues its final policy on genomic data sharing. The new policy will apply to all NIH-funded projects that generate genetic data.

Twitter helps Chicago find sources of food poisoning

Health officials within the Chicago Department of Public Health are using aggregated Twitter feed data to identify restaurants causing food poisoning in the city.

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Morning Headlines 8/27/14

August 27, 2014 Headlines 1 Comment

DoD Takes Next Step in Modernizing Electronic Health Records

The Defense Department issues an $11 billion RFP for its next generation EHR. The RFP calls for initial field testing by the end of 2016.

There’s finally someone in charge of HealthCare.gov

CMS names Kevin Counihan to the newly created CEO of Healthcare.gov position. Counihan was previously the chief executive of Connecticut’s largely successful health insurance exchange.

VA Takes Next Step to Modernize Scheduling System

The VA announces that it will issue an RFP for a new medical appointment scheduling system by the end of September, one of many corrective actions being put in place following the VA’s recent off-the-books scheduling scandal.

In Indiana, state government tries using big data project to reduce infant mortality

Indiana will spend $9.1 million to implement SAP’s data analytics platform with goals of reducing its infant mortality rate from 7.7 to 6.89 deaths per 1,000 births.

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News 8/27/14

August 26, 2014 News 10 Comments

Top News

The Department of Defense issues an RFP for its $11 billion EHR replacement. Dim-Sum brought up a great point in our conversation the other day: the government requires that a significant chunk of the bid be awarded to companies owned by women, minorities, and veterans. That means a lot of companies beyond the winning primary contractor and EHR vendor will earn business. Stay tuned for Dim-Sum’s September 18 HIStalk webinar. I didn’t think of it until this minute, but I bet he could provide a good overview of how to do business with the DoD – that would give small players time to get their ducks in a row.

Reader Comments

From Medwreck: “Re: cloud. I’m on a life sciences panel for an upcoming cloud-based content management software conference. Will all healthcare hosting and apps go the way of the cloud at some point?” Yes, for the most part. Data center operation isn’t the core competency of providers, security challenges are exceeding local resource capabilities, access to bandwidth is nearly universal, and cloud providers can offer higher reliability and recoverability. Assuming the price point is comparable or favorable and the cloud provider offers solid service levels, it makes no sense for providers to run data centers, just as it makes no sense for them to run electrical generators or wells when electric and water companies can do it better and with the higher efficiency that specialization brings once the grid has been established. The exceptions will be applications from small vendors that don’t offer them via the cloud or charge excessively for that option, which won’t be the case for long because they’ll be out of business.

HIStalk Announcements and Requests

The CHS Heartbleed-related breach is getting a lot of interest. I’m putting HIStalk Advisory Panel reactions together for a post next week since I suspect many hospital IT people are scrambling to explain what it means to their peers. Please add your thoughts here if you work for a hospital.

Listening: masterful early 1970s progressive rock from Peter Gabriel-led Genesis (Phil Collins was just drumming in overalls then – it was later he moved out front to lead the band to bubblegumdom) and the even more talented but criminally underappreciated Gentle Giant and the brilliant Kansas. Forty-year-old music shouldn’t sound this good and the now-balding and rotund 64-year-old Gabriel shouldn’t have been quite so androgynously attractive in video from his early 20s.

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.

The Breakaway Group created this fun intro to their September 11 webinar.

Acquisitions, Funding, Business, and Stock

Premier, Inc. reports Q4 results: revenue up 17 percent, adjusted EPS $0.34 vs. $0.29. The company also announced that it will acquired Raleigh, NC-based supply chain analytics vendor Aperek for $48.5 million. It’s Premier’s third acquisition so far this year and the announcement hinted at more to come, which CEO Susan DeVore suggested when I interviewed her last month.

AirStrip raises $25 million in funding. New investors include The Gary and Mary West Health Investment Fund, Leerink Partners, and AirStrip customers Dignity Health and St. Joseph Health.

Visage Imaging’s parent company, Australia-based Pro Medicus Limited, discusses FY2014 results.

Sunquest owner Roper Industries announces two medical acquisitions: Strategic Healthcare Programs (post-acute care analytics) and Innovative Product Achievements (surgical scrub dispensing).

Columbia City, IN-based supply chain software vendor Solstice Medical secures $2.5 million in funding, $1 million of that from a state investment program for potentially high-growth businesses.

Sales

Greater Hudson Valley Health System (NY) chooses Strata Decision’s StrataJazz for complete financials.

Baptist Health (FL) selects Explorys for analytics.

Flagler Hospital (FL) chooses MModal for speech-driven clinical documentation.

Integrated Health Network (NJ) selects eClinicalWorks EHR and population health management for its 45 practices.

North Carolina Pediatric Associates will deploy NextGen Ambulatory EHR, PM, and patient portal.

People

UPMC EVP/CIO Dan Drawbaugh will resign after 30 years with the health system to pursue unspecified other professional interests. SVP Ed McCallister will serve as interim CIO. Drawbaugh was one of the highest-paid non-profit CIOs in the country, earning $1.6 million in 2012.

Emanuel Medical Center (GA) promotes David Flanders from CIO to COO.

CMS names Kevin Counihan (Access Health CT) to the newly created position of CEO of Healthcare.gov. Connecticut’s exchange, built with minimal functionality to meet ambitious deadlines, was one of few state-developed exchanges that worked, to the point that other states with overly ambitious visions and questionable contractors asked it for help. Earlier this week, when asked if the federal government would benefit from Connecticut selling its services to other states, he said:

I think this idea about trying to keep things as efficient and cheap as possible, and simple as possible, has a lot of value whether it’s to a state or to the federal government. And, as I said, I just believe that this is about simplicity and ease in doing everything that either the states or the feds can do to make a complex purchasing decision easy as possible. If there’s opportunities within something that a state has, like Connecticut, I think the feds have to look at it.

Announcements and Implementations

Philips introduces its Lifeline smartphone-based medical alert app for seniors. I didn’t realize that Framingham, MA-based Lifeline Systems was founded in 1972 by a Duke gerontologist on sabbatical, was bought by Philips in 2006 for $750 million, and is now the number one medical alert service with 7 million subscribers.

The NextGen Share HISP solution earns DTAAP and EHNAC accreditation.

Caradigm will offer providers unlimited identity and access management for a single annual all-inclusive price that includes provisioning, single sign-on, and context management for an unlimited number of applications.

3M announces its Coding and Reimbursement System Plus (CRS+) coding system.

Lincor launches an Android-based TV system MediaLINC for education, entertainment, and clinical content delivered to hospital beds via standard HD TV sets.

Imprivata introduces enhancements to Imprivata OneSign Secure Walk-Away that include advanced 3D camera technology, video tracking, and facial recognition.

Government and Politics

The VA will open an RFP for a commercial patient scheduling system in September and will award a contract by the end of the year. VA CIO Stephen Warren says the agency will “acquire a commercial, off-the-shelf scheduling system,” but then oddly adds that it wants a system “tailored specifically for our Veterans.” (the VA always capitalizes “veteran” even though that’s incorrect).

A White House video profiles the first day at work of former Googler Mikey Dickerson, recently named the first administrator of the new US Digital Service under the White House CTO (the departing Todd Park is prominent in the video, sitting beside President Obama). Dickerson also helped revive Healthcare.gov. The government modeled the service after a similar UK one, but skeptics say a lack of clout will probably hamper this effort like it did a couple of previous open government initiatives that everyone has forgotten. Dickerson seems sufficiently nerdy, although working for the White House isn’t nearly as lucrative as banking Google stock options and DC is a very long way from the Silicon Valley. The President brags on camera about the small-team success with Healthcare.gov, not mentioning that its development was the exact opposite with pathetic CMS oversight, political meddling, and poor contracting practices — Todd Park wasn’t brought in until it blew up. It’s a fun video even if it propaganda for a White House program that probably will amount to very little (pardon the redundancy).

A New York Times article exposes Medicare’s nursing home rating as irrelevant, where plush amenities and unaudited self-reported statistics earn high marks for clinically dangerous facilities that have figured out how to game the system. One five-star home was fined the maximum state penalty after a killing a patient in a medication error and despite having twice the average number of consumer complaints and a dozen lawsuits from patients and families. In that facility, residents are often housed three to a room, quality employees are in short supply, and basic supplies are scarce. According to one resident, “If I fell down, they’d pick me up, but that’s about it.” Two-thirds of the 50 homes on a federal watch list for quality still have four- or five-star ratings due to their self-reported staffing and quality numbers.

Tuesday’s HITPC interoperability Workgroup Governance Subgroup suggests five problems (above) that ONC should address through policies or programs. Overall barriers for the quantity of information exchanged were named in responses (a) lack of a national provider directory; (b) inconsistent data sharing laws; (c) DirectTrust accreditation is not universal and is not inexpensive; (d) lack of a common trust bundle for HISPs; and (e) inconsistent data matching methods.

Former FDA Commissioner Andrew von Eschenbach says the agency is holding back innovation by requiring too much red tape for conditional drug approval and by not recognizing the possible benefits of drugs combined with medical devices or diagnostic tests. He also advocates using EHR data along with specific molecular patient characteristics to streamline pre-market testing and post-market surveillance.

Innovation and Research

An Indiegogo campaign for The Defender rape defense system raises far more than its $100,000 goal. It sprays pepper spray, takes a photo of the assailant, connects with a 24-hour response center, and sets off an alarm and flashing light.

Tennis ball boys at the US Open will wear Ralph Lauren’s Polo Tech Smart Shirt for testing as the company plans for a spring retail rollout. An accelerometer, gyroscope, and heart rate monitor are embedded in the shirt, with wires woven into the shirt’s fabric serving feeding them information.

Technology

MOVEO Foundation, which advocates for the use of virtual reality in surgical training, creates a video showing the use of the Facebook-owned Oculus Rift during surgery.

Microsoft claims at a partner conference that several hundred customers have switched from Google Apps to Office 365, displaying a slide of 15 organizations that include University of Colorado Health. Google researched those 15 and found quite a bit of Microsoft inaccuracy, including its listing of UC Health, which had never been a paid Google Apps user. University of Colorado Boulder uses Google Apps exclusively for students and is considering moving faculty to it. I’ll say this: I use Gmail and hate it and the entire Google Apps suite, vastly preferring Office 365 to Google’s ugly, quirky, minimally maintained, and unreliable apps. I use Gmail mostly to read other hosted email accounts, so I should probably just move to Outlook since it now appears to have a web client that doesn’t require a locally maintained Exchange server.

Other

Ice Bucket Challenges have jumped the shark, but are still fun to watch when it’s someone you know. Here is Matt Hawkins of Sunquest, calling out Tee Green of Greenway Health to ice up (or is that ice down?)

Health Affairs offers a short-term solution for the seemingly random pricing of the same test and procedure at different hospitals: cap payments at 125 percent of the price Medicare pays since that price is already adjusted by local cost of living. Then, they say it’s time to dump the AMA-supervised committee (RUC) of mostly specialists who set Medicare prices, which not surprisingly recommends paying more for procedures like they perform and less for primary care and prevention. Not many industries would let a trade group set government-paid prices.

A security expert analyzing the healthcare breaches such as that experienced by Community Health Systems says the suspected China-based group seems to be most interested in stealing oncology data, either to create knockoff chemo drugs or to try to address China’s cancer problems. Patients have already started filing class action lawsuits against the chain. Meanwhile, in more of an old-school breach, ProPublica uncovers the illegally hushed and still-unreported case in which an unvetted Chinese national was hired in 2007 to work in the Arizona Counter Terrorism Information Center and is believed to have returned to Beijing that year with the personal information of 5 million Arizona drivers. Lastly (for today anyway) the Chinese government announces plans to develop an operating system to eventually replace Windows, Android, and iOS.

The information of 595 patients of Steward-owned St. Elizabeth’s Medical Center (MA) is exposed when the personal laptop and thumb drive of a formerly employed physician are stolen from his home. Hospital policy prohibits storing PHI on personal devices. Neither were encrypted.

Greenville Health System (SC) will issue $91 million in bonds, with the proceeds partially used to pay $97 million in Epic implementation costs.

A New Jersey paper describes how for-profit hospital operators turn facilities around (note that IT isn’t on their list, for-profit hospitals being minimally interested in technology outside of the billing area in my experience):

Buy struggling or bankrupt hospitals cheap.
Hire well-connected political influencers to get the deal approved.
Sell the property to investors and lease it back.
Lay off employees, cut staffing, and use more per-diem workers, especially if buying a bankrupt hospital where union contracts can be renegotiated.
Squeeze vendors using corporate leverage.
Streamline and standardize care to get patients out the door faster.
Cut executive positions and salaries.
Improve billing and collections.

Fitness tracker Jawbone collects the sleep tracking data of its users (Quantified Someone Else?) and creates this analysis of the Napa earthquake, in which it could even tell how many users were awakened by tremors and didn’t go back to sleep that night. They could probably perform some interesting sexual metrics.

I was thinking about this on a plane recently when the guy in front of me kneecapped me by reclining his seat hard even before takeoff. An altercation between two United passengers forces the flight to divert for an unscheduled landing at O’Hare when a male passenger uses the banned Knee Defender gadget to block the seat in front of him from reclining so he can use his laptop, causing the angry woman in the seat to throw water on him. The irony is that both passengers were in extra-room seats. I can’t blame the guy – I’ve had my laptop screen jammed and nearly broken when the person in front of me decided to recline, which squeezed the laptop under the tray table latch.

Sponsor Updates

Nuance announces that users of its PowerShare Network have shared 3 billion medical images, with the number growing 30 percent per year.
PerfectServe announces the formation of its customer advisory panel.
Also making the Inc. 5000 list run here earlier is Direct Recruiters, Inc.
Wellcentive releases its 2014 PQRS application.
The World Economic Forum announces the selection of Health Catalyst as one of 24 global Technology Pioneers.
Versus discusses the hospital’s responsibility to prevent violence against healthcare workers.
Administrative Eyecare Magazine features Versus Technology client Key-Whitman Eye Center for its use of RTLS to increase patient volume while reducing wait times.
The Advisory Board Company recognizes four healthcare organizations for RCM improvements up to $8.2 million.
CareTech Solutions presents a case study titled “Maximize Uptime with Stretched Clusters” at VMworld 2014 this week in San Francisco.
Beacon Partners offers seven ways organizations can protect themselves against hackers.

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.

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Morning Headlines 8/26/14

August 25, 2014 Headlines Comments Off

Assessing The Financial Impact Of 4.5 Million Stolen Health Records

Forbes looks back on prior data breaches to calculate the likely true cost that Community Health System will incur as a result of its recent 4.5 million-record data breach, pegging the total cost at between $75 million and $150 million.

No proof deaths caused by delay in care, VA says

After completing its assessment of scheduling improprieties at the Phoenix VA Health System, a VA inspector general’s report concludes that there is no evidence that the unethical delays in care directly contributed to preventable veterans deaths.

EMR Market Share by the Numbers: The Cerner/Siemens Acquisition, Part I

In the first of a two-part piece, KLAS covers the Cerner/Siemens acquisition and what it might mean for Cerner’s market share in the years ahead.

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Curbside Consult with Dr. Jayne 8/25/14

August 25, 2014 Dr. Jayne 6 Comments

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I usually start my day with a bagel and the local news, courtesy of a newspaper website. Once I catch up on homefront happenings (the comments are usually more entertaining than the articles they accompany) I hit a couple of national websites.

In the course of my usual surfing, I came across a link to “The End of Absence: Reclaiming What We’ve Lost in a World of Constant Connection.” I was able to find a couple of reviews and it looks like it will probably be one of my next reads.

Author Michael Harris looks at people born before 1985, namely because they “know what life is like both with the Internet and without.” For non-IT professionals and the general consumer base, I’d broaden that to include those that experienced life BC and AC: before computers and after.

I enjoy history, but never thought of myself as having lived through a major transformation. Don’t get me wrong — there have been many sociopolitical changes in the last few decades, but I missed out on the moon landing and other key “tech” touchstones.

I remember thinking some years ago about my great grandfather (who was born in the late 1800s and died in his 90s) and all he had seen in his life: from the Wright Brothers to the Concorde, and from Sputnik to space stations. He also saw the progression from the crank-powered phone to the cell phone and many other advances. At the time I thought of how cool that would be – to see that kind of change – and I also remember thinking that technology had come so far that I couldn’t fathom something that revolutionary.

Back then, broadband Internet was available, but it wasn’t a fixture in peoples’ daily lives like it is now. There was no Facebook, no Twitter, no cell phones in every person’s pocket. The iPod had barely been invented and it was for music only. We didn’t know we were on the cusp of an information revolution.

I was talking about this idea with a friend of mine over lunch yesterday. She has kids in middle and high school and was joking about the classic “back in my day, we rode dinosaurs to school uphill both ways” sayings she finds herself throwing at them. We talked about when we were exposed to our first computers (Commodore 64, anyone? TI-99? Apple II?) and what kids of today would think if they saw them in action compared to the smartphone firepower in everyone’s pockets. It used to be a major undertaking to put a computer lab in a school and now it’s expected.

Still, there are completely different sets of issues that today’s kids are dealing with involving technology and its appropriate use or lack thereof. At my friend’s local school, some teachers demand that students use technology in the classrooms and others ban it. I can only assume that the pre/post Internet generation gap might have something to do with it.

In thinking about my physicians who complain about the EHR, I don’t see a clear line age-wise. At least in our group, some of the older physicians tend to be more forgiving of the software’s shortcomings, perhaps because they expect less than the more tech-savvy physicians who tend to be younger. It would be interesting to do some actual research on their attitudes and opinions regarding technology in general as well as the EHR, but I’m not likely to find the time (or funding) to do something like that anytime soon.

One of the other concepts the book addresses is how people now use technology to quantify their self worth. I know the HIStalk team enjoys seeing how many Facebook friends, LinkedIn connections, and Twitter followers we have, but we don’t let it drive who we are.

I’ve seen multiple discussions on physician forums looking at teenagers who have significant psychological issues that stem from interactions with social media. One might infer that those of us in the “before” column had established our own sense of self independently of that kind of input, where those in the “after” column “lose the ability to decide for ourselves what we think about who we are,” according to the review’s interview with Harris.

I mentioned my own run-in with the “quantified self” after my running GPS was waterlogged. Being able to translate subjective experiences such as daily activities into actionable numbers is a powerful thing. It’s made a tremendous difference in my health and well-being, but I can see how data points might be overwhelming or discouraging to some. I can’t run a half marathon as fast as I could three years ago, but I can chalk that up to a bad knee and an uncooperative training schedule rather than letting it get me down.

Harris ends up taking a month off from the Internet while writing the book. Most of us could never do that for occupational reasons, but I like the idea of the challenge. As a physician, I frequently ask patients to limit “screen time” for their children. For many adults, it might be time to do the same. A quick search of ICD-10 codes fails to reveal much Internet-specific pathology, but we’ll have to see what ICD-11 brings.

Who’s with me for some time off the ‘net? Email me.

Email Dr. Jayne.

6 Comments

Morning Headlines 8/25/14

August 24, 2014 Headlines Comments Off

U.S. CTO stepping down

Todd Park steps down as US CTO after two-and-a-half years in the position and will transfer to a new White House staff position where he will lead a team responsible for recruiting technology leaders from Silicon Valley to work on government projects.

Usability and Impact of a Computerized Clinical Decision Support Intervention

Researchers at the University of Pennsylvania Health System test CDS alerts designed to boost timely urinary catheter removals and found that customized CDS alerts are far more effective, and result in more significant improvements to patient outcomes, than basic CDS alerts provided by EHR vendors.

Oregon: State Sues Over Health Website

Oregon files its anticipated lawsuit against Oracle over the state’s failed health insurance exchange website, which Oracle was contracted to develop and deploy.

Patient Portals. Patient Engagement: The Holy Grail of Meaningful Use

Peer60 publishes a report that trends patient portal engagement rates by hospital size, patient portal vendor, and local population sizes.

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Monday Morning Update 8/25/14

August 23, 2014 News 9 Comments

Top News

Todd Park will reportedly step down as US CTO but will remain a White House employee, moving back to the Silicon Valley to work on brokering relationships between technology companies and the federal government.

Reader Comments

From HIEway Robbery: “Re: HIEs holding registries hostage per Carl Dvorak’s testimony to ONC. Several CIOs have told me that HIEs have been allowed to use state-based immunization and public health registries to as a leverage point under Meaningful Use, forcing their health systems to join the HIE for up to several hundred thousand dollars.” Hospital IT people, please let me know if you’ve had such pressure applied. I promise to keep your details confidential, but I’d like to know the registry, state, and price quoted for HIE access. ONC needs to know that the generally noble idea of connecting to public health agencies as part of MU2 is being milked as a profit center by revenue-desperate HIEs if that’s the case. I’ve heard that one health system had to pay $700K to an HIE just to access the state’s immunization registry.

From Surveyor: “Re: Modern Healthcare’s top employers and Inc. 5000. These lists are a joke and your running the results is questionable.” I only mentioned in the Sponsor Updates which sponsors won. I don’t think the lists are a joke, but publications give awards to sell magazines and generate ad revenue, no different than those full-page airline magazine ads for “best steakhouses” or “best plastic surgeons.” Which means: don’t take them too seriously either as a reader or a winner. Let’s take a look at those two awards based on what I could find online. Readers with more information are welcome to chime in.

Modern Healthcare’s Best Places to Work

Participation is free, but companies are offered a detailed employee feedback report that isn’t (the price, however, is modest).
Information is self reported and not verified by the magazine.
The survey asks for the voluntary employee turnover percentage, but it’s not clear how that number fits into the rankings even though it’s arguably the best way to assess employee satisfaction.
A random number of company employees are surveyed directly using an adequate sample size from the entire employee database. The survey company was created specifically to conduct “Best Places to Work” programs across all industries and is a division of a publishing company.
My grade of the methodology: B+. The employee survey portion seems sound and is of sufficient depth, but online survey of company programs and benefits is self reported and apparently unaudited (but the company HR people who respond aren’t likely to game the system to win). I’d like to see the voluntary turnover number reported in the profile of the winners. I think the winners are probably doing a good job in how they manage their employees, but it’s easy to forget that most companies don’t participate. It’s not quite perfect, but as good as can be expected from a voluntary survey type program designed to simultaneously stroke the egos of winners and the magazine.

Inc. 500/5000 list of fastest-growing private companies

Information is self reported and not verified by the magazine.
Companies send in 2013 gross revenue vs. 2010 gross revenue and basic demographic information only.
Applicants have their short entry form signed by any CPA, financial analyst, or attorney. No proof of the claimed revenue numbers is required.
Companies could be losing a ton of money and still make the list as long as their gross revenue increased in the previous three years. Privately held companies aren’t going to disclose profits, so the magazine has to go with revenue alone.
Companies have to pay $150 to submit their information. The magazine pitches the exposure they’ll get as a result. They don’t indicate the number of applications received, but the 5,000 winners alone would generate 5,000 x $150 = $750,000 for very little work on Inc.’s part since they don’t verify the submitted information – they basically plug it into an Excel worksheet, sort by revenue growth percentage, filter by industry and a few other factors, and call it done.
My grade of the methodology: F. The entire premise of the award – that revenue growth is the single best measure of company success – is suspect enough, but choosing winners from fee-based unaudited company submissions is lazy. Winners aren’t necessarily even the fastest growing companies – only the fastest growing of those that dash off the quick information form and mail in their $150. I wouldn’t dock a company points for trying to generate some easy PR in return for an investment of $150 and the five minutes it takes to complete the application form, but I also wouldn’t necessarily think more highly of the winners, especially noticing that some of the highly-ranked companies have only an employee or two. I like seeing fast-growing companies, but I wouldn’t buy shares of a publicly traded company’s stock based on a one-time snapshot of unaudited revenue growth.

From The PACS Designer: “Re: iPad vs. Android L. The iPad monopoly may start to start to shrink with the Android L, scheduled for release in late October with a true 64-bit system.” I would argue that the iPad doesn’t have a monopoly even now, representing less than a third of tablets sold in Q1 2014. Samsung is gaining ground quickly and Lenovo is coming on strong in the past year, although tablet sales seem to be hitting the wall anyway since there’s not much incentive for people to trade up.

HIStalk Announcements and Requests

Nearly two-thirds of poll respondents thing Cerner is getting a good deal in buying the Siemens healthcare IT business for $1.3 billion. New poll to your right or here, for health system IT employees: is your organization taking new security steps in reaction to the Community Health Systems breach? I would be interested in hearing more … click the Comments link after voting.

Listening: new from SOJA (Soldiers of Jah Army), an eight-piece DC-based reggae band. It’s not my favorite genre, but I like this since it sounds more like decent pop music instead of formulaic noodling by ganja-stupefied Rastafarians.

Last Week’s Most Interesting News

Chinese hackers steal the data of 4.5 million Community Health Systems patients, most likely enabled by outdated network software as vendors responded slowly to address the Heartbleed exploit after it was announced in late spring.
Oracle’s lawsuit against the state of Oregon says state officials should have hired a systems integrator to oversee the creation of its failed health insurance exchange, comparing Oregon’s project to an inexperienced company deciding to build a skyscraper without hiring an architect. The failed rollout of Healthcare.gov has been similarly attributed to CMS’s attempt to serve as its own project overseer.
CMS statistics show that few providers (and thus few vendors) are clearing the Meaningful Use Stage 2 hurdle, with the early trend suggesting that practice-based users appear to be moving from smaller vendors to Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
A New York Times article says CMS’s Medicare fraud prevention efforts are expensive and ineffective due to its poor management of private recovery audit contractors and the bogged down provider appeals process.
The private equity owners of revenue cycle vendor TriZetto are rumored to be shopping the company at a price of $3 billion.

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

Announcements and Implementations

The Albuquerque business paper profiles Seamless Medical Systems, which will release SNAP Express RX on Monday. It’s an iPad-based patient self-history system for pharmacies (vaccines, immunizations, and medications). The company also says its SNAP Practice check-in system will be piloted at Houston Methodist Hospital starting in October.

Government and Politics

The state of Oregon finally files the lawsuit it has been threatening against Oracle, saying it paid Oracle $240 million to build the dysfunctional Cover Oregon health insurance exchange site. The Associated Press named the spectacular failure of Cover Oregon, which will be shut down, as the state’s top news story in 2013:

Once considered a national healthcare leader, Oregon produced the worst rollout in the nation of the new national health insurance program. While the crippled federal website eventually got up and walked, Oregon’s remained comatose, unable to enroll a single person online. The state had to resort to hiring 400 people to process paper applications. Officials lay much of the blame on the primary information technology contractor, Oracle Corp., and withheld some $20 million in payments. But state officials’ own actions played a role, too. In the face of disaster, they insisted on doing things The Oregon Way, clinging to a grandiose vision of creating a grand health IT system that would not only enroll new people in the national health insurance program, but also provide other vital services.

The personal information of 25,000 Homeland Security employees is compromised when hackers penetrate the systems of a federal contractor that performs security clearance. The contractor, USIS, says the cyberattack appears to be the work of an unnamed country’s government.

For-profit hospital operator Steward Health Care System (owned by a private equity firm) and The Boston Globe engage in legal wrangling over the hospital’s use of a patient’s medical records. The newspaper is running an in-depth feature about the man’s experience with the mental health system that Steward expects to be uncomplimentary to its hospitals, so it filed a lawsuit asking to be able to publicize the man’s records to tell its side of the story. The court said no. All of this happened before the article ran in Sunday morning’s paper and it appears that Steward’s heavy-handed actions were premature – the article touches little on the patient’s experiences at the chain’s Quincy Medical Center and Norwood Hospital and focuses more on the challenge of fitting mentally ill people into society so they can’t harm themselves and others.

Innovation and Research

Wired profiles Enlitic, a just-announced startup that will use deep learning algorithms to diagnose medical conditions. Data scientist founder Jeremy Howard says the company’s approach is different from that of IBM, which tries to teach Watson by feeding it textbooks that contain information that doctors already know vs. giving the computer raw data and letting it figure out the patterns that represent new knowledge. I’m not sure doctors need as much help diagnosing patients as computer people tend to think, but at least a small percentage of patient conditions are baffling.

Other

Cedars-Sinai Medical Center (CA) reports exposure of the information of at least 500 patients following the theft of a laptop from an employee’s home. The hospital says the device was not encrypted per hospital policy because of an installation mistake. The description of the employee’s job suggests that he or she has IT responsibilities since it includes “troubleshooting software used for clinical laboratory reporting” and requiring off-hours availability.

A peer60 report on patient portals finds that the most implemented are from Cerner and Epic, while those most often being considered by the 10 percent of providers who don’t have one are Cerner, Medfusion, Meditech, Epic, eClinicalWorks, and Medhost. Generally deficient functionality includes meeting the needs of specialists, EHR integration, appointment scheduling, streamlined enrollment, bill pay, and managing the information of patients under 18. It concludes that health systems can hit the 10 percent engagement threshold required by Meaningful Use Stage 2.

Jonathan Bush’s 1990s business idea as described in his book finally happens: EMTs are providing primary care services in the home instead of just giving 911 callers expensive rides to the ED for non-emergent issues. It’s a smart idea: the supply of relatively easily trained EMTs and paramedics exceeds the available jobs (often in fire departments) and most people would prefer being evaluated and treated at home, especially if the EMR/paramedic was in touch with a doctor via telemedicine as needed.

A University of Pennsylvania Health System study finds that urinary catheters were removed more promptly (presumably reducing the chance of urinary tract infections) when EHR provider reminders were replaced with an integrated homegrown alert that required fewer clicks to generate the DC order.

Interesting: improved guidelines and more widespread use of less invasive surgical procedures have reduced blood transfusions by a third and blood profits by 70 percent in the last five years. The Red Cross takes in nearly $2 billion of its $3 billion annual budget from selling blood and employs 17,000 of its 26,500 employees in its blood program, requiring layoffs and expense cutting. People don’t realize that their thoughtful blood donations are sold to hospitals for hundreds of dollars per unit, sometimes by for-profit blood centers that don’t exactly broadcast that fact, one more aspect of healthcare that doesn’t seem like it should be a business but very much is one.

An investigation of the corporate support services department of Health and Hospitals Corporation of New York finds that officials contracted with friends and neighbors for no-work temporary jobs and hired unqualified but connected employees. In one case, a supervisor who was also a minister performed a wedding in his office during work hours.

The individual is no longer an employee of Memorial Hermann. We cannot disclose any further information.

— Memorial Hermann (@memorialhermann) August 20, 2014

Memorial Hermann Southeast (TX) fires an employee after someone complains to it about a racist comment she posted on her personal Facebook, on which she doesn’t identify herself as a hospital employee. The hospital announced the employee’s firing on Twitter, ironically. According to a legal analyst, “People have the right of free speech, but employers can fire you for whatever they want in the state of Texas.”

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.

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Morning Headlines 8/22/14

August 21, 2014 News Comments Off

FBI warns healthcare firms they are targeted by hackers

The FBI issues an alert to the healthcare industry that hackers are targeting them following their breach of Community Health Systems.

Oracle Calls State’s Health Exchange Planning Akin To Building ‘A Skyscraper With No Architect’

Oracle blames Oregon officials for not hiring a systems integrator for developing its health insurance exchange.

AliveCor Receives First FDA Clearance to Detect a Serious Heart Condition in an ECG on a Mobile Device

The free app, which requires a $199 sensor, monitors ECG activity to detect atrial fibrillation.

HealthQuest Capital raises $110M for healthcare investments

The investment group plans to invest in medical devices, diagnostics, and healthcare IT.

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News 8/22/14

August 21, 2014 News 10 Comments

Top News

The China-based hackers who stole the information of 4.5 million patients of Community Health Systems used the Heartbleed exploit for access, the first major cyberattack to do so since Heartbleed received major world attention in April 2014. Community Health Systems provides employee VPN access using networking equipment from Juniper Networks, which along with other networking vendors was slow to update its products in response to Heartbleed. The hackers were able to log in as employees in the weeks after Heartbleed was announced and before vendors updated their software. There’s a lesson to be learned: watch for unusual behavior from user accounts and certainly for huge data files being sent outbound. Meanwhile, the FBI issues a flash alert to healthcare firms, warning that that they’re being targeted by hackers.

Reader Comments

From Former SMSer: “Re: former Shared Medical Systems employees. A members-only Facebook group was started on August 15 and has 1,200 members. It is special to have so many warm personal connections 14 years after the Siemens acquisition.”

From Eek How? “Re: Ekahau. Let its president go and the VP of marketing walked out. The company has gone from 119 employees to fewer than 45 in the past year. WiFi-based RTLS still disappoints hospitals.” Unverified, but former CEO Mark Norris has updated his LinkedIn profile to indicate his immediate availability.

HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi digs deep into data on the EHR replacement market. Industry representatives weigh in on Walmart’s foray into primary care. Newt Gingrich makes the case for integrating mobile health tools into care for veterans. Greenway Health and Apple are granted patents, though for decidedly different innovations. A physician in Alaska gets creative when attempting to opt out of Meaningful Use. Azalea Health CEO Baha Zeiden dishes on the simplifyMD acquisition and the role of telemedicine in rural communities like his. Thanks for reading.

I talked today with the brilliant and articulate Dim-Sum, who knows everything about the Department of Defense and its impending choice of EHR vendors for its $11 billion EHR project. He graciously agreed (probably while grimacing at the arm-twisting Lorre and I were applying) to host one or more webinars on the topic. Mark your calendar for September 18 at mid-day for the first one, in which Dim-Sum will describe the DoD’s healthcare reach, current systems, relationships with contractors and other government agencies, and selection process. The webinars will be fun, slightly cynical, and highly educational to those of us who don’t really understand military health, as well as crucial to those with a vested interest in what will be one of the largest and most expensive government IT projects in the world.

Also in September: the virtual launch of Ed Marx’s upcoming book, “Extraordinary Tales of a Rather Ordinary Life.”

I’m always interested in hearing from providers who would like to be interviewed, write guest articles, or otherwise participate in HIStalk. Let me know if you are willing. I get plenty of volunteerism from vendor people, but not much from those working on the provider side.

Upcoming Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

Acquisitions, Funding, Business, and Stock

HealthPrize Technologies, which offers a medication adherence app, raises $3 million in its first institutional financing. Co-founder Tom Kottler’s first startup was MedAptus.

HealthQuest Capital raises a $110 million fund to invest in medical devices, diagnostics, and healthcare IT.

Aging services technology vendor Healthsense, which offers a remote monitoring system for chronic diseases, adds a $10 million funding round.

Vocera shares touched a 52-week low this week, closing Thursday at $8.48 and valuing the company at $216 million. Above is the one-year price of VCRA shares (blue) and the Dow (blue).

Sales

Saint Agnes Hospital (MD) chooses clinical alerting and secure texting solutions from Spok, also upgrading its hospital call center suite.

Baylor Scott & White Health chooses the Allscripts dbMotion HIE platform.

Baystate Health (MA) selects Premier’s PremierConnect Enterprise to support development of solutions within its Health Informatics & Technology Innovation Center, a co-working space and late-stage accelerator.

The Froedtert & Medical College of Wisconsin network chooses the analytics platform of Explorys.

Atlanta Gastroenterology Associates chooses Greenway PrimeSUITE EHR/PM.

People

Surescripts names Tom Skelton (Foundation Radiology Group) CEO.

Announcements and Implementations

PerfectServe opens an Atlanta office.

Forbes names Cerner to its list of the world’s most innovative large, publicly traded companies. Salesforce.com came in #1, and other familiar companies joining Cerner in the top 30 are Amazon, VMware, Red Hat, Stericycle, and Express Scripts. The ranking is derived from the somewhat questionable metric “Innovation Premium,” representing the degree that share price exceeds current business value.

SAS and 39-hospital Dignity Health (CA) will create a big data platform to reduce readmissions, create best practices for CHF and sepsis, and manage drug costs.

Greenway Health receives a patent for the function of automatically aligning billing codes with payer- and location-specific fee schedules.

AliveCor receives FDA clearance for its atrial fibrillation detection app that monitors ECG in real time and allows the user to email, print, and analyze their single-channel ECG records. The app is free, but the monitoring hardware costs $199.

UltraLinq’s cloud-based image management solutions will be available through athenahealth’s No More Disruption Please program.

Government and Politics

Oracle, in its lawsuit against the state of Oregon for not paying the company for its work on the state’s failed healthcare insurance exchange, says the state should have hired a systems integrator instead of trying to run the project itself. CMS made the mistake in trying to run the Healthcare.gov project without outside help.

CMS Administrator Marilyn Tavenner didn’t just accidentally delete Healthcare.gov-related internal emails as she claimed, although this request pertains to a largely dull conversation about training telephone reps handling manual insurance sign-ups after Healthcare.gov failed.

The FDA releases an API to allow programmers to access its MAUDE medical device problem database.

Other

Cerner CEO Neal Patterson not only dumps ice water over his head, he issues an Ice Bucket Challenge of his own to John Glaser, CEO of the Siemens health IT business that Cerner is acquiring. Glaser accepted the challenge.

As simultaneously cute and annoying as the virally spread ice bucket challenge videos are, this one is worth watching if you really want to understand the non-entertaining aspects of the disease as one of its sufferers takes the challenge and then explains how ALS affects him.

Jamie Stockton of Wells Fargo Securities provides updated slicing and dicing of CMS hospital attestation data through June 30. The significant Stage 1 vendors are (in order) Meditech, Epic, Cerner, CPSI, McKesson, and Medhost. Of the 10 hospitals that have attested for Stage 2, Cerner has four, Meditech and CPSI have two each, and Medhost and Allscripts have one each. Top vendors of the EHRs used by the 977 physicians who have attested for Stage 2 are, in order, athenahealth, Epic, and Practice Fusion, who have 97 percent of the Stage 2 attestations among them.

Economist Uwe Reinhardt writes a brilliant and remarkably compact criticism of the bizarre payment system of US healthcare. A tiny sample:

For starters, we allow our providers of health care – doctors, hospitals, pharmaceutical companies and other providers—to use classic price discrimination in the markets for their products and services. That tactic helps sellers to extract from buyers with different abilities or willingness to pay as much total revenue as can possibly be extracted from the buyers collectively … Altogether, the highly complicated cash flow resulting from this strange system of financing, flowing through so a myriad of capillaries, makes it almost impossible to hold any providers formally accountable for all of the moneys they receive. Somehow this rickety Rube Goldberg contraption of financing health care has worked in some fashion in this country, for over half a century. Many hospitals have thrived financially under it, while hospitals located in mainly low-income areas have struggled or gone under. And as a series of journalists—most recently Steve Brill in “The Bitter Pill”—have reported, this system also has put brutal financial stress on the budgets of many American households.

Aaron Carroll, MD, MS, a medical school professor and contributor to “The Incidental Economist,” explains why doctors have plenty of data problems without having to deal with patients sending them their fitness tracker information.

The Columbus business paper profiles CoverMyMeds, which is doubling in size every year while remaining profitable as a bootstrapped company.

Honored to meet doctors & Veterans with @RepAnnaEshoo at @VAPaloAlto, now using iPads to help treat Vets & families. pic.twitter.com/lOZwDT8KZu

— Tim Cook (@tim_cook) August 21, 2014

Apple CEO Tim Cook visited the VA hospital in Palo Alto, CA, tweeting a photo from the facility that is using iPads.

Massachusetts eHealth Collaborative President and CEO Micky Tripathi examines the EHR replacement market in an HIStalk Practice post:

The number of EHRs used to attest has dropped considerably from MU Stage 1 to Stage 2.
Customers are switching from smaller vendors to the benefit of Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
Athenahealth and eClinicalWorks are losing customers to Epic.
Allscripts lost more customers than anyone, most likely because of its retirement of MyWay, which boosted Aprima’s customer base.
Epic, Greenway, and athenahealth are the EHR vendors most acceptable both to larger practices as well as hospitals given their maturity,support, and product stability.

Burke Mamlin, MD of Regenstrief Institute pens a letter in response to the Indianapolis newspaper’s article on medical scribes, recommending caution since physicians don’t always review scribe EHR entries until after the fact, they don’t see clinical decision support recommendations, and they become dependent on the scribe. The letter describes Regenstrief’s vision:

Rather than using a scribe to reduce the computer’s role in the exam room, we envision the medical scribe’s role to increase the computer’s role. By using the scribe as a “Wizard of Oz” replacement for the keyboard and mouse, the computer can become an intelligent, anticipatory and active participant in the conversation between patient and physician. Physicians can become super-users as they learn from watching the scribe, there is less chance for errors when the physician is actively monitoring input, and benefits of real-time decision support will not be lost.

Weird News Andy finds this article interesting in that not only have an estimated 90 percent of hospitals and clinics lost patient data, the black market pays $50 per stolen medical record vs. just $1 for credit card information.

Sponsor Updates

Craneware will hold its first Revenue Integrity Summit October 14-16 in Las Vegas.
HCS participates in LeadingAge Center for Aging Services Technologies (CAST) EHR 2014 Selection Portfolio.
Ingenious Med employees complete their third annual 100-day team-centric Thrive Challenge.
Andrew Borland, Wellcentive’s director of architecture and research, is interviewed on Atlanta Business Radio.
The SSI Group adds contract management to its RCM offerings.
Aspen Advisors, Clinovations, CoverMyMeds, CTG Health Solutions, Cumberland Consulting Group, Encore Health Resources, Hayes Management Consulting, Health Catalyst, Iatric Systems, Impact Advisors, Imprivata, Intelligent InSites, Nordic, Santa Rosa Consulting, and The Advisory Board Company are named on Modern Healthcare’s 2014 Best Places to Work in Healthcare list.
Besler Consulting, Clinovations, CompuGroup Technologies, Cornerstone Advisors, CoverMyMeds, CSI, Cumberland Consulting Group, Divurgent, eClinicalWorks, ESD, Etransmedia Technology, Forward Health Group, GetWellNetwork, Health Catalyst, Health Care Software, Healthcare Data Solutions, Impact Advisors, Imprivata, Informatica, Ingenious Med, Patientco, pMD, Santa Rosa Consulting, SRSsoft, Strata Decision Technology, HCI Group, and Wellcentive are named on the Inc. 5000 Fast Growing-Growing Companies 2014 list.

EPtalk by Dr. Jayne

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One of my CMIO duties is to periodically review the patient care protocols in our EHR and recommend updates and additions. Evidence-based guidelines have been a part of our organization for almost two decades, but they’re constantly evolving. I like to do a comprehensive review every year, but there are always guidelines that change on the fly.

Occasionally, it seems like every day brings a new recommendation for screening or treatment. Some of the updates are relatively straightforward, but others can be quite controversial.

This year my review process took a twist. Our organization wants to start building financial information into our care protocols, including the cost and accessibility of various services according to the patient’s insurance coverage. Most payers are fairly transparent about what they do or don’t cover. Sometimes, however, the nuances between different plans offered by a given payer tends to make me a little crazy.

In addition, our state legislature has mandated coverage for certain services, but most of the laws were written to apply when patients enroll in a plan after the law goes into effect. For patients who are on older or existing plans, they may not be covered for the services until they change jobs or their employer changes plans or payers. We have some large regional employers who self-insure and somehow they seem to skirt some of the payment requirements as well.

Medicare has always been the steady player as far as knowing what will be covered and how. The payment guidelines are transparent and usually follow along with other federal guidelines. This year we have a bit of a wrinkle since the Medicare Evidence Development and Coverage Advisory Committee has decided not to cover CT screening for lung cancer, which is a “B” grade recommendation by the US Preventive Services Task Force. I read the commentary from their meeting and they cite the American Academy of Family Physicians, which feels the evidence is insufficient to recommend for or against the test.

This is where it gets really fun. In accordance with the Patient Protection and Affordable Care Act, marketplace insurance plans and many private plans are required to cover the screening with no out-of-pocket costs to the member. However, the law does not specifically state that Medicare is required to pay the full cost to Medicare beneficiaries. Instead of being able to do some relatively clean development around the USTSPF “A and B Recommendations” list, we have to continue with the patchwork approach.

Quite a few guidelines have been revised for 2014 and more are under revision, so this project is definitely the gift that keeps on giving. I’ll be taking my recommendations to our clinical quality committee in the next week or so and then the development team can get to work. I’ll also be giving a report of my findings to our managed care negotiation team so we can try to leverage better coverage for the services we find most clinically appropriate.

Got guidelines? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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Morning Headlines 8/21/14

August 20, 2014 News Comments Off

US hospital hack ‘exploited Heartbleed flaw’

A cybersecurity firm claims that the theft of information on 4.5 million patients of Community Health Systems was performed using the Heartbleed exploit. The firm says CHS used network equipment from Juniper, which was slow to correct software vulnerabilities.

Cerner lands on Forbes’ most innovative companies list

Forbes names Cerner #22 on its list of large, publicly traded companies that invest in innovation.

SAS to build cloud-based big data analytics platform for Dignity Health

Analytics software vendor SAS will create a big data platform for Dignity Health to support care planning, value-based reimbursement, and outcomes and value performance analysis.

Wearable Intelligence is raising $8.4M for Google Glass for doctors

San Francisco-based Wearable Intelligence has raised $7.9 million of its goal of $8.4 million from investors that include Google Ventures and Andreessen Horowitz. Its Google Glass technology displays information from EHRs,clinical alerts, and real-time information from patient monitors.

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HIStalk Interviews Chris Longhurst, MD, MS, CMIO, Stanford Children’s Health

August 20, 2014 Interviews 9 Comments

Christopher Longhurst, MD is CMIO of Stanford Children’s Health, founding program director of the clinical informatics fellowship of Stanford University School of Medicine, and clinical associate professor of pediatrics and biomedical informatics at Stanford University School of Medicine of Palo Alto, CA.

Tell me about yourself and your job.

I’m the chief medical information officer at Stanford Children’s Health. I have a faculty appointment in pediatrics and a courtesy appointment in biomedical informatics at the Stanford School of Medicine. I help to lead our clinical information technology and strategy for the health system as well as the academic fellows training program.

The new clinical informatics board certification allows physicians working in an informatics role to be grandfathered in for the first few years. Can you describe how you see that morphing into the requirement that applicants complete a clinical informatics fellowship and explain how your program is structured?

This started in 2011 when the American Board of Medical Specialties approved informatics as a board-eligible subspecialty. It’s a particularly unusual subspecialty because you can board in a subspecialty after training in any of the 24 primary specialties. Until 2017, people can grandfather in through extensive work experience and education, after which time the only way to be board eligible will be to have completed an accredited fellowship training program.

What is the audience that you anticipate will sign up for the fellowship?

When we opened the Stanford clinical informatics fellowship last year, we got dozens of applications. Some of those were from physicians with strong computer science backgrounds who wanted to write code and develop apps. While they have an important place in the ecosystem, that’s not what the fellowship program is looking for.

We’re recruiting physicians who are interested in driving improved healthcare delivery outcomes. We’re looking for people who are going to keep their eye on the ball in terms of where we’re headed and using informatics and IT as a tool to improve the delivery of the care that we provide.

We’re really excited about our first two fellows, Lance Downing and Veena Goel, who are doing some amazing work and will be future healthcare leaders. In fact, the mission of the program, we decided, was not to train physicians to become informaticists, but to train the next generation of healthcare leaders in the skill of informatics.

Once the grandfather period is over, who will offer fellowships for those people working in an applied informatics CMIO role that isn’t research based but rather feet on the ground technology adoption?

There are 140 or so medical schools in the United States and 6,000 hospitals. If the fellowship programs are only at those academic medical centers with medical schools, we’re not going to train enough people for the next generation of healthcare leaders. I anticipate, though, that we will see training programs coming up at non-academic medical centers.

In fact, I think it’s important that that happens just as with other specialties. We have internal medicine programs at over 800 hospitals. I think we’ll see opportunities for training informaticists at many, many other healthcare settings.

What’s different between this and the master’s degree programs of the past is that these fellowship programs offer experiential training. It’s the opportunity to come in, be part of the office of the CMIO or other applied clinical informatics environments, and contribute in a meaningful way to real projects. I think that this type of experiential training complements the didactics, but is a critical piece for training our next generation.

The Institute of Medicine’s recent review of medical education questioned why it’s only offered in hospital settings. Why wouldn’t a public health setting for informatics training be equally desirable given the need for population health management?

As part of our fellowship program, we offer rotations not just at the two hospitals at Stanford, but also in the clinical research informatics group at Stanford medical school. We also offer elective rotations in the industry. Our fellows have the opportunity to spend a month at a large company like HP Labs, where they do healthcare analytics research, as well as at a small startup company, Doximity. We think that there are physicians who are going to be working in all sorts of settings and having those experiences is important.

We also have our fellows rotating through the Kaiser and Sutter healthcare systems, where they have an opportunity to see a large, integrated delivery network that’s not an academic medical center.

What subjects will be covered in the two-year fellowship?

We break it down as follows. We think that it’s important that our clinical informatics fellows maintain clinical activity. They’re expected to spend 20 percent of their time seeing patients. We’ve partnered with Bill Hersh and the Oregon Health & Science University distance learning program to provide didactic support, so we anticipate they spend another 20 percent of their time with the classwork. That leaves 60 percent of their time, which is a combination of these experiential rotations and unstructured time for scholarship and longitudinal projects.

The OHSU program is rigorous and you are adding additional elements to it. It will take some work to complete the fellowship.

[Laughs] Well, we expect that the fellows will be working hard, but we also think it’s going to be a really gratifying program to complete training.

What training are medical students receiving in practicing with an EHR and then performing data analysis for research or for population health management?

At most health systems, the training for medical students is pretty limited. They may get a little introduction to the electronic health record systems, but it’s generally focused on the front-end data input and review on single patients, not on population health. Dr. Bill Hersh just co-authored a publication suggesting new competencies for undergraduate medical student training in informatics. I think that we’ll see adoption of those concepts widely moving forward.

Everybody wants to get their specific area covered in medical school education, but it’s already a busy program even though informatics is in some ways as important a stethoscope or a scalpel. Do you think the 10×10 program is meeting that need now and will that change over time?

I think the AMIA 10×10 program has played a really important role in raising the bar on informaticists. Ten years ago, any consultant with experience in clinical information systems could declare themselves an expert. But having some formal classroom understanding of what’s happened in the last 50 years in this field and where the grand challenges lie is important for coming together as a field to attack those big problems.

You’ve done work with a “patients like mine” button idea where a doctor can quickly find similar patients to the one they’re seeing. Are you doing that or is it still a concept?

We have an exciting story that was published in the New England Journal of Medicine in 2011. The story was about a 13-year-old girl with a known diagnosis of lupus who was admitted to our hospital with a flair in her lupus. One of my colleagues, Dr. Jenny Frankovich, asked a really important question, which was whether her lab findings made her at higher risk for clotting and whether we should consider prescribing anticoagulants for her.

Of course, we did what any good evidence-based clinicians would do and looked in the literature, but as in many special areas of pediatrics, there was no literature on teenagers with lupus and risk of clotting. We then asked our colleagues, and the first colleague we asked said absolutely you should anticoagulate. The next colleague we asked said absolutely not. We were left holding the bag with one of these clinical decisions that occurs every day across this nation, but has to be made in the absence of data.

My colleague Dr. Frankovich did something at this point which had not been done before. She used her IRB-approved access to a data warehouse to look at a holistic experience with teenagers with lupus at Stanford over the last five years. She found 100 similar patients, and on the day that we admitted this teenager, was able to determine that her lab findings put her at six- to seven-fold increased risk of clotting. Based on that, we made the decision to anticoagulate her. That was the experience that launched my interest in using aggregate electronic health record data for point-of-care decision making.

We just published in Health Affairs last month in the big data issue the concept of a green button. Just as a blue button is both a metaphorical and visual indication of patient’s abilities to download their own data, the idea behind the green button is that in the absence of good peer-reviewed evidence on a clinical decision, that you would be able to use the aggregate data in your electronic health record — or perhaps federated across multiple databases — to generate real-time, personalized comparative effectiveness cohorts, or “patients like mine.”

Imagine if you saw a 55-year-old woman with hypertension, asthma, and of Vietnamese heritage. Recognizing that this lady would not fit well into the American Heart Association guidelines, you could look at the experience of all 50- to 60-year-old Vietnamese women with hypertension and which medications have the most efficacious impact.

This could really change our clinical decision-making and our cost effectiveness and value of care across the United States. But there will have to be some important policy changes as well as technology developments to ensure this happens in a systematic and formalized way.

Kaiser has done interesting things given their huge database and control over all care settings for their patients. The PCORI project generates cohorts across participating health systems. Do you see the use of data going beyond the four walls to make clinical decisions as a trend?

Absolutely. I think a lot of good work on interoperability of databases is occurring. I2B2 is one example. PCORI is another and the PCORnet. Kaiser and Geisinger have been leaders in using their own data sets to make more data-driven decision about what medications they offer on formulary, for example.

But I think ultimately we need to get to a point where rather than go into a group of analysts and researchers to mine data for six to 12 months, we need to enable the clinicians with the right tools to do these queries at the front line of care. That’s really what the green button concept is about.

Do you think that’s a significant argument for virtual affiliations? The six Wisconsin hospitals jut announced plans to work together to share patient information from their Epic systems.

Unquestionably. In fact, we use the Epic electronic health record system at Stanford. One of the things that’s really exciting to us is the amount of data exchange that’s occurring in Northern California. We have such a high rate of data exchange that in the first 10 weeks on the Epic system at the children’s hospital, we connected with over 35 outside institutions for over 30,000 patients.

We know that enables continuum of care for our patients who are receiving primary care elsewhere as well as for the subspecialty care that we offer at Stanford Children’s. But the next step is using that data to provide better analytics for population health. The Wisconsin example that you describe is a great pilot and prototype for what I believe will occur increasingly as we move forward.

I should also mention that one of our clinical informatics fellows, Dr. Downing, is actively working on a project now to look at data exchange in Northern California in a 360-degree view. Most studies to date of healthcare information exchange are focused on what it means to the emergency department that they can get outside data, but in fact, the major use case that we’re seeing is that we offer tertiary care services and a lot of our patients get primary care elsewhere.

We’re really supporting the continuum of care. Being able to look at data that’s sent and received from the perspective of multiple different health systems in Northern California is one of the benefits that this fellowship offers.

Putting on your CMIO hat, what are some other interesting projects that you’re working on?

I also have the opportunity and privilege to lead our analytics and data warehouse team. I believe, as in the green button concept, that the future of leveraging these electronic health records is going to be how we use it not just for the care of an individual patient, but for the care of populations of patients.

We’ve got a number of innovation pilots in our analytics team. My colleague Dr. Jon Palma, who’s also the associate program director for the fellowship, is leading some exciting work in text analytics that’s already benefited our hospital in an operational way. We’re also looking at predictive analytics and forecasting. For example, our census report right now looks at historical trends. Shortly we will be adding the ability to forecast census trends for the next week.

Any final thoughts?

Stanford is accepting applications now for 2015-2017 fellows in clinical informatics. We welcome applications from candidates of any any clinical background.

I would close by saying that we’re at an exciting junction of the field. I believe in the future, as we see more and more physicians involved with health information technology, that this board certification will become a mark of somebody who’s achieved a certain set of core competencies and will be increasingly important across the spectrum of physicians working in these settings.

9 Comments

Morning Headlines 8/20/14

August 20, 2014 News 1 Comment

Community Health Systems data hack hits 4.5 million

Chinese hackers hit the for-profit operator of 206 hospitals for the identities of 4.5 million patients.

Apax seeks $3 billion sale of healthcare IT firm TriZetto : sources

The private equity firm is rumored to be seeking a buyer for revenue cycle vendor TriZetto in the $3 billion range after taking the company private for $1.4 billion in 2008.

White House won’t reveal documents related to ObamaCare website security

CMS and the White House refuse to turn over documents related to the security capabilities of Healthcare.gov, citing HIPAA concerns.

A Medicare scam that just kept rolling

Medicare paid $8.2 billion for power scooters, many of them for patients who had no medical need for them.

1 Comment

News 8/20/14

August 19, 2014 News 1 Comment

Top News

For-profit hospital operator Community Health Systems says it was the victim of a cyberattack in which the demographic information of 4.5 million patients of its 206 hospitals was stolen. The attack, which occurred in May and June, appeared to originate in China. The FBI is investigating. Community Health Systems is in the Fortune 500 with $7.2 billion in annual revenue and a pending $3.6 billion acquisition of Health Management Associates, which would make the company the largest for-profit hospital operator in the US.

Reader Comments

From Changing Wind: “Re: Orion Health. With the upcoming IPO, employee bonuses are being changed from four times a year to once, holding cash at the expense of their employees.” According to a forwarded email from Orion Health CEO Ian McCrae, “As part of the Board and Management review of the company measures and targets, a decision has also been made to move the frequency of the Company Incentive payment to annual, which aligns with the personal component of the Short Term Incentive. This change now aligns us with what is common market practice and also takes into account the recognition that the achievement of the revenue target is heavily reliant on our performance in the second half of this financial year.”

From Anonymous Tipster: “Re: Carl Dvorak’s testimony. To hear Mr. Dvorak complain about their customers bearing the cost of participating in data exchange governance mechanisms while spending many millions of dollars on Epic and then during verbal testimony claim that Epic is the underdog of the EHR industry made me laugh.“

Acquisitions, Funding, Business, and Stock

Private equity firm Apax Partners LLP is looking for a buyer for payer and revenue cycle vendor TriZetto, according to rumors. Apax took TriZetto private in 2008 for $1.4 billion and hopes to sell it for up to $3 billion. TriZetto made $190 million in profit in the most recent fiscal year.

Inc. profiles the British doctor who founded hospital workflow software vendor Medisas and the expensive, lengthy process involved in getting a visa to set up shop in this country.

Clinician rounding app vendor Listrunner raises $500,000 in seed funding from independent physician investors. A trial version of the app is free.

Physician services group Mednax will acquire revenue cycle management vendor MedData. I’m hoping new ownership doesn’t interrupt the delicious flow of fresh-baked scones that MedData provided in the exhibit at HIMSS14 since they were a high point of the conference.

Sales

MultiCare Health System (WA) chooses Infor’s human capital management system.

People

Surgical Information Systems promotes Jonathan Lujan to EVP of North American sales for SIS and AmkaiSolutions.

Paul Sinclair (Allscripts) joins Beacon Partners as VP of business development.

Ford Phillips, who has worked in healthcare IT for 38 years, has written a short story collection about growing up in a small town in southern Illinois called “East of the Sun and West of of the Moon.”

Announcements and Implementations

KPMG will use Blue Cross Blue Shield claims information from Blue Health Intelligence, along with the CMS claims database, to enhance its service offerings.

A Baltimore technology site profiles Maven Medical, an eight-employee startup that offers a medical procedure price transparency app that helps doctors choose cost-effective tests based on average Medicare reimbursement rates.

Self Health Network raises $5.6 million to further development its patient communications and private social network platform that supports patient-clinician communications, personal health records, home monitoring device data collection, and caregiver alerts.

Accelerator Rock Health signs three new corporate sponsors: Abbott, Blue Shield of California, and Deloitte.

Two Michigan senior living facilities implement the Visibility Resident Care call system, powered by Versus Technology’s RTLS.

Government and Politics

The White House denies a Freedom of Information Act request filed by the Associated Press that asked CMS to disclose records related to the security capabilities of Healthcare.gov. CMS refused to turn over the documents, claiming that doing so could violate HIPAA by making it easier for hackers to access consumer information. A legal expert comments, “Here you have an example of an agency resorting to a far-fetched privacy claim in an unprecedented attempt to bridge this legal gap and, in the process, making it even worse by going overboard in withholding such records in their entireties.”

Premier, responding to a call from the Senate Committee on Finance for ideas that would make healthcare data more useful while maintaining privacy, says that ONC should mandate open APIs for data access as recommended in the recent JASON report. Other suggestions: open up access to government-related claims data, allow researchers access to EHR information, and provide incentives for interoperability that includes patient matching.

A Washington Post investigation finds that Medicare has paid $8.2 billion buying power wheelchairs and scooters for patients, many of whom didn’t need them. Companies, many of them set up by immigrants who became overnight millionaires, paid recruiters to get Medicare patients to participate in the scam. One patient found it odd that the medical equipment company that claimed he couldn’t walk had second-floor exam rooms with no elevators. Medicare put out fraud alerts, but kept paying, required by law to pay most claims within 30 days and reviewing only about 3 percent of them before paying. Medicare is a bit wiser, so criminals are moving on to selling drugstore shoe inserts as $500 orthotics and prosthetic arms and legs for patients in Puerto Rico who have no record of amputations.

Other

A Brookings blog post says HIEs are “Facebook for doctors,” with three factors that encourage doctors to use them: (a) receiving referrals; (b) being located where other communications channels are limited, such as in rural areas; and (c) peer influence.

In Australia, South Australian Health argues with Allscripts over lack of functionality in its Sunrise billing module, falling short so far over exchanging lawsuits.

Sponsor Updates

Billian’s HealthDATA discusses five hospital hiring trends in the C-suite.
Kareo CMIO Tom Giannulli will speak at the UBM Medica’s Practice Rx conference September 19-20 about the role technology plays in improving patient care.
Medhost announces that Cottage Hospital (NH) has attested for Meaningful Use Stage 2.
CoverMyMeds doubles its employee count and is expanding into a larger office space.
Quantros will showcase its Pharmacy Safety Suite of Solutions at the NACDS Total Store Expo 2014.
Navicure launches Navicure Payments that enables clients to estimate and secure patient financial responsibility and collect balances before service and after adjudication.
South County Radiologists (MO) selects McKesson Business Performance Services for its 14-physician practice.
The Advisory Board Company explains how it became a “Best Place to Work.”
DocuSign publishes a blog entry, “Fuel the Digital Revolution in Life Sciences with SAFE-BioPharma.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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1 Comment

Morning Headlines 8/19/14

August 18, 2014 News Comments Off

Community Health says data stolen in cyber attack from China

The for-profit chain of 206 hospitals says the information of 4.5 million patients was stolen, possibly by hackers with links to the Chinese government.

Microsoft cloud service Azure restored after partial outage

The hosting platform for cloud-based applications went down in multiple centers Monday evening, but the issue has since been resolved.

When Patients Read What Their Doctors Write

NPR covers the OpenNotes project with an opinion piece from an ED doctor and author.

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