Curbside Consult with Dr. Jayne 8/18/14

Thanks to Bianca Biller, who shared information about the new Practice Management System Accreditation Program (PMSAP).  The accreditation was developed through a partnership between EHNAC and WEDI. Three vendors (GE Healthcare, Medinformatix, and NextGen Healthcare) will be participating in a pilot program.

The program’s web page says the program “reviews the key functions of portability, interoperability, clinical integration, compliance monitoring, billing, reporting, and industry certification/accreditation” and that it will serve “as a baseline standard for providers in the process of PMS vendor selection and KLAS reviews.”

Although I like the idea of a program to ensure practice management systems meet the baseline needs of practices, I worry about yet another certification program whose hoops vendors will have to jump through. They can barely keep up with Meaningful Use, ICD-10, and CMS rules. Now we’re going to throw another set of requirements at them.

I also wonder whether practices will really find the separate certification of practice management systems to be meaningful. Many sites use systems that have combined practice management and EHR features. I doubt the lure of PM certification would be enough to convince physicians to consider changing systems when they are still struggling to attest for Meaningful Use. For those who may use separate EHR and PM systems, interfacing is a challenge that most wouldn’t want to repeat with a new vendor.

There are also the vendors that don’t allow interfacing with other systems. Others require you to purchase their PM system with the EHR and most physicians don’t have enough spare cash lying around to purchase a separate PM and interface it. On the other hand, if there is anyone who wants to make a change in their systems, transitioning from one PM system to another is often easier than trying to do an EHR conversion.

I downloaded the criteria document. Some of its elements include:

• A diagram of “all sites that create, receive, maintain, or transmit PHI for the delivery of the services provided, whether company sites or outsourced organizations.”
• Determination of the candidate’s status as a Covered Entity, Business Associate, etc. under HIPAA.
• PHI disclosure and protection policies.
• Controls against malware.
• Documented customer service and escalation policies.
• Minimum availability and redundancy to assure 98 percent system access.
• Capacity monitoring and plans for handling peak load.
• Compliance with applicable federal and state requirements and regulations.
• Offsite six-month backup archive, storage, and retrieval capacity for all batch transactions with progress toward a seven-year back-up archive.
• Ability to regenerate transactions going back 90 days within two business days.
• Intrusion/attack monitoring capabilities.

One of my favorites is the requirement that “candidate must have sufficient qualified personnel to perform all tasks associated with accomplishment of the stated mission.” In speaking with most of my ambulatory-based colleagues, many feel their vendors are understaffed and overwhelmed most of the time. It’s a good thing that particular element isn’t mandatory for certification.

I find it interesting that the certification program only targets practice management systems. In my experience (both clinical and administrative), the inpatient financial systems are much more in need of supervision than their outpatient counterparts.

What do you think about the new PMSAP certification program? Email me.

Email Dr. Jayne.

Morning Headlines 8/18/14

Health IT Policy Governance Subgroup

Epic President Carl Dvorak testifies on the company’s position and progress on interoperability.

M*Modal Announces New Board

MModal CEO Duncan James resigns and a new board is named two weeks after the company emerges from Chapter 11 bankruptcy

Pervasive Medicare Fraud Proves Hard to Stop

A New York Times article says HHS’s fraud prevention efforts are minimally effective because the agency doesn’t manage private contractors well and provider appeals have overwhelmed the system.

Variation in charges for 10 common blood tests in California hospitals: a cross-sectional analysis

A study of 2011 California data finds that hospitals charged between $10 and $10,169 for the same lipid panel lab test. The same author previously found that the list price for an uncomplicated appendectomy prices ranged from $1,500 to $187,000.

Monday Morning Update 8/18/14

Top News

Epic President Carl Dvorak testifies at an ONC HIT Policy Committee interoperability governance subgroup hearing. Some of his points:

• Epic’s Care Everywhere exchanges 4.6 million C-CDA documents each month with 26 non-Epic vendor systems, 21 HIEs, 29 HISPs, and 28 government agencies. Its connections to other organizations carry 20 billion transactions annually to 88 public health agencies, 18 research societies, 51 immunization registries, and 17 research registries. This, Dvorak says, portrays a broader definition of interoperability than just exchanging patient summary documents.
• Dvorak said providers who receive Meaningful Use money should be required to participate in a national list of exchange-ready participants.
• Epic recommends that Meaningful Use Stage 3 add eHealth Exchange standards for unplanned transitions of care.
• Epic suggests allowing multiple trust verification services since DirectTrust is too expensive for some organizations.
• Dvorak says data exchange should be simplified for data used only for patient treatment and not for the “payment and operations” part of HIPAA where information is often sold or redistributed to business associates.
• Epic says ONC should give patients control of information sharing with a simple opt-in/opt-out option and let patients who want finer control to use their own personal health record instead.
• Epic customers are reporting that state and local HIEs are demanding payments that exceed their connectivity value and that some are trying to pass laws requiring providers to pay their full fee just to access state immunization registries. Epic says immunization and public health reporting should be free to users and paid for by the states, and providers in states that refuse to do so should get an exemption from those Meaningful Use requirements.
• Epic urges ONC to be wary of “political agendas and commercial competition” in assessing interoperability, adding that if ONC wants to get a true picture, they should encourage health care systems to voluntarily report their interoperability statistics directly to ONC. 

Also testifying at the subgroup meeting, CORHIO Executive Director Morgan Honea said one practice was quoted $50,000 to connect to its network. He also said independent providers and small health systems should get Meaningful Use money for connecting to HIEs since they have little incentive otherwise.

Tim Burdick, MD, CMIO of OCHIN, said that data are tethered to one EHR and one patient portal, giving an example of a cancer patient who has to log into the patient portals of six organizations to see her information, then send messages to the other five asking them to update their EHRs. He says that most of the 22 states in which OCHIN operates have their own technical standards and they are often outdated, vague, or impractical (example: data standards for immunization registries required 15 different interfaces.) He said that his organization struggles with connecting to specialized registries as MUS2 requires because not only is every state different, some registries are run by drug and device companies and require each participating doctor to pay a monthly fee or make them agree that the patient data they submit can be sold or used for any purpose. He says it’s hard to match Direct addresses to specific providers because some of them work for multiple organizations and it’s not clear whether each role has its own Direct address or what happens when that doctor stops working at that location. He finished by suggesting that ONC rate organizations that are using HIE best practices, which he calls “Yelp for HIE vendors.”

Reader Comments

From HIErarchical: “Re: new insurance company-sponsored HIE in California. This has CalRHIO 3.0 written all over it. The program came from the president of UCLA, where former CalRHIO head Molly Coye, MD is chief innovation officer. She has surfaced to restart what was thrown out in 2010.” CalRHIO’s ambitious California-wide RHIO plans were thwarted in early 2010 when the state created a new entity that paired CalRHIO with a competitor with whom it had fought over HITECH money. CalRHIO, like former National Coordinator David Brailer’s Santa Barbara project, talked a lot but accomplished little – it brought one county’s EDs online. The chair of the newly created Cal Index HIE, which is funded with $80 million from Blue Shield of California and WellPoint’s Anthem Blue Cross, is the president of UCLA’s health system.  

From Information Governor: “Re: information governance. I’m curious whether organizations have an information governance policy as described by a recent AHIMA white paper.” AHIMA recommends that hospitals define information as a critical business asset that is managed using published standards and the appropriate resources. Two-thirds of survey respondents said their organizations haven’t developed that kind of strategy. The most interesting part to me was the information life cycle management of electronic information, including accuracy, access, protection against loss, preservation for legal holds, managing data deletion, and plan for technology obsolescence. Actually, maybe even more interesting was the section on information controls: documentation requirements, downtime planning, data definitions, software testing, how information is corrected, and how data quality is measured. The survey went out only to AHIMA members, which may have skewed the results. Leave a comment if you’d like to describe your organization’s efforts.

From Lodi: “Re: EMRs and quality improvements. You are a hospital IT person. Why do you always question study results proving that EMRs improve care?” Because the studies prove no such thing. It’s appalling to me that the people who conduct those studies, many of whom have a vested interested in being EMR cheerleaders, misstate their results as proving causation rather than correlation. Clueless reporters then add another layer of obfuscation by writing punchy but flat-out wrong headlines. I believe that hospitals using EMRs have better outcomes. I also believe that hospitals that have bigger profits, prettier buildings, cafeteria sushi bars, and showcase helicopters also have better outcomes. I’m throwing down a challenge to anyone who claims EMRs improve outcomes: show me your data.

HIStalk Announcements and Requests

Cerner handily won the vote of which EHR vendor is best equipped to support population health management, although the IP addresses of respondents suggest that a huge percentage of the nearly 1,500 votes it received came from inside the company. Cerner contacted me to say they didn’t encourage ballot box stuffing, but non-Cerner voters nonetheless left scathing poll comments upon seeing the results, one of whom suggested giving the win to Epic by default (who also had some homers clicking away, with 62 of its 216 votes.) Let’s move on to a new poll to your right or here: is it a good deal for Cerner to buy the Siemens HIT business for $1.3 billion? Vote and then click the Comments link to expound further. Add some insightful comments and I bet some healthcare publications will use the results for further articles since information is otherwise scarce.

I asked readers whether their employer requires them to share hotel rooms for group travel. The results: only 12 percent of respondents said yes, which is about the same percentage as reported in other national surveys. The numbers were the same for both vendor and provider employees. My thoughts:

• Vendors theoretically save their customers money by forcing the rank and file to share rooms, but the frugality often ends when executives are involved as the lavish salaries and stock options dwarf the cost of a few hotel nights. Customer costs never go down, and it’s likely that customers of the room-sharing vendors pay just as much.
• I would bet anything that company executives don’t share rooms. I’m not a fan of policies that only apply to people in the trenches.
• A better option would be to book single rooms in cheaper hotels and provide group transportation to the event’s location.
• The “two same-sex people should be comfortable and safe as roommates” idea is a dated concept that makes incorrect and stereotypical assumptions about sexuality and body image.
• A shared employer isn’t enough reason for me to be comfortable with forced cohabitation with someone I barely know.
• I’m a big fan of asking employees if they will share rooms instead of insisting they have to. That gives people who are uncomfortable with the idea for any reason a discrete way to opt out.
• Lawyers would salivate at the chance to represent someone exposed to sexual harassment or violence because of employer-mandated room sharing.

Last Week’s Most Interesting News

• Epic hires a lobbying firm, breaking from its long-held claim of having nobody assigned to sales, marketing, and government relations roles.
• Free EMR vendor Practice Fusion raised the ire of practice customers and hopefully the awareness of other cloud-based system users in reminding those customers to insist on access to local copies of their data for downtime situations.
• A survey of ACOs finds that most have only basic IT systems.
• Massachusetts says it will spend more money to fix its struggling health insurance exchange website rather than move to Healthcare.gov.

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

Cerner shares (blue) are up nearly 12 percent since the company announced that it will acquire the healthcare IT business of Siemens on August 5, but they still lag the Nasdaq (red) over the past year.

People

MModal announces that CEO Duncan James will resign from the company, which exited Chapter 11 bankruptcy two weeks ago. MModal has also brought in a new board.

Government and Politics

The New York Times reviews the government’s Medicare fraud efforts that cost $600 million per year, concluding that the 90 percent of fraud isn’t caught because HHS doesn’t manage the private recovery audit contractors it uses very well. The article says hospital pushbacks and extensive appeals have nearly completely shut down recovery efforts and cases can take up two years to get in front of a judge. It also notes that RAC bounties are so high that the companies paying fraudulent claims are sometimes the same companies paid to investigate them.

Other

I missed this: Health Information Technology Exchange of Connecticut died a quiet death on July 1, 2014 when a new state budget bill repealed the creation of several quasi-public agencies, of which HITE-CT was one. Nobody seemed to notice or care, so that probably says it all.

In Canada, B.C. Emergency Health Services drops its $2.8 million ambulance electronic patient care record a year after it was supposed to go live, saying that, ”the vendor was unable to meet our business requirements.” The vendor was Interdev Technology.

A study of 2011 California data finds that hospitals charged between $10 and $10,169 for the same lipid panel lab test. The same author previously found that the list price for an uncomplicated appendectomy prices ranged from $1,500 to $187,000. Nobody pays list prices except the uninsured, who obviously wouldn’t be able to afford the ridiculous prices even if they wanted to pay. Healthcare prices are even more irrelevant than the inflated nightly rates listed on the back of hotel room doors.

In a relevant story, a man who went to the ED of for-profit Bayonne Medical Center (NJ) to have them look at a finger he had cut days before is billed $9,000 for a tetanus shot and a bandage. The hospital’s CEO says it went out-of-network for the insurance company because of low payments and that it needs high ED charges to survive. The insurance company says the CarePoint Health-owned hospital is deliberately gouging consumers by dropping out of networks since New Jersey law requires the insurance company to pay for ED services anyway. The insurance company settled with the hospital for $6,640, and after the local TV station picked up the story, the hospital wrote off the balance owed by the patient. It’s ridiculous to put in-network verification responsibility in the hands (no pun intended) of a patient seeking emergency treatment, or to ask every employee who walks in the door whether they are in-network since hospitals always have private doctors and contractors running around who issue their own bills.

The top 10 executives at the non-profit Blue Cross and Blue Shield of Alabama made more than $1 million each in 2013, doubling their 2011 pay. The president and CEO made nearly $5 million.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 8/15/14

Keys to HIT Success: Results from the 2014 Survey on ACOs

A survey of 62 ACOs finds that most operate with a basic health IT infrastructure comprised of an EHR with clinical decision support features, a data warehouse, and a disease registry. Most do not use population health systems, referral management systems, or telehealth platforms and more than 90 percent reported having concerns with the cost and return on investment potential of health IT solutions.

Update: 8/14/14 – Intermittent EHR access restored

Practice Fusion’s cloud-based EHR went down Tuesday and Wednesday, leaving customers unable to access their schedules or patient charts. Practice Fusion reported that the problem was likely caused by a “global internet brown-out,” citing a recent Fox News report as evidence.

The Meaningful Use Stage 2 Finish Line

John Halamka, MD and CIO of Beth Israel Deaconess Medical Center, reports that the hospital will attest for Stage 2 by the September 30 deadline, but that they are struggling to meet the 10 percent transition of care threshold because there are not enough practices ready to receive CCDs electronically.

HHS on the hunt for HealthCare.gov emails Issa wants

HHS has spent 23,000 staff hours trying to recover deleted emails from CMS administrator Marilyn Tavenner’s email account in response to Congressional investigations into the failed Healthcare.gov rollout. Tavenner, whose email address is public, receives between 10,000 and 12,000 emails a month.

News 8/15/14

Top News

A survey of 62 ACOs finds that many lack tools for risk management and patient engagement and haven’t made much IT progress in the last year. Every respondent said they have problems getting data from external organizations as they struggle with interoperability, workflow integration, and infrastructure maintenance. Few of them use secure messaging, referral management tools, self-scheduling, remote monitoring, smartphone apps, or telemedicine. Most do not coordinate care via an HIE.

Reader Comments

From Bucolic Splendor: “Re: Practice Fusion. Was down most of the day Wednesday, a major catastrophe for practices all over the country. Nobody really believes their explanation.” Practice Fusion blames its multi-day downtime on unnamed third parties, their data center partner, and a “global Internet brown-out.” Strangely, some users could access the system on their phones only, others could get on with the Safari browser but not Chrome, while some users said they could get partial access by turning off Shockwave. Users ripped the company in Facebook messages for not answering the support line and failing to provide updates as their practices sent patients home without treatment. The bottom line: get SLAs from your cloud-based vendors (so the burden of reviewing their infrastructure is theirs, not yours) and make sure you have a local information retrieval option since even Internet connectivity itself isn’t guaranteed. The cloud is great except when it isn’t and then you’d give anything to have that under-the-desk server back. Some user comments:

• “I just had a consultation with a patient I only see once monthly and I had no idea what we talked about last time.”
• “Don’t care about your acquisition since I can’t see my patient charts!”
• “Practice Fusion deleting comments & removing unfavorable forum threads is a BAD IDEA. One step away from charging for negative reviews. Spend more time on keeping the system up, and less time combing your social rep.”
• “It is amazing how many people there are out there who is getting a superb free handout and then bite the hand that feeds them. And you are supposed to be professionals. Give me a break. Go out and actually pay for another premium service. Then you will have every right to bitch when things go wrong.”
• “I see lots of photos of team-building games and fun … and bravo for that … but it appears there is less emphasis, as David Stewart suggested, on building infrastructure and contingency plans. Your suggestions to have a backup server and hub do us no good when the problem in on your end.”
• “We may be looking for another EMR system. I’ve been relatively happy with the program when it functions, but the lack of adequate support has challenged our practice more than once.
• “Although it is free to medical provider, some huge advertisers are paying big dollars and are the ones allowing it free for us. I hope they are aware of this inconvenience.”
• “For everyone that is frustrated, how long have you been with PF? How many times has it gone down? I’ve been with them for 3 1/2 years and had a total of 4 hours of unplanned down time.”
• “I am OK with a Day or 2 of outages, but this is a wake up call to how much we rely on you. Next time it might be a security issue and we are helpless to do anything about it. I would feel better knowing that if there is a catastrophe, I at least have a backup that I can use to go forward with. Maybe even a paid option – like $50 a month to be able to do a daily backup to my local computer.”

From Reluctant Epic User: “Re: new Epic patent. I’m surprised the patent examiner thought that was novel for a Level of Service user interface.”

From Details … Details: “Re: Habersham Medical Center. With Meditech’s industry-leading 800+ attestations, it would seem that there might be some missing information here.” I don’t doubt that a bit – it was the client that said it was a software problem. However, they also fired the IT director, so that plus Meditech’s lack of attestation problems elsewhere seems to put the blame on the hospital.

From ShoezyQ: “Re: sharing hotel rooms. At the Allscripts user group meeting and annual sales meeting, the company requires employees to share hotel rooms. Maybe they should just send fewer people if they can’t afford the rooms. Can you ask your readers? I would never share a room with a colleague.” I’m with you. I bet Paul Black isn’t bunking up with Jim Hewitt at a Motel 6 and coordinating bathroom times, apologizing for snoring, and agreeing on the TV channel, so the policy is just for the “little people” who weren’t born with a suit on. It’s a pretty cheap company that requires employees to work a company event (which probably also means putting in a ton of excess unpaid hours away from home) and then forces them into steerage to save a few bucks. Maybe the peons could cook ramen noodles in their room’s microwave to save even more money. My strategy would be: (a) ask if you can apply your half-room cost to a single room and pay the difference for your privacy; (b) say you have sleep apnea and use a very loud CPAP machine that will keep your roomie up all night; or (c) find a new employer who values your dignity over their dollars. Meanwhile, I will ask readers as you requested: take the poll here and feel free to explain your employer’s policy via a comment.

From John Britton: “Re: Cerner acquires Siemens. I am the CIO at a medical center that uses Cerner as our primary EMR as well as their Smart Room technology. We also use Siemens MedSeries4 for General Financials (AP, MM, GL). In 2010 we became one of the first Cerner ‘smart’ hospitals when we went live with this technology in 2010. Since then, I’ve had a front-row seat to the work Cerner has done to connect medical devices to the EHR through their CareAware ecosystem. Avoiding duplicative data entry and preventing errors are some of the biggest benefits of this approach. I think Cerner’s acquisition of Siemens will only accelerate their work to connect different data sources to the EHR. It might also help get closer to realizing more comprehensive interoperability and data sharing models between disparate information platforms using initiatives currently underway like the CommonWell Health Alliance.” John is CIO of Fisher-Titus Medical Center in Norwalk, OH.

HIStalk Announcements and Requests

This week on HIStalk Practice: HHS spends precious man hours (and taxpayer money) attempting to find emails related to the Healthcare.gov rollout. ONC launches a website to collect feedback on its interoperability roadmap. HIPAA worries cause OBs to remove baby pictures from their office walls. Dr. Gregg explains how HIT leads to HID. The Healthcare Administrative Technology Association opens for business. Investors outline their attraction to healthcare IT firms in Nashville. Square’s new appointment-booking feature poses potential HIPAA concerns for small practices. Thanks for reading.

This Week on HIStalk Connect: HealthMap, a Boston Children’s Hospital and Harvard Medical School collaboration, combines public health data, Twitter data, and Google news alerts to track the recent Ebola outbreak with greater accuracy than the World Health Organization. Apple is reportedly in discussions with Allscripts, Johns Hopkins, Cleveland Clinic, and Mount Sinai to generate support for its HealthKit rollout. Validic raises a $5 million Series A round that it will use to expand its digital health integration engine and grow its customer base.

The first book written by ”CIO Unplugged” Ed Marx of Texas Health Resources will be released in late September. Watch for details of the upcoming virtual book launch for “Extraordinary Tales of a Rather Ordinary Life: How Applying Common, Everyday Principles Can Lead to Uncommon Results” on HIStalk.

Listening: new from The Gaslight Anthem, a hard-rocking New Jersey working class band that sounds like Springsteen backed by the Ramones. Also: new hard rock from the latest of several incarnations of Fuel from Henderson, TN – none of the 16 people who have played in the four-piece band’s 21-year history were in it continuously, but they always sounded good. 

I had a cool customer support experience today with one of our webinar tools. I had opened a ticket since the company basically rewrote the web-based software without instructions or updates to the knowledgebase. The support rep emailed me a screen capture movie showing how to do what I needed to do, even having a little one-way chat with me as he stepped through it. It would have taken him three times as long to write out the steps instead of just turning on Camtasia or whatever capture software he used to dash off a quick video.  That was both brilliant and personal, exactly what you want from a support tech.

BOSS Award Winner – Riton Khan

Several people nominated Riton Khan for the HIStalk Beacon of Selfless Service (BOSS) Award. Riton is an HISP/iNexx deployment engineer with Medicity.

Adam Rossback of the Ohio Health Information Partnership said in his nomination, “Riton spent countless hours working with me to establish HISP integration with our organization to allow 30+ hospitals to attest for July MU2 attestation.” Donna Maxey of Healthcare Access San Antonio says Riton went above and beyond his job description by working through EMR integration issues with her clients, adding, “Whenever I felt my client was stuck, no matter what the issue was, I asked for a meeting and Riton would send me a screen shot of his calendar. He allowed me to pick any open day/time that the client’s vendor was available. I have yet to work with any vendor employee that is that transparent so that my clients could get the project done on time.” Several other of Riton’s customers added their accolades.

Congratulations to Riton for his excellent work, which makes him entirely deserving of both the thanks of his customers and the BOSS Award. 

You are welcome to nominate a non-management individual for BOSS Award recognition.

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

MedAssets will acquire consulting firm Sg2 for $142 million in cash.

Private equity firm GTCR will invest up to $200 million Cedar Gate Technologies, which it will form with former Medco CEO David Snow, who will add $20 million of his own money and serve as CEO. The company plans to “build a transformative company in the healthcare information technology industry by acquiring outstanding healthcare data and analytics businesses and accelerating their growth.” Snow is hardly an entrepreneur – he’s worked his whole career running giant insurance companies, although he’s on the board of a couple of startups.

Geneva Healthcare, which offers a pacemaker data management platform that also integrates with other medical devices, raises $1.8 million in financing.

Sales

Princeton HealthCare System (NJ) selects Premier’s integrated supply chain, performance, and technology services.

In England, West Suffolk NHS Foundation Trust signs for Cerner Millennium. I think they went live a few years ago on iSoft’s Lorenzo (now owned by CSC) as part of the now-dead NPfIT. You may infer from the hospital photo that despite having the superior healthcare system, NHS doesn’t suffer from the Edifice Complex of aggressively billing Medicare and using the otherwise restricted profits to erect huge, artistically stunning buildings whose exteriors can’t be viewed by the sick people inside their walls but that stroke the egos of the proud community and the executives in charge.

Azalea Health signs up the physician groups of two Georgia hospitals for its EHR and RCM systems, Dorminy Medical Center and Irwin County Hospital.

Wake Forest Baptist Medical Center (NC) chooses Tonic Health’s patient survey system.

National physician specialty services company Sheridan Healthcare chooses VitalWare’s iDocuMint ICD-10 code assignment and bill preparation tool for its 2,800 providers.

Basset Healthcare (NY) chooses Strata Decision’s StrataJazz as its complete financial platform.

Urology Centers of Alabama adds Greenway’s PrimeRCM revenue cycle solution, joining its PrimeSUITE EHR/PM system.

People

Louis Leibhaber (Fundamental Succcess LLC) joins WeiserMazars as director of the healthcare group.

Asif Ahmad, CEO of Anthelio Healthcare Solutions, is appointed to the board of orthotics vendor Hanger, Inc.

People Magazine profiles the family of MedAptus employee Jennifer Crowley, whose six-year-old son Padraig has been diagnosed with stage 4 neuroblastoma, the same rare childhood cancer that killed her infant son in 2006. Friends have started a fundraising page to help cover the family’s medical bills. Padraig was started immediately on chemotherapy and will have a long stay at Memorial Sloan Kettering.  

Larry Covington, former CEO of Unibased System Architecture, died earlier this week at 75. Services will be next Friday, August 22, in St. Louis. 

Announcements and Implementations

Allscripts will integrate Clinical Architecture’s terminology management system, Symedical, with dbMotion.

Two Texas hospitals are using Holon’s CollaborNet HIE platform in a state-developed pilot project to refer smokers to a free telephone-based smoking cessation program. Annual referrals jumped from seven to 1,254 after the single-click electronic system was put in place.

4medica announces the release of the first laboratory PHR licensed by MMRGlobal, which is curious in that paying off a patent troll is bragworthy.

The non-profit Healthcare Administrative Technology Association launches to provide advocacy and member education to practice management system stakeholders.

Impact Advisors joins the Epic-IBM team in pursuing the Department of Defense’s EHR bid.

Allscripts and Netsmart will partner to co-develop solutions for their acute care and behavioral health EHRs, respectively.

Nordic announces that it has worked with 100 Epic-using organizations, about a third of all Epic clients. That’s double the company’s 2012 total.

Government and Politics

HIMSS EHR Association responds to a request from the Senate Finance Committee asking for comments about the availability of patient data vs. the need for patient privacy. The association says the biggest barrier to using existing data effectively is lack of a patient matching strategy, although it stopped just short of suggesting implementation of a national patient identifier.

CMS reactivates its Open Payments system for reporting drug and device company payments to doctors 11 days after taking it offline. Data problems had misattributed some of the physician payments.

HHS says CMS Administrator Marilyn Tavenner inadvertently deleted emails related to the failed rollout of Healthcare.gov, explaining that she receives so many emails that she regularly hits her Outlook inbox limit and has to clear space. They added that she is supposed to forward or copy the emails for retention as the law requires before deleting emails, but she sometimes forgets. The National Archives and Record Administration says they can probably recover most of the internal emails since they would have been saved by their recipients, but those going to outside addresses may be gone for good. HHS has spent 23,000 staff hours so far trying to retrieve the emails in response subpoenas from Rep. Darrell Issa (R-CA), chair of the House Oversight Committee, so that’s a million-dollar plus delete key.

Innovation and Research

A HIMSS Analytics telemedicine study finds that … well, we don’t know what it finds since they provided a six-page teaser that only included the table of contents. That’s probably enough since the response rate was only 2.7 percent, so any generalization would be suspect.  

Speaking of HIMSS Analytics, they should know better than to make this speculative leap even though clueless reporters do it constantly. They did the usual lazy test of mashing up some clinical quality data with their own EMR Adoption Medical scores and found that mortality was generally better in EMR-using hospitals. What the study couldn’t find – despite the headline stating otherwise – is that the EMR cause the improved outcomes. Why couldn’t they use the same detailed Healthgrades data and compare it to each hospital’s EMR go-live date from the HIMSS Analytics database and see if mortality improved afterward? It’s just absurd to try to claim that because EMR-using hospitals have better outcomes that the EMR should get all the credit. The same study found that sepsis mortality rates were higher in EMR-using hospitals, so if you feel an infection coming on and you believe this report, you should seek out any randomly chosen hospital that still uses paper charts.

It was love at first sight between Gartner’s Hype Cycle and me years ago. Here’s a current version, which says mobile health monitoring is about to start moving up the Slope of Enlightenment. Big data and Internet of Things are still years away from matching their hype.

The Michael J. Fox Foundation and Intel announce their collaboration to objectively analyze data created from wearable devices to determine the progression of Parkinson’s Disease.

Technology

Apple quietly adds another healthcare expert to its payroll: Divya Nag, founder of StartX Med, an accelerator to commercialize Stanford research. The beta version of iOS 8, released last week, includes support for spirometry data, an option to display medical ID on the lock screen, and health privacy options.

Other

Epic officially breaks from its long-held “no marketing or government relations” position by engaging lobbying firm Card & Associates, run by the brother of the former White House chief of staff under President George W. Bush, as it seeks the DoD’s EHR bid.  

Beth Israel Deaconness CIO John Halamka says the hospital is almost ready for Meaningful Use Stage 2’s September 30 deadline, but is struggling with the 10 percent transitions of care threshold since few other providers, especially small physician practices, are capable of receiving the hospital’s information electronically. He adds, “On some days it feels that we have the only fax machine in town and thus it’s hard to fax.” That’s going to be everybody’s problem — so few providers are ready for Stage 2 that the go-getters don’t have anyone to exchange information with.

Former Allscripts CEO Glen Tullman says patients don’t want more engagement with their chronic diseases – they want less engagement so they can get on with their lives. He says that pushing patient engagement is a patronizing approach that will kill off all the technology startups that haven’t made a dent in managing illness anyway. He adds that words such as “tracking,” “monitoring,” and “intervention” are disempowering because they suggest a loss of independence and that nobody’s going to analyze their own data or look up ways to be healthier. Not everything Glen said when he was at Allscripts made sense, but this does.

An article in The Atlantic says that big data from expectant women is being used for both good and bad: good for analyzing fetal DNA to uncover genetic problems, bad because marketers are using it to find purchasers of pregnancy tests and other products so they can launch aggressive marketing campaigns that hope to turn their offspring into long-term customers. Crafty data brokers use browser cookies, page view histories, Facebook posts, and online purchasing histories to build marketing profiles that are sold to any willing buyer. An example is the father who complained to Target that sending coupons for maternity clothing to his daughter encouraged teen pregnancy, only to find that Target knew something he didn’t: she was already pregnant.

Torrance Memorial Physician Networks blames its EMR for allowing one of its doctors to code “homosexual behavior” in a male patient’s problem list. The patient, who is suing the doctor and practice for emotional distress and libel after seeing the entry in his chart after the hospital said they would remove it, says the doctor argued that the medical community is still not sure whether or not homosexuality is a disease. The man’s chart was coded with ICD-9 code 302.0, “ego-dystonic sexual orientation,” a code that was retired in 1987 to describe someone who’s unhappy with their sexuality. According to a spokesperson, “Due to the highly complex software used in creating an electronic medical record, the incorrect code continued to exist in an electronic table only. As a result, this incorrect diagnosis code was included on a paper copy of the record, which was provided only to the patient.”

It’s surprising how much technology is being developed around the medical marijuana industry, but then again the financial alignment is clear. A radiologist and clinical owner develops CannaScan, a real-time, cloud-based validation system that allows Massachusetts police departments to verify that people found with marijuana have been issued a valid prescription. Massachusetts doctors were previously charging patients for ID cards, which the Department of Health found unethical, leading to CannaScan’s claim that it allows the “Good Guys to Weed Out the Bad.” The doctor says the software allows better care coordination and real-time patient management since it supports videoconferencing, scheduling, and notifications, or as he calls it, “A Clinic in the Clouds.”

Weird News Andy utters one of my favorite Monty Python lines in titling this article “I’m not dead yet.” A hospital in Australia apologizes for faxing death notices for 200 still-breathing patients to their family doctors, saying someone accidentally changed the templates involved. At least it’s not just the US healthcare system that’s keeping long-abandoned technology such as pagers and fax machines alive.

WNA also likes a story he calls “a knife on his mind.” A man in China taking a stroll feels pressure in his head, not realizing the cause until a shopkeeper points silently at the five-inch kitchen knife protruding from his skull. It had fallen from the balcony of a high-rise. He’s OK.

Sponsor Updates

• NextGen describes the three tiers of the Patient Centered Medical Home.
• The Meditech Solutions Group within Dell adds DataMotion Direct secure messaging to its portfolio of services.
• CompuGroup Medical US and Teche Action Clinic (LA) team up to celebrate the 2014 National Health Center Week.
• Levi Ray & Shoup announces the release of its Virtual Session Printer Agent.

EPtalk by Dr. Jayne

I attended a CME seminar this week which was actually pretty fun. It was good to get away from the grind of the IT world and remind myself why I became a physician in the first place.

Although most of us continue to have grumbles about payers, conflicting recommendations, and of course EHRs, we also have great stories about our patients and what it means to care for them. The course was on delivery of culturally competent care, which is pretty far away from what we usually deal with in the IT trenches.

Several of the physicians I met were interested in the fact that I gave up a busy solo practice to go into the world of IT. Many were from cities of a size that they may not have dedicated physician IT resources and were interested in how they could get more involved in the decisions that impact their practices and how they care for patients. Most were employed, although there were a few solo holdouts.

A couple are in direct-pay practice situations which I think is a very interesting solution to many healthcare issues. The patient sees the doctor, a fee is assigned, and the patient pays. If the patient wants to submit to insurance, they are given information about the visit so they can self-file. Although one uses EHR, the others don’t. All of them have opted out of Medicare and Medicaid. At least for now, all are happy.

It was strange to talk to physicians who aren’t dealing with MU attestation or the risk of audits. That’s become so much of our world lately. It was invigorating to see whether the grass is greener on the other side or not. I’m not interested in hanging up my IT hat, but I certainly would consider that model if I went back into a continuity-type primary care practice. It reminds me of the physician I saw when I was a kid.

Of course not being connected has its disadvantages. I don’t think I’d take it that far. I like the benefits of EHR too much to go back entirely.

Speaking of e-prescribing, I mentioned that I enrolled in the free Allscripts eRx product through the National ePrescribing Patient Safety initiative. Although the registration process was easy, I still am not set up to e-prescribe. Apparently they need to verify my NPI number. First they asked me to fax proof of my NPI, which I don’t have – I don’t have the original enumeration letter from way back when. I also don’t have a fax machine.

I asked if I could email it. They said yes, but again I need to provide proof. They helpfully directed me to a website where I could look myself up and find my NPI number, which I already knew and submitted to them. I’m not sure why they couldn’t go to that website and verify that the number I provided matches my name, but instead sent me 12 emails and called the office multiple times to tell me to go take a screenshot of a public website and email it to them.

I was finally able to find time to do that and sent it off, so hopefully they’ll get me set up soon. In the meantime, the system isn’t that useful since we don’t have a demographic interface to it and everything has to be manually keyed. Looks like I’ll be going back out to look for other vendors regardless of the outcome with the NPI.

From The Grey Goose: “Re: Allscripts user group meeting in Chicago. My kind of town! Check out this view from my hotel room.” I wasn’t sure initially if this picture was real or from a postcard, but I can only hope I have such a great view when I’m in town for HIMSS. This will be an interesting HIMSS for me since we’re in the middle of consolidating our systems. By the time it rolls around, we’re likely to be under contract with a new vendor. That will put a whole new spin on things.

The Allscripts user group meeting is in full swing and purports to have a Thursday night client event with bands Styx and The Gin Blossoms performing. Sounds like a great time and I hope some of the attendees share pictures. I’m off to the airport now. It will be good to sleep in my own bed before handling the torrent of emails that flooded in while I was away.

What’s your favorite vendor user group client event? 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.

Readers Write: Lessons on How to Survive in Healthcare

Lessons on How to Survive in Healthcare
By Nick van Terheyden, MD

From Samsung to Google to salesforce.com, the flurry of tech companies making a healthcare play over the past few months has left me both excited and dismayed. Excited because these companies have, in their own ways, revolutionized the way people interact with technology. Dismayed because of the steep hill they must climb and their battle to truly make their mark in the healthcare space.

We’ve seen it before. Tech companies dipping their toe in the water and then jumping back when they start sinking ankle-deep and losing their footing. From my 25+ years sitting at the intersection of medicine, technology, and policy, here’s my advice to these tech giants looking to make their mark in healthcare.

• Get out of your comfort zone and consider the clinician. One of the biggest misses for these tech companies entering into healthcare is they’re expecting the patients to drive the revolution. That’s where they’re comfortable – with consumers. But so much happens on the clinical data side that needs to be factored in. Data needs to flow both ways. Even more importantly, doctors and nurses are drowning in a morass of technology and data that in many ways is hindering their ability to do their jobs effectively and with the passion they had when they entered the field. Add on the fact that working with and interpreting information gathered by a clinician about patients is not a pure art or science. That makes it hard to create consistency in working with it. While a patient app, sensor, or portal is nice, any company entering into healthcare needs to pay as much attention to the clinician as to the patient.
• Build trust. We’re not making widgets. Google can’t mine healthcare data the way it mines ads and shopping data. It’s one of the major reasons they’re feeling the pain — it doesn’t fit into their core business. Healthcare data comes with all sorts of security and regulatory challenges, but even more important is that the healthcare consumer is a different kind of consumer and implicitly trusts their healthcare professional. They are already wary of ads targeted to their own needs – layer in data about their prostate exam and it becomes even more personal and they’re on the defensive. People interacting with the healthcare systems are typically vulnerable, stressed, and sometime scared. They need to trust their sources. Companies like Apple and industries like banking have built enormous trust with consumers, but replicating that in healthcare requires a different approach.
• Stop looking for standards and release data from hostage. For these companies to be successful, they need to learn to operate outside of the world of data standards. Google was wildly successful moving into email, successfully because the iMac and Simple Mail Transfer Protocol (SMTP) made it easy. There’s no such advantage in healthcare. There are so many variations of standards – from Health Language 7 (HL7) to Clinical Document Architecture (CDA) to the Continuity of Care Record (CCR) and Digital Imaging and Communications in Medicine (DICOM) – that even when they do exist, they’re insufficient for sharing. But there may be an opportunity for Google or another company to actually create a new standard and have it take off. While Google is good at navigating and working with large amounts of data (i.e. Google Maps is constantly updating itself to have the most accurate information), the truth is that patients are ultimately going to own their healthcare data. For anything to change and for progress to be made, it all needs to be easily shared. How companies can turn a profit from shared data remains to be seen.

The more innovation in healthcare, the better for all of us. We need it more than ever. But any new entrant into the space needs a little Healthcare 101 to be successful and to make a difference in the lives of patients, clinicians, and their caregivers. 

Nick van Terheyden, MD is chief medical information officer of Nuance Communications of Burlington, MA.

Readers Write: The Looming Leadership Shortage

The Looming Leadership Shortage
By Frank Myeroff

Executives all the way up to CEOs and CIOs are expressing concerns about the looming leadership shortage in the US and around the globe. Because this shortage will hinder business growth, companies are in hot pursuit of professionals who demonstrate leadership potential at a greater rate. They are also willing to invest more resources in leadership programs. In fact, a survey conducted by The Conference Board and Right Management (talent, career, and management experts) indicates that businesses plan to spend 37 percent more on leadership programs this year than they did in 2013.

We’ve identified 10 principles of successful leaders:

1. Vision. A leader has the ability to share a dream and direction that inspires others to follow.
2. Trust. Without trust, vision can’t happen. A leader must walk the talk in order for people to give up what they know and venture into the unknown.
3. Participation. A true leader can unleash the potential in others and get the best from them as they work to accomplish company initiatives.
4. Learning. Leaders have a thirst for continuous training. Applying this knowledge creates real customer value.
5. Respect. True leaders respect and have a deep appreciation for people’s differences, and as a result, are able to cultivate more committed employees.
6. Innovation. Creativity and innovation are essential elements to building a successful company. Leaders need to express original ideas and ingenuity to motivate and inspire others to follow suit.
7. Honesty. The hallmark of a good leader is integrity, honesty, and morality. We need leaders who have a deep sense of purpose and are true to their core values.
8. Community. Today’s leaders need to be measured over and above the success of the company. They need to do for others and show involvement in their community.
9. Courage. An effective leader must have the courage to see difficult situations through to the end and accept responsibility for the outcome of decisions.
10. Selflessness. Leaders should be servants who facilitate the success of others. They spark action in others by seeing the value of others. In return, others start to think more highly of themselves and their abilities.

Today’s leadership training programs extend well beyond traditional classroom instructor-led activities. More resources are being allocated to a full spectrum of leadership learning initiatives.

• Coaching. Often senior managers will serve as coaches to develop the capabilities of high-potential performers and help them achieve explicit workplace objectives and goals. Coaches have a vested interest in improving specific skills and interpersonal relationships that pertain to specific jobs because it impacts the company’s bottom line.
• Action learning initiatives such as business challenges and simulations. Action initiatives enable trainees to jump right into the real world of upper management. Most business simulations are used for business acumen training and development. Learning objectives include strategic thinking, financial analysis, market analysis, operations, teamwork, and leadership.
• Critical thinking and cognitive ability assessments. Administering these types of assessments will measure the learning capacity as well as the problem solving and decision making ability of an individual.

The bottom line is that the demand for quality leadership in the US and around the world is expected to far outpace the supply. Organization should identify potential leaders and implement new and effective leadership training programs in order to stay competitive and improve performance of both people and the company.

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

Readers Write: For Small Practices, The Time Is Right for Business Intelligence

For Small Practices, The Time Is Right for Business Intelligence
by Matt Barron

Small medical offices are dealing with increased patient volumes, Meaningful Use, Accountable Care Organizations, ICD-10, and declining reimbursement. Accordingly, physicians are spending less time with patients and more time dealing with the noise that surrounds the business of medicine.

Many small practices already have a critical solution at hand — they just need a better way to access and use it. The solution is big data, a trendy term for all the digital information medical practices already have in the form of electronic health records, billing records, practice management information, and more.

The trick is that big data alone doesn’t do much, and until recently, the software that small medical practices need to turn all that data into meaningful business intelligence was too expensive and difficult to use.

Now business intelligence software is more advanced and ready to address the needs of small medical practices that have  been wary of adopting cutting edge software because it was too costly and cumbersome.

Let’s take a look at a few ways BI software can help boost the financial health—and the quality of patient care—at small practices:

1. Market segment analysis. To help practices find and generate more revenue, the latest software enables geographic analysis that determines where patients are coming from so practices can better target their marketing efforts.
2. Claims management. Advanced tools make it simpler to increase first-time reimbursement capture and support follow through on denied and underpaid claims.
3. Financial overviews. Financial overviews and details on the state of the practice are available in seconds with automatic comparisons to key performance indicators. Physicians can view revenue cycle performance, and find out how many days it takes to collect on accounts receivable. Armed with this information, they can institute best practices, make comparisons among various payers, and increase the overall productivity of their practices.
4. Compliance support. The latest business intelligence software is designed to work with and address new requirements and regulations. It’s ICD-10 compliant and can be used to track progress toward demonstrating Meaningful Use and earning stimulus money.
5. Individualized patient care. Physicians can create customizable health plans to manage patient conditions based on demographics, diagnoses, lab results, and more. They can check on whether the plans are being followed, automatically determining whether patients had their tests taken and viewing the results. By setting up alerts and reminders, physicians can also see which patients are most prone to a chronic disease, how many risk factors they have, and what actions can be taken to successfully manage the disease or avoid it altogether.
6. Aggregate patient care. Physicians can track patient health trends over time and send reminders to patients automatically, providing medical advice and suggestions. On a broader level, the latest software makes it possible to uncover patient population trends and spot disease outbreaks, even determining by ZIP code which population segments are most at risk.

Today’s business intelligence software is more powerful, more affordable, more secure, and far easier to use.

Matt Barron is COE leader of business intelligence and consulting at ADP AdvancedMD of South Jordan, UT.

Morning Headlines 8/14/14

Health Policy Brief: Interoperability

“Health Affairs” discusses the state of health data interoperability in the US given the nation’s $26 billion investment in health IT adoption.

Norton Healthcare stabilizes as EHR expenses fall

Five-hospital Norton Healthcare (KY) returns to a net positive revenue after two years of posting losses brought on by its system-wide Epic implementation. With the implementation complete, overhead costs have dropped and Norton’s revenue has climbed 4.7 percent.

Secretary Burwell further strengthens HHS management team

HHS welcomes Kevin Thurm as its new senior counselor. Thurm worked with HHS under the Clinton administration, and most recently worked at Citigroup as a senior executive overseeing corporate compliance.

Morning Headlines 8/13/14

Dallas County gets futuristic general hospital

A local paper highlights some of the technology being installed at Dallas-based Parkland Memorial Hospital, a $1.3 billion “digital hospital” set to open in May 2015.

The new No. 1 private-sector employer

Cerner has grown to become the top private sector employer in Kansas City, driven by a hiring spree that added 1,500 new hires in the past year.

Apple prepares Healthkit rollout amid tangled regulatory web

Apple is reportedly in discussions with Allscripts, Johns Hopkins, Mount Sinai, and Cleveland Clinic as it continues recruiting new digital health partners ahead of its upcoming HealthKit rollout.

Telemedicine could yield $6B per year in savings

A new study claims that adopting telemedicine as the primary means of treating certain non-urgent conditions could theoretically save US employers $6 billion annually.

News 8/13/14

Top News

The White House creates the US Digital Service, a new program that will recruit the “country’s brightest digital talent” to provide strategic guidance on major IT projects like Healthcare.gov and iEHR. Mikey Dickerson, an ex-Google engineer credited with saving Healthcare.gov, has been tapped to run the service. As a deputy federal CIO, he will work with similarly titled Lisa Schlosser in her role of policy, agency oversight, and accountability. The new service will ultimately consist of 25 experts brought in on two- to four-year term appointments to help agencies plan, improve, and fix IT programs. It will be financed with existing funds in 2014, and scale in 2015 as outlined in the President’s FY 2015 budget.

Acquisitions, Funding, Business, and Stock

Cerner jumps to the top spot of the Kansas City Business Journal‘s Top Private-Sector Employers List due in large part to the addition of 1,550 local employees in the past year. That’s not counting the 16,000 it will need to hire to fill its planned $4.5 billion Three Trails Campus, or the unknown number it may create in the coming years as a result of the Siemens acquisition.

National staffing company Jackson Healthcare acquires Sullivan Healthcare Consulting, which focuses on improving the performance of the hospital perioperative suite through surgery benchmarking, scheduling, staffing, sterile processing, and surgery IT implementation. SHC will serve as a complementary service line to Jackson Healthcare operating companies Premier Anesthesia and Jackson Surgical Assistants.

Hospital administrators at Emerson Hospital (MA) attribute the facility’s operation-margin gains and service-line upticks to an increase in outpatient services. Though IT upgrades in the mammography department have led to the need for fewer patient visits, referrals from other places for Emerson’s new, higher-quality mammographies have made up for the decline.

Healthcare IT firm Priority Consult acquires business intelligence and analytics software developer Balanced Insights to form Cordata Healthcare Innovations. The new company will use Balanced Insight’s technology as a starting point for a new generation of patient navigation and tracking applications. Priority Consult president and CEO Gary Winzenread will serve as Cordata’s president and CEO, while Balanced Insight founder and CEO Tom Hammergren will serve as CTO.

Population health and workflow technology company Acupera secures $4 million in financing from Lightspeed Venture Partners. It will use the Series A funding to scale its product development team and add to its customer implementation group.

People

Travis Crenshaw (United Surgical Partners International) joins Foundation Healthcare Inc. (OK) as CIO.

Announcements and Implementations

University of Colorado Health selects Zix Email Encryption to provide consolidated, secure email to 18,000 users across its system, which includes University of Colorado Hospital, Memorial Health System, and Poudre Valley Health System.

Allegheny Valley Hospital (PA) becomes the first in the state to equip its paramedic team with iPads. The pilot project has so far enabled AVH ER physicians to observe 12 patients on their way to the hospital. The hospital paramedic team will present the results of the project to the Pennsylvania Department of Health, which is considering rolling out similar programs across the state.

Providence Medical Center (KS) selects the GroupOne Health Source One Rate platform of medical billing and EHR implementation services for 40 of its providers. PMC will use the OneRate platform to facilitate integration of physician practices into its multi-specialty network across the greater Kansas City area.

UnityPoint-Allen Hospital and Black Hawk-Grundy Mental Health Center in Iowa announce they will begin electronically sharing patient records early next year.

St. Joseph Mercy Health System launches a telemedicine service from MDLive that provides real-time physician appointments 24 hours a day, seven days a week via video, phone, or app. Patients are connected with a SJMHS or MDLive physician who can offer treatment evaluation and advice, and e-prescriptions.

Halifax Regional (NC) launches the HalifaxHealthLink patient portal, which follows the successful rollout of the FollowMyHealth portal for patients of Roanoke Clinic, Roanoke Valley Internal Medicine, and Halifax Regional Cardiology.

The Willis-Knighton Physician Network (LA) selects InteliChart’s Enterprise Patient Portal to serve as a single portal solution for its system of network clinics. Physician Network Administrator Greg Gavin noted that “[a] vendor-neutral patient portal that provides a single source solution for our patients as well as a consistent brand across the entire Willis-Knighton System were top priorities in selecting a solution” to improve communication, coordinate care, and facilitate patient healthcare goals.

Government and Politics

ONC launches a website designed to collect feedback on its proposed interoperability roadmap. Stakeholders have until September 12 to provide their thoughts and comments, after which ONC will present aggregated feedback to the Federal Advisory Committee for its input and recommendations. An updated version of the roadmap will be posted for public comment early next year.

Research and Innovation

Creative England announces a £1m fund for small and medium enterprises in the North, Midlands, and Southwest regions designed to stimulate creative and digital innovation in UK healthcare. Four new programs will open as part of the fund. The first is the West Midlands Interactive Healthcare Fund, which will offer five £50,000 investments to support projects that focus on improving quality of care, caring for people with dementia, supporting people with long-term conditions, and data visualization. Applications will be assessed on a rolling basis and the fund will close on Oct. 31, 2014.

A new report finds that using a touchscreen EHR to support and monitor a national antiretroviral therapy program in Malawi faced challenges similar to that of EHR adoption in the U.S.:

• Implementing a point-of-care EHR has been more challenging than initially anticipated.
• The success of a POC system ultimately depends as much on a commitment from system users as on the technologies employed.
• Poor adherence to system use will result in incomplete data.
• Health workers will not adopt a system if they do not find sufficient value in it. Consequently, the primary challenge is to identify and address the value proposition for the user. This is an iterative process that requires a commitment to regular and ongoing dialog with the users if this paradigm shift to POC system use is to be sustainable.

Technology

Reports surface that Apple is in HealthKit development talks with providers at Mount Sinai, Johns Hopkins, and the Cleveland Clinic, as well as with Allscripts. Cleveland Clinic CIO William Morris says the clinical solutions team is experimenting with HealthKit’s beta and is providing feedback to Apple. Representatives from the other three organizations have not yet chimed in.

Simple Medical Software Inc. releases the SimpleRounds app to help providers better communicate and collaborate on patient care. Developed by SMS founder Rubén Zamorano and Manuel Martinez, MD the app features secure text messaging, billing manager, physician directory, rounds manager, patient census, and sign-out manager.

Other

The local paper highlights the new $1.3 billion Parkland Memorial Hospital, one of the first “digital hospitals” in the U.S. The hospital, set to open in May 2015, will feature $80 million worth of digital technology including touch-screen way finding kiosks, smart beds, baby tracking devices, and hand-held communication devices for nurses, as well as an integrated digital system controlling nearly every aspect of its operations. CIO Fernando Martinez points out the hospital will be similar to a smart home: “All the digital devices in a smart home can talk to each other because they’re connected to a common hub. That’s not unlike what we do, only we’re much bigger.”

Irish health service officials find that the number of patients waiting more than a year for hospital treatment surged 600 percent between December 2013 and May 2014. They have not formally addressed the spike, but have noted they are addressing the issue “in the face of significant financial challenges.”

Jersey City Medical Center (NJ) reveals that a computer disk containing 2011 Medicaid patient information was lost in June when a package sent via UPS failed to arrive. The unencrypted disk contained an undisclosed number of patients’ names, and many of their Social Security numbers and birth dates.

This article highlights the success of the Maryland Chesapeake Regional Information System for our Patients (CRISP) HIE, which has seen patient searches by providers jump from under 10,000 in late 2012 to nearly 55,000 as of last month.

Sponsor Updates

• Capsule discusses why timing is everything with vital signs.
• Rochester Regional Health Information Organization (NY) and HealtheConnections RHIO of Central New York are live on eHealth Technologies’ Image-Enabled Results Delivery.
• The Advisory Board Company offers its ready-to-present slides on the surgical services market trends for 2014.
• OhioHealth upgrades its Infor Cloverleaf solution to V6.0.
• Aventura client Hunterdon Healthcare System’s Greg Melitski will explain how they met their ED workflow challenges at the Optum Client Forum in Chicago, August 18-21.
• Streamline Health is participating in the Allscripts ACE 2014 Conference, which kicks off today.
• Wolters Kluwer ProVation offers a white paper entitled “ICD-10: The Gift of Time.”
• Black Book names Allscripts “Best of the Best” Ambulatory EHR vendor for interoperability.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Curbside Consult with Dr. Jayne 8/11/14

Several readers were in contact this week to share their stories of what is going right in healthcare IT as well as to sympathize with my experiences in the trenches. Others tried to guess the location of the lighthouse – no one has nailed it yet and I’m reluctant to give up my favorite beach just yet.

From Northern Lights: “I wanted to share what we are doing based on big data. Evidence has shown the outcomes are better if the mother carries the baby for at least 39 weeks. We’re working to reduce the number of elective births before 39 weeks to zero statewide! My little ‘ole community hospital captures the expected due date from the mother at the first maternity encounter. Then we programmed the scheduling system to not allow scheduling of elective inductions or C-sections before the 39-week threshold. Rocket science, I know, but our hospital hasn’t had elective early deliveries in over a year.” She went on to say that a couple of the providers were afraid this would cause problems with vacation schedules, but accepted it once they saw the evidence. These are the kinds of interventions we should be doing with big data. I appreciate your sharing it with me.

From The Other Jane: “I saw Mr. H’s post about OBs having to take down the photos of the babies they’ve delivered, even when the photos in questions have been provided by the babies’ mothers. It’s sad that HIPAA is so restrictive.” I agree – I hadn’t seen that article before I read the Monday Morning Update. Most of our OB offices still have a baby board, so I forwarded the article to a couple of my colleagues. I thought our compliance offers were uber-conservative, but they haven’t caught onto this one yet. I doubt they read HIStalk and I’m going to pretend that I didn’t see the article.

I forwarded it to a couple of friends out of state as well. One sent back a copy of the consent form they keep on the checkout desk for parents who want to drop off a picture. Another said they’re skirting under the premise of implied consent and the parents have to physically place the picture on the bulletin board. The article mentioned fertility clinics not wanting to “out” parents who used an egg donor. I’m guessing that parents in that situation might not be so apt to give their infertility specialist a picture to post in the first place if they have that concern.

As a family doc who had a solo practice in a small town, I had to get used to patients who didn’t care about showing off their problems in the supermarket checkout lane. Patient privacy took a back seat to impromptu consultations or the chance to avoid a co-payment.

My favorite privacy violation took place one year during the Founders’ Day parade, when I was riding on the hospital’s float. A patient’s wife called over the crowd to tell me how much better her husband’s hemorrhoids were doing. No one batted an eye or looked shocked, which tells you a little about life in a small town.

Over on HIStalk Connect, Dr. Travis has written a fair amount about mobile fitness trackers and applications to promote health and wellness. I have used Garmin devices to track my runs for nearly five years. Unfortunately, my current one’s specifications for being waterproof didn’t stand up to my recent beach activities. I tried to resuscitate the patient using a Tupperware container full of rice, a Ziplock bag with silica gel, and even prayer, but it could not be saved.

I only use a fraction of its capabilities and use the same routes all the time, so I thought I’d test drive using a regular sports watch and manually logging my activities on the GarminConnect website. Even though I had the same data points, there was something less satisfying than having all the details for each unique run. I hadn’t realized how much I had subconsciously bought into the concept of the quantified self until I could no longer track my activities.

I could have done an out-of-warranty replacement for my GPS, but I decided to instead go for something newer and smaller. The process of trying to find the “right” device was daunting to say the least. One of my vendor friends turned me on to the DC Rainmaker blog, which had some great device comparisons that ultimately helped me make up my mind. I’ve never used a Fitbit or any of the other activity trackers, but ended up selecting a running watch that also has those capabilities. It was actually the battery life that made me choose that device over a similar one, but I thought I might have fun with some of the other features.

I braved the back-to-school tax-free shopping madness and it’s on the charger for tomorrow morning. I can’t wait to wear it to work. The inactivity indicator tells you to MOVE when you’ve been sitting more than an hour. I think that feature might become an integral feature for Meeting Monday.

What do you use to track your activities or quantify yourself? Email me.

Email Dr. Jayne.

Morning Headlines 8/12/14

Nuance fourth-quarter forecast misses expectations

Nuance downwardly revises its Q4 earnings forecast to $500 million or $0.24 per share, well below analyst expectations of $0.34 per share, driving stock prices down 10 percent in after hours trading.

White House launches ‘U.S. Digital Service,’ with HealthCare.gov fixer at the helm

The White House launches a new program, the US Digital Service, that will recruit the “country’s brightest digital talent” to providing strategic guidance on major IT projects like Healthcare.gov and iEHR. The department will be run by Mikey Dickerson, the engineer credited with saving Healthcare.gov.

Lawsuit Filed After Doctor Diagnosed Homosexuality as "Chronic Condition"

A Los Angeles man is suing his primary care provider for documenting “homosexual behavior” as a chronic condition in his medical record, and for subsequently failing to remove it when a compliant was made. The practice was given a year to remove the entry, but reported in a court document that “due to the highly complex software used in creating an electronic medical record,” the code could not be completely removed.

Morning Headlines 8/11/14

Massachusetts will keep state-based health website

Massachusetts officials have announced that the state will move forward with a plan to rebuild its failed health insurance exchange, rather than migrating to the federal exchange.

Oracle Sues Oregon Over Health Insurance Exchange

After overseeing the development of the worst-performing health insurance exchange in the country, now-fired Oracle Corp. is suing the state of Oregon for $23 million plus interest that it claims it was owed but never paid.

Google Fit Preview SDK now available

Google unveils the developer kit for its recently announced health data aggregator service, Google Fit.

Monday Morning Update 8/11/14

Top News

Massachusetts will upgrade Massachusetts Health Connector instead of piggybacking on Healthcare.gov, officials decide. The state will replace fired contractor CGI, to which it has paid $52 million, and replace it with Optum. The struggling site has cost $108 million so far.

Reader Comments

From Chris: “Re: jaded by the industry. We vendors are jaded too because it is a very difficult industry to serve. Fat cat EMR vendors have stolen from hospitals for years for very little value or improved outcomes. Then ACA just dumps millions into the hands of the same vendors, starving those innovating and trying to change a culture from the ‘80s. We have to deal with absurdities like IE7 (and IE8, 9, 10, and 11) while we push boundaries with iPad. There is so much apathy and very little standardization and consistency from one hospital to the next. You have to laugh at the amount of money that’s being spent to convert to electronic medical records and protect privacy. Paper wasn’t so bad after all and it was certainly cheaper. Until human behavior changes and the FDA starts protecting our food supply, we’re just fooling ourselves about improving healthcare.”

From Sticky Clicky: “Re: Habersham Medical Center. Which EHR forced them to return their Meaningful Use payments due to lack of capability?” They’ve been running Meditech forever, I believe. The hospital spent $3 million on software upgrades and attested for Stage 1, but later found that “a statement we made to CMS that it would work was in error” so they returned the $1.5 million in incentive money.

From Equitable: “Re: a recent vendor raising debt funding. I’m guessing it’s because they failed to raise equity after hiring Blair to try. Investors were concerned about the viability of an e-prescribing vendor at this point in the market.”

From Certified: “Re: LabCorp. Nationwide systems down as of noon Friday. Radio silence from corporate. Why aren’t they at Starbucks informing customers by Gmail? They can afford elite collection agencies, but their IT systems are primitive.” Even LabCorp.com is down as I write this Saturday evening and their portal log-in page returns an internal server error. That’s some major downtime.

HIStalk Announcements and Requests

Two-thirds of poll respondents think the federal government should develop EHR interoperability standards and make them mandatory. New poll to your right (or here):  which EHR vendor is best positioned to support population health management?

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

Last Week’s Most Interesting News

• Cerner announces that it will acquire the healthcare IT business of Siemens for $1.3 billion in cash as Siemens finally unloads the business it bought in 2000 for $2 billion, making Cerner the biggest vendor in the industry in terms of revenue. Cerner’s interest is buying a captive audience for conversion to Millennium, incorporating patient data from the legacy systems of Siemens into a population health management system, and using R&D to blur the line between diagnostic and therapeutic equipment and IT systems in a post-EMR world.
• Six Wisconsin health systems announced their affiliation to manage populations and earn business, including sharing patient information from the Epic system used by all six to deliver care and manage patients across institutions.
• The annual EHR report by the Robert Wood Johnson Foundation finds that HITECH-incented hospitals and practices have rapidly implemented basic EHRs, but few are using them comprehensively and only a tiny percentage of users are ready for Meaningful Use Stage 2.
• HHS OIG released a report that said ONC’s certification program doesn’t focus enough security issues ,such as enforcing password complexity and managing user privileges.
• The State of Vermont ends its $83 million health insurance exchange contract with CGI, saying the site still isn’t fully functional.
• Allscripts announces Q2 results that meet analyst expectations.

Acquisitions, Funding, Business, and Stock

Voalte will open Voalte Labs, an independent research center, in its home town of Sarasota, FL. It will be run by Don Fletcher, PhD, the company’s chief scientist.

From the Allscripts earnings call:

• President and CEO Paul Black says the company will benefit “as clients look for solutions that are both interoperable and fully integrated, something Allscripts’ open platform is uniquely positioned to provide.”
• The company’s one Sunrise hospital sale in the quarter was to a 78-bed hospital.
• Black says the company’s new “fusion” technology will integrate parts of dbMotion, Sunrise, TouchWorks, and Pro.
• The company blames reduced revenue vs. 2013 on “a continued shift toward subscription software arrangements.”
• Maintenance revenue dropped as customers moved off MyWay.
• The company blames flat transaction revenue on Medfusion, which cancelled its agreement with Allscripts claiming it wasn’t getting paid and that Allscripts was urging its portal users to switch to Allscripts acquisition Jardogs, now called FollowMyHealth.
• The company is targeting Siemens customers now that its business will be acquired by Cerner.
• Allscript expects international business to double as a percentage of total revenue, from 5 percent to 10 percent.

The CEO of Siemens Healthcare, quoted in the announcement that it will sell its health IT business to Cerner, said:

We have continuously invested in our HS-portfolio and achieved significant progress on the technology side. At the same time, we realized that business success of our hospital information systems could not always keep pace with our competition. Additionally an increasing number of country-specific requirements, such as resulting from US healthcare reform, make it increasingly challenging to achieve sufficient scale effects. Going forward we will focus on the development of information systems that support our businesses in laboratory diagnostics as well as imaging and therapy.

People

Patient data monitoring app vendor Conversa Health appoints Peter Levin, PhD (US Department of Veterans Affairs) to its board.

Announcements and Implementations

Google announces availability of preview version of its Google Fit software development kit. It allows programmers to access a user’s fitness history as recorded on Android-powered apps and sensors. Google Fit is scheduled for a fall release.

Government and Politics 

Oracle sues the state of Oregon, claiming that the Cover Oregon health insurance exchange owes it $23 million for using its software. This follows the state’s announced intentions to sue Oracle for the $134 million it paid it to develop the site, which never went live because of problems. According to a state spokesperson, “The state fully expected to end up in litigation over Oracle’s failure to deliver." Oracle says the state failed to define system requirements, focused on the site’s appearance instead of its functionality, and failed to hire a systems integrator. Oracle adds that state officials went on a 60-day day retreat to define specifications but “returned empty-handed.” Legal experts say the state probably won’t win its lawsuit against Oracle because of the state’s weak contracting practices and the fact that its actual contract is with Dell, which paid Oracle time and materials as a subcontractor. Meanwhile, the state is planning to dump Cover Oregon and use Healthcare.gov after spending $250 million in federal taxpayer money on the failed website.

Innovation and Research

Here’s how surgeons use TedCas’s Microsoft Kinect-powered user interface in the OR.

Texas Health Resources / CVS MinuteClinic Affiliation

CVS Caremark and Texas Health Resources announced an affiliation three weeks ago to provide convenient primary care services such as medication counseling, chronic disease monitoring, and wellness programs at CVS/pharmacy stores and MinuteClinic locations. The organizations hope to keep people healthier and out of the hospital and ED. I spoke to Barbara Adams, VP of Innovative Technology Services for Texas Health Physicians Group / Texas Health Resources about the relationship.

She says the driver for THR was to increase its access points. She said, “We have 250 clinics in DFW. We wanted to be able to refer after-hours patients so they don’t have to go to the emergency room. Many of the THR ED patients don’t have primary care doctors.”

Minute Clinic is staffed by nurse practitioners. Texas law requires physician supervision in the form of a review of 10 percent of charts. CVS will pay THR’s physicians for providing that supervision. THR also may gain referrals if patients choose them from the list MinuteClinic provides.

CVS is using a homegrown EMR but is moving to Epic, which THPG already uses. For now, the organizations will exchange information using Surescripts. The NP can push a message into THPG’s Epic system and the organizations can exchange CCDs over the HISP. Once CVS goes live on Epic next year, message exchange will be directional using Epic’s Care Everywhere.

Other

TechCrunch profiles five-employee PicnicHealth, which offers a $39 per month personal health record that is populated from information the company obtains by performing manual records requests for a person’s encounters. The fee also includes ongoing digitization of new records, synching with patient portals, and unlimited records delivery to doctors. The company’s official address is a San Francisco apartment.

HIPAA worries are causing obstetricians to remove “baby boards” that feature photos of babies they’ve delivered from their office walls. An OCR representative confirms that the practice is illegal even if the family sends the picture for that purpose since “implied consent” doesn’t count.

A new regulation in India requires doctors to write prescription in all capital letters to avoid sloppy cursive handwriting that was causing medication errors.

A California pathologist is charged with embezzling $500,000 from the pathology company that promoted her to CFO, with one of her first accomplishments being to give herself a raise from $226,000 to $739,000.

Weird News Andy says this story involves a million-dollar typo. A family who purchased  health insurance through Nevada’s health insurance exchange finds themselves on the hook for $1.2 million in medical bills related to premature birth of their daughter because of an incorrectly entered date of birth. The state has already fired Nevada Health Link’s contractor Xerox, who says the only way to add a newborn is to cancel the family’s policy and start over.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 8/8/14

Allscripts announces second quarter 2014 results

Allscripts reports Q2 results: a nine percent increase in quarterly bookings drove revenue up two percent, to $354 million. Adjusted EPS EPS $0.09 vs. $0.05, meeting analyst expectations.

More Than Half of US Hospitals Have At Least A Basic EHR, But Stage 2 Criteria Remain Challenging For Most

A Health Affairs study finds that only 5.8 percent of hospitals are currently able to meet all of the MU Stage 2 criteria.

Walgreens stock smacked after tax inversion out

Walgreens acquires overseas pharmacy chain Alliance Boots in a move many assumed would be followed by a tax-dodging transfer of its headquarters out of country. Instead, Walgreens announced that it would keep its headquarters in the US, leading to a 14 percent drop in its stock price.

Health Information Technology in the United States: Progress and Challenges Ahead, 2014

RWJF publishes a report on the EHR incentive program and the state of EHR adoption across the US.

News 8/8/14

Top News

Six Wisconsin health systems that cover 90 percent of the state create a network to share resources, manage populations, and attract the business of employers, insurance companies, and individual insurance holders. All of the 44 hospitals owned by the unnamed network’s members use Epic and will share their Epic EHR information to manage populations and deliver care across facilities. The systems are Aspirus, Aurora, Bellin Health, Gundersen, ThedaCare, and UW Health. The board chair of the network says the members chose a virtual affiliation because working out the financial and administrative details of a merger would have taken too long.

Reader Comments

From Pink Slip: “Re: hospital IT department layoffs. Do  you agree that the number seems to be increasing, or am I just noticing the announcements more?” That’s a good question to pose to readers, who are welcome to provide their thoughts. I asked the Advisory Panel about layoffs recently and few reported any, so I’m skewing toward it being perception more than reality.

From Frazzled CIO: “Re: Cerner. Our hospital announced the same day of the Cerner-Siemens announcement that we’re in discussions to acquire another hospital. We’re Cerner and they are Siemens. The announcement may have sent me over the edge if I hadn’t already been alerted through HIStalk of the potential deal and pondered the potential impacts ahead of time. Awesome work and thank you.” I will pass those thanks along to the readers who alerted me months before it happened and then provided thoughtful analysis Tuesday when it was announced. The “analysis” run by other sites was generally lame and dull, showing a remarkable lack of insight in gravely pontificating that Cerner should keep Millennium as its showcase platform (were they seriously thinking that Cerner would be tempted to lead with Soarian?) or that Cerner paid too much (they bought the Siemens IT business at the fire sale price of one year’s revenue, most of it probably recurring since Siemens isn’t selling much, and those customers can’t bolt short term.) The financial risk to Cerner is low as long as they don’t let the Siemens mess distract them.

The Siemens business needed to be bought because they had trashed it in the 10 years they owned it, as is often the case when a big company jumps into healthcare IT because it seems like easy money and because it makes their executives fell Silicon Valley-ish. I will repeat my mantra: only three companies (Epic, Cerner, and Meditech, although CPSI might logically be included) are serious competitors in the hospital core systems market and all three (a) built most or all of their products on a single platform; (b) sell and support one core system; (c) rarely acquire companies; and (d) haven’t themselves been acquired. Cerner breaks what would have been my fifth rule since they aren’t privately held, and now that they are buying the Siemens business, they will violate my third rule as well and we’ll see how that goes. Siemens was waiting to fall – events of similar importance that may happen one of these days that would put the industry into a similar frenzy are (a) Judy Faulkner retires and hands off Epic to her successors; (b) the retirement-age owners of Meditech decide to sell it given lagging market performance and the chance to cash out at the top; (c) Allscripts throws in the Sunrise towel because of infrequent sales, poor ambulatory integration, and a missed DoD contract if that happens; and (d) DoD’s selection makes Cerner, Epic, or Allscripts a household word but threatens to suck the energy out of them with endless government bureaucracy and implementation challenges.  

From Brian Yeaman, MD: “Re: Cerner acquires Siemens. In my longstanding history with Cerner as a major client in interoperability and around HIE an population health for nearly a decade, we’ve seen Cerner commit and engage deeply around interoperability. We’ve had great success with Cerner native solutions as well as acquired solutions and their ability to support all platforms while integrating the best of both worlds regarding the front and and back end for HIE, Long Term Care, reporting, Direct and other EHR integration have empowered tremendous success in our efforts in Oklahoma. I’m very confident that this will be a big win for existing and new Cerner clients via Siemens alike. Cerner’s efforts to enhance interoperability and the entire care continuum and care regions like Coordinated Care Oklahoma just took a quantum leap, in my opinion, to the good.” Brian is chief administrative officer of Coordinated Care Oklahoma. I think it’s a good deal all around. Siemens was not that great of a vendor, hoarding its legacy system recurring revenue and pretending the world hadn’t changed since the swinging SMS 1980s. Its customers would have been faced with abandoning the company’s antiquated core systems at some point anyway since Siemens did little beyond half-heartedly dangling the unattractive Soarian bait in front of them with no bites. Cerner will force Siemens customers to finally make a long-term choice, hopefully soothing the pain of the ripped-off Band-Aid with attractive Millennium pricing and conversion assistance.

From Holly Mathews: “Re: Epic. Putting the health back in healthcare—that’s been a big initiative of mine at Epic for the past three years. It finally seems like preventative care is coming to the forefront of EMR attention or at least it’s slowly being pieced together. There is absolutely more emphasis on what folks are to doing to maintain a healthy lifestyle. To a new Epic customer today I responded, ‘Yes, we do integrate with Fitbit.’ There is a genuine desire to promote and manage not just the patients who are sick. I work at Epic as a project manager, but I also race bikes on a professional cycling team. Last week I won a stage at the Prairie State Cycling Series in Chicago. I thought it was pretty cool. 🙂 Epic will ultimately help drive the shift of medical practice paradigms to focus on and manage active lifestyle choices.” My favorite part of Epic is the youthful, idealistic enthusiasm of its mostly 20-something very smart employees with no pre-Epic healthcare experience who jump in with both feet, have fun, and work hard. My stock in trade is jaded, world-weary cynicism formed by many years of being ground down by clueless executives, dysfunctional vendors, and healthcare decisions made by everybody except patients and clinicians, so it’s fun to see new optimistic new blood who think they can change the world and who in fact just might, no matter who they work for.

From OGMD: “Re: Practice Fusion. Don’t even mention their name on HIStalk – cover them on HIStalk Practice. The only docs I know that use it are one-doc practices too cheap to purchase a best-of-breed EMR. They still use paper charts because Practice Fusion comes with no training and is not robust enough to go entirely paperless.”  

From LFI Masuka: “Re: patient portals. The government mandates them, but patients will go online when it’s convenient or necessary. Kaiser’s success didn’t come from government mandate – they have things set up where it’s a bigger hassle to not use the portal than to use it. Most healthcare organizations don’t have such comprehensive control of the patient experience. My PCP is on Centricity, my specialist in the same clinic is on paper, and the local hospital is on an old version of Meditech. There’s a rudimentary RHIO trying to aggregate everything. As a patient, what compelling reason do I have to use a portal on any of these systems? I might trend some vitals or use it more if I had emergent health issues, but that won’t push the mandated numbers. We are throwing millions of dollars at technology in search of a problem.”

From Curious and Curiouser: “Re: patient portal opt-in. People are building the field to plug into the CCD format, but not actually placing the question anywhere it can be answered, essentially making every patient opt-in. What is your readers’ experience with opting in/out of portals? Are they asking the question or just opting everybody in to meet their numbers? It bothers me that the patients’ wishes aren’t being taken into consideration.”

From The PACS Designer: “Re: Apple. Reports suggest that the iPhone 6 could be announced on September 9.” 

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Andy rants about the review of systems and checklist solutions. Telemedicine’s future in small practices comes into question. Big-box retailers continue to encroach on the business of primary care. Patients go the Priceline route for non-emergency care. Over 100 medical groups call for delay of the Open Payments system. Physician and EP Stage 2 MU attestations continue to underwhelm. Mark Gettleman, MD leaves brick and mortar for mobile and online at Goofy Gettwell Pediatrics.

This week on HIStalk Connect: Dr. Travis discusses the overlooked direct primary care segment of digital health and why he’s excited to see what new technologies it spawns. The FDA publishes draft guidance reducing its regulatory oversight on a large segment of Class I and II medical devices. Doctors On Demand raises a $21 million Series A to expand its national telehealth platform. Researchers at the Medical College of Wisconsin link text message-based reminders with improved preoperative instruction adherence. 

I almost never look at HIStalk readership stats, but May always starts the summer slowdown that runs through September. Surprisingly, the numbers jumped sharply up this past May despite mostly routine news and the rise has continued through June and July to record levels. Tuesday’s Cerner-Siemens announcement drove record single-day traffic with 10,600 visits from 7,800 unique people – I run HIStalk on a high-powered dedicated, rack-mounted server (geek alert: Xeon E3 four-core CPU, dual 7,200 RPM primary disks, 120GB SSD for MySQL databases, 16GB DDR3 memory, CentOS 64-bit Linux) and the page still took forever to load on Tuesday afternoon when the site was slammed. Visits in the past 30 days exceeded 150,000 and the number of unique people reading is 38,000, more than double the July 2013 total. I get an amazing amount of support from readers, sponsors, and contributors and I’m glad to see the numbers reflect that.

Listening: new from Mary Lambert, an eloquent and empowering 25-year-old Seattle singer-songwriter with a heartbreaking history of sexual abuse, body image problems, and bipolar disorder whose dark and emotional live performances often elicit tears from her audience. Lyrics: “Girls like us are hardly ever wanted, you know. We’re used up and we’re sad and drunk and perpetually waiting by the phone for someone to pick up and tell us that we did good. Well, you did good. I know I am because I said I am. My body is home.” If that’s not your thing, the new Godsmack rocks – my hand is tired but happy from desk-drumming.

Acquisitions, Funding, Business, and Stock

Allscripts announces Q2 results: revenue up 2 percent, adjusted EPS $0.09 vs. $0.05, meeting analyst expectations for both.

Practice Fusion acquires Ringadoc, which it calls a “telemedicine platform” and “next generation patient-doctor communication tools” vs. Ringadoc’s self-description as “medical answering service software.” The appeal to Practice Fusion — other than the fact that its CEO is an investor and mentor to the now-acquired company — is that Ringadoc is testing a doctor consultation service for consumers, although it seems to be phone-based rather than online.

The private equity firm that has owned healthcare product research vendor MD Buyline since 2011 sells the company to contract management solutions vendor TractManager.

Valence Health says its first-half revenues are up 51 percent year over year and it has added 10 clients so far in 2014. Headcount has risen 150 percent in three years to 470 and the company just leased 125,000 square feet of new office space in Chicago.

Walgreens announces that it will spend $15 billion to complete its acquisition of a European pharmacy and beauty company, but will surprisingly decline the resulting opportunity to declare its headquarters offshore to save a fortune in US taxes because of expected protracted IRS challenges and consumer backlash. The stock market’s reaction: shares dropped 14 percent. Meanwhile, the CIO of Walgreens hopes to leverage IT to meet the company’s goal of cutting operating expenses by $1 billion annually as it expects annual revenue to jump to $130 billion in the next two years.

Doctor on Demand, which offers $40 video visits, raises $21 million in a Series A round, with Sir Richard Branson as one of its investors. The company is recruiting doctors to staff its service, touting flexible shifts, $200K income for full-time work, no overhead, malpractice coverage, the ability to work from anywhere with Internet access, and easy-to-use paperless technology that is “more like applications they use personally than traditional medical software.” Sounds like the job-frustrated Dr. Jayne should work some shifts and report back.

Optum-owned QSSI, which was called in to save Healthcare.gov, will be the lead office tenant at a new Columbia, MD downtown office project scheduled for completion in July 2016.

CoverMyMeds will lease 64,000 square feet of office space in Columbus, OH to handle its expected growth from 70 to 180 employees in the next few years.

DrFirst secures $10 million in debt financing, which it will use to expand its development resources and prepare for international expansion.

People

Peter Csapo (VHA Inc. and McKesson before that) joins Accretive Health as SVP/CFO as the struggling company prepares to restate its financials.

CompuGroup Medical US promotes Werner Rodorff as CEO/SVP, replacing Norbert Fischl.

Announcements and Implementations

MModal joins athenahealth’s More Disruption Please program, adding its Fluency Direct and Fluency Flex mobile solutions to the MDP Marketplace.

Medicity and athenahealth will improve interoperability between their systems.

T-System donates T Sheets to QuestCare Clinic, a Dallas-area non-profit urgent care clinic. It is operated in partnership with Watermark Community Church and sees patients without requiring ID, insurance, or appointment, asking only for a $10 donation.

Children’s National Health System (DC) goes live on MedAptus’ dual-code ICD-10 solution for 600 physicians and 400 nurses.

Government and Politics

A VA hospital social worker and union president who claimed in May that her hospital was keeping secret patient waiting lists says the hospital harassed her after she met with a White House representative in July by taking her desktop PC away for a week to encrypt it.

A review of 2013 AHA hospital survey data finds that only six percent of hospitals met Meaningful Use Stage 2 criteria. The actual number is probably even lower because the authors looked only at EHR capabilities, not actual usage in tricky areas such as sending summaries of care and allowing patients to access their own information. The study also did not take into account where hospitals stood with regard to 2014 Edition criteria.

Other

A former Epic employee posts details of the company’s “cryptic raise/bonus black box,” explaining that the normalized results from ranking each employee against co-workers in the same role are sent to the compensation team that assigns raises. This person was hired right out of college at $60K and earned bonuses of $16K and year-end raises of 18 percent and 10 percent. The annual salary of the employee, who was probably 24 when he or she left Epic two years later, was $84K. 

Can Sanjay Gupta, MD please get back to his medical practice and ask CNN to return to its regularly scheduled programming of cute cat videos and celebrity gossip?

An internist writes in a NEJM article what it’s like coordinating the ambulatory care of a newly diagnosed cancer patient. In the 80 days from the time the internist told the patient about a liver mass until the day it was removed, the patient saw 11 other clinicians, had 11 office visits other than with the internist, and underwent five procedures. The internist communicated with those other clinicians via 32 emails and eight telephone calls, adding another 12 calls with the patient or the patient’s wife. He concludes that such coordination is essential for patient safety, but is difficult since it involves distributed teams of people who don’t know each other and the healthcare system was not designed to support collaboration. The internist was modest enough to not point out that neither he nor his employer (Weill Cornell Medical Center) were paid a penny for all of his efforts.

The annual Robert Wood Johnson Foundation report on EHRs finds that:

• Two-thirds of hospitals have received HITECH money, but few of them can meet Meaningful Use Stage 2 criteria.
• 59 percent of hospitals are using at least a basic EHR, quadruple the percentage of just four years ago, but only 26 percent have a comprehensive EHR and that number has increased only 3.6 percent since 2010.
• Of the physician practices that received a Medicare EHR incentive check in 2011, 12 percent didn’t get one in 2012.
• Of the physician practices earned a Medicaid EHR incentive payment in 2011, 61 percent did not in 2012.
• The only hospitals that fell on the wrong side of the “digital divide” are critical access and small rural hospitals.
• Health information exchange is still in its infancy, with barriers being privacy and security, competition concerns, and lack of physician demand.
• Most hospitals use their EHR to create organizational performance dashboards, but only about half use them to identify care gaps and allow doctors to query their data directly. The key barrier is lack of EHR dashboard and query functionality.

Weird News Andy speculates that patent trolls are getting bolder given this newly issued patent for this innovative process: (a) a patient calls a doctor’s office; (b) the receptionist records their information and asks the doctor if they want to talk to the patient; (c) if so, the receptionist calls the patient back, transfers the call to the doctor, and adds the recording of the call to the patient’s file. The article points out the infamous MMRGlobal/MyMedicalRecords, which sent threatening letters to practices who dared speak to their patients by telephone without paying it a license fee.

Sponsor Updates

• Aperek posts highlights of its attendance at the AHRMM conference.
• Blanchard Valley Health System extends its Wellcentive PHM initiative by instituting a Nurse Care Navigation program that nets significant ROI.
• Boston Software Systems publishes a white paper on avoiding five myths of EHR migration and eliminating the chaos.
• MEA|NEA uses the importance of a good website as an example of the importance of technology to growing a business in a recent blog post.
• PerfectServe posts an article titled “The Changing Role of the Physician.”
• Aprima kicks off its user conference in Dallas.
• ADP AdvancedMD spotlights three smaller private practices using its cloud solution to stay clinically and fiscally efficient.
• Kareo suggests six steps to take in hiring the right staff for a medical practice.
• NextGen Healthcare announces a new name for its November user group meeting, NextGen One.
• Premier Health (OH) discusses how it solved the challenges and complexities of payer pre-certification by deploying Passport Health’s OrderRite.
• SRSsoft will participate in the American Society for Surgery of the Hand conference September 18-20 in Boston.
• Allscripts shares what “Open” means for healthcare and why it’s so important.
• IHT2 offers an infographic, “Analytics: The Nervous System of IT-Enabled Healthcare.”
• Susan Niemeier questions whether the new cool thing is always the smart choice when it comes to technology on Capsule’s blog.

EPtalk by Dr. Jayne

Of course the big news around the IT corridors today was the announcement of Cerner’s purchase of the Siemens Healthcare IT business. We are using solutions from both parties in at least some fashion. I’m not going to say exactly which ones (or respond to a reader comment asking specifically what systems I use) because I’d like to keep my day job. Let’s just say we have multiple hospitals that we’ve acquired over time and thus have a variety of systems in play.

We’re consolidating, which made the announcement more interesting although it’s not clear at this point how the marriage will impact us. If we decide to chuck everything and move to a different vendor entirely (always possible, but I’m not sure we can scrape up that much cash) it might be a moot point. Unfortunately, so many of our users have grown accustomed leveraging multiple systems to get the work done that the idea of a single vendor isn’t as sexy as it once was.

There was exactly zero discussion of the merger in the physician lounge, which didn’t surprise me. Unless they have stock in a given vendor or were involved in a selection process, some of our providers are oblivious to what system they’re actually using. We’re one of those cutesy organizations that gives every system an acronym used in a branding campaign to assist with user buy-in. I once had a user tell an auditor that our vendor was “SMILE” because we had used that acronym for a go-live.

Coupled with the fact that some of our systems are from vendors that acquired other products that we already owned and morphed them into a suite of quasi-connected pieces under a single name, it’s a wonder we can keep track of everything that’s in place.

For those users who do care that we use multiple systems, one benefit of consolidating our vendors would be a more consistent user experience. We already do a fairly good job of interfacing the data from system to system so that users don’t have to duplicate data entry, but it would be nice to have a more uniform look and feel. I’ve been through several product demos as part of the consolidation effort and have to say that even among vendors purporting to be single system, the look and feel can vary dramatically depending on whether they purchased components or built the system from scratch.

In the same set of comments, Brian Too asked how physicians want technology to reconcile the “tactical” needs of point of care IT support with the “strategic” needs of population health and statistical capabilities. “How do you make the physician interactions with an EMR low-friction while still gathering enough information, of sufficient quality, to support the strategic imperatives?” The answer is a difficult one. The key is in finding an easy way to enter discrete data that physicians don’t perceive as “clicky” or overwhelming.

I’m personally holding out hope for voice-to-data in which narrative can be parsed to identify discrete elements. Physician notes could appear like the dictations they’re accustomed to, but the data could sit underneath, ready for the picking. Technologies are getting closer and closer, but we’re still not to the point where we can pull it off in the way physicians expect.

Even with the slickest user interface, most of our providers still perceive data entry as being something they shouldn’t have to do (even though they did it in the paper world, only with a pen). I think it’s a factor of the volume of data they have to enter now compared to the pre-MU, pre-ACO era.

He also asks: “How much of current physician griping is more about having lost a certain amount of workplace control versus serious mismatches between software capabilities and real workflow needs?” Particularly among ambulatory physicians (and especially among those whose practices have been acquired by a hospital or health system) loss of autonomy may be the majority of the problem. Many organizations do not do a great job with the change management piece of the EHR transition. I see them doing a similarly bad job in transitioning purchased practices from independent to employed models, especially when the organization desires to standardize workflows or centralize certain practice functions.

When we hire new physicians coming out of training, I don’t hear anywhere near the level of complaining that we do when we acquire practices. Most new physicians have used EHRs during training and they’re used to the limitations, so whether they’re using one system or another it doesn’t seem to be as much of a big deal. You’d think we get more complaining from our most tenured physicians, but we actually don’t. The most vocal and unhappy of our providers are in the 45- to 55-year-old range. They’re generally proficient users, but they also have the highest expectations for what the system should be able to do and don’t like it when it doesn’t deliver.

At this point my perspective is so warped, I’m not sure what an ideal EHR would look like. For more and more physicians, the ideal EHR looks like a scribe.

What is in your ideal EHR? Email me.

Contacts

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

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