Morning Headlines 8/7/14

Practice Fusion buys startup Ringadoc in telemedicine play

Practice Fusion acquires Ringadoc, an after-hours call routing system that it says will play a vital role in its plans to roll out a full telehealth platform for its customers. Financial terms were not disclosed.

ONC lays down 10-year interoperability plan milestones

ONC interoperability manager Erica Galvez outlines details from the office’s 10-year interoperability plan during Wednesday’s HIT Policy Committee meeting.

M*Modal Partners with athenahealth to Empower Physicians with Speech-Based Clinical Documentation

MModal joins athenahealth’s More Disruption Please program, bringing natural language processing functionality to athenahealth’s customer base.

UW Health, five other providers enter statewide partnership

In Wisconsin, six health systems representing 44 hospitals, all of which run Epic, have created a state-wide partnership that will share emerging best practices around IT, research, care management, and patient experience. The new partnership is also launching its own insurance plan backed by Anthem Blue Cross Blue Shield’s Blue Priority network.

Readers Write: Make It Happen

Make It Happen
By Mike Carr

I’ve been in healthcare IT for more than 25 years. While I’ve known and appreciated the impact we have on people’s lives, I had a recent personal experience that made me see the impact of what we do firsthand and reminded me of why we do what we do.

Unfortunately, my mom suffered a severe stroke in June from which she never recovered.  I was at the hospital with her for almost six days.  During that time, I got to know the nursing staff, therapists, neurologists, and palliative care team pretty well. This was an amazing team of healthcare providers and the best I’ve seen in all my years in healthcare – every one of them. They all treated my mom like she was part of their family. 

The entire palliative care team took the time to meet with our family to explain that my mom probably wouldn’t recover and the options we had. Almost everyone, including the chief neurologist, had tears in their eyes. This amazing group of people really cares about their patients.

During my mom’s remaining time in the hospital, all of her medical information, including any significant changes in her condition, was available to me whenever I asked. The EHR, PACS, etc. was all at her bedside. 

On one occasion, when I requested that she get additional pain medication beyond the standing order, the nurse immediately entered the request into the system. The doctor approved it and entered the order from his mobile device and my mom had her medication from the medication cart in about five minutes. To make that possible, someone understood the importance of a patient getting pain medication quickly, reviewed the relevant processes, integrated those systems, developed the workflows, and implemented the technology to make it all happen. 

I think it’s important, on a daily basis, to keep in mind why we do what we do and our role in making it happen. The medication order example is just one small example of how we can help improve patient care, but it made a huge difference for my mom at the time. The recent experience my family and I had with this amazing group of healthcare providers and their ability to effectively use technology to make decisions and treat patients made a very difficult time a little easier.

Shortly after my mom passed away, someone sent me this. I think these are pretty good words to live by.  

– Regina Brett

The one thing I would add: and make it happen. By understanding the importance of what we do and its impact on patients and clinicians, we can take the steps to review the processes, integrate the systems, develop the optimal workflows, and implement the technology to make it all happen.

Mike Carr is director at Aspen Advisors of Pittsburgh, PA.

Readers Write: How to Actually Get Patients to Engage with a Portal

How to Actually Get Patients to Engage with a Portal
By Zach Watson

From increased interoperability requirements to percentage benchmarks for online patient usage of digital assets, Meaningful Use Stage 2 has several requirements that are making eligible professionals sweat. Let’s address the latter of the two.

From a high-level view, getting more than five percent of patients to download, transmit, or view health information online should be low-hanging fruit. But as the Mayo Clinic famously found out, simply creating this type of functionality doesn’t guarantee engagement. Of a reported 240,000 patients who signed up for portal accounts, less than 12,000 had actually logged in 2013. In contrast, Nashville’s own Vanderbilt experienced significant success with getting patients to interact with their portal. During 2012, they reported 193,969 unique logins.

And for truly outrageous engagement numbers, one need look no further than Kaiser Permanente. A reported 4.4 million of Kaiser’s 9.1 million members use the online portal.

Meeting Stage 2 engagement requirements is doable. The disconnect arises from providers simply implementing technology without truly integrating it. Online portal access should be introduced in the context of the patient-physician relationship, not as an extra feature that patients can access should the compulsion strike.

Here are three actionable methods for crossing the five percent chasm:

1. Get a mobile app. It’s well known that electronic health record functionality varies by product, so it’s natural that patient portal capabilities will too. Part of granting patients greater access to their medical records lies in the intuitiveness with which they can retrieve said information. If they are asked to type in a username and password from the web browser on their phone, it’s unlikely they’ll go through the trouble. Mobile applications are becoming standard across all business verticals because they are formatted for ease of use. If a patient portal doesn’t come with a mobile app for patients to download, the physician implementing it should demand one. Kaiser launched their mobile app in 2012. Patients downloaded it over 450,000 times last year.
2. Do a walk-through. Patient satisfaction is inherently tied to interaction with the physician or other clinician. To create an environment in which patients will be receptive to new information, have a knowledgeable staff member walk patients through how to login and use the portal. Explain the benefits of scheduling appointments and refilling prescriptions online. Perhaps even have the patients navigate the portal for 60 seconds or so to make sure they’re comfortable finding all the information. Will this affect clinic time? Yes. Will it help meet Stage 2 criteria? Absolutely.
3. Create some marketing. It doesn’t have to be anything too spectacular, but some signs in the waiting room detailing the benefits of patient portals can certainly spark some interest from patients who are waiting.

This type of online access isn’t unexplored territory. Patients already enjoy this freedom with their bank accounts, credit reports, and so on. They want to be able to schedule appointments online. Make sure they know that they can.

Who knows, maybe they’ll download the app while they’re in the waiting room.

The key is to embrace patient portals – and other information technology for that matter – as a foundational element to the way healthcare works going forward. It’s already a reality. Patients simply need to be shown how easy it is to use.

Zach Watson is an analyst at TechnologyAdvice of Brentwood, TN.

Readers Write: Why Payers Are Seeking More Consumer “Likes”

Why Payers Are Seeking More Consumer “Likes”
By Scott Rotermund

It’s no secret that payers are not well liked among consumers. In fact, recent data shows that only seven percent of consumers trust their health plan, only slightly better than the likes of oil and tobacco companies.

Additionally — and maybe even more importantly — when looking for health advice, only 18 percent of consumers turn to their health plan, which is startlingly close to employers at 12 percent. With a reputation for being stuck in concrete towers locked away from the real world, health insurance companies are increasingly working to connect with consumers and up their likability.

In their defense, health insurance companies earned a sour reputation of being the evil ogre denying claims because of how the market defined their role. It was a check and balance in the clinical system of physicians prescribing care and health plans assessing the value of it.

Now, with the rollout of Obamacare — be it good or bad — the payer’s role has changed along with its business model. Health plans are looking at the entirety of their populations rather than those seeking treatment. That is going from the 15 percent of its population that is in the “sickcare” system at any given time to 100 percent of the population, a startling and overwhelming change.

This shift is driven by the moral and economical desire to 1) prevent people from sliding into the sickcare system by keeping them healthy, and 2) build brand loyalty to retain low risk members. Retention is a primary focus for health insurance organizations, as the health insurance industry is now similar to the car insurance industry. People can shop around and receive premium reductions for good health just as they do for good driving. Innovating and transforming the customer experience is more important than ever as consumers are empowered to choose the payer of their choice.

How does an entire industry change its reputation from being the school principal to class president? It starts by building an emotional connection and providing something that genuinely impacts their life. It’s not passing out free one-size-fits-all t-shirts, but connecting with consumers on an individual level and getting them to take action.

Playing a more active role in optimizing consumers’ health is a huge leap for payers and inherently may not be immediately welcomed by consumers. Here are some down and dirty tips for health plans looking to become the cool kids in healthcare:

• You can’t appease the masses. Take a personalized approach to supporting consumers in achieving their health and wellness goals. Similar to what we are seeing in the clinical setting with personalized medicine, personalized healthcare will have a greater impact and results. This is challenging when you managing a population of millions, which leads into the next tip.
• If it works … partner with it. Some national plans have allocated millions into wellness and prevention programs and have not seen significant uptake. Take a card from cross industry collaborations like Apple and Mercedes and forge partnerships with companies that already have the asset or relationship you are looking to build. Companies that have a consumer mindset and can deliver an experience that may be outside a health plans’ expertise. Today’s on-demand, multi-mobile consumer expects to have a solution that speaks directly to them, about them. By leveraging a health optimization platform to deploy a personalized, interactive experience, payers have an effective and efficient way to support consumers in improving their health. Plus, a true integration platform will allow payers to plug in existing programs such as video health coaches or other digital resources so those investments to date pay off too.
• Provide optimal rewards for optimal health. While one may assume that it’s human nature to take care of yourself, its been proven that incentivizing consumers for healthier behaviors pays off for everyone. In a recent survey, 96 percent of consumers said they would be healthier if rewarded. From premium reductions to badges, incentive-based tools can be the extra motivation consumers need to make a healthy choice or address chronic decisions. Payers can build a more “rewarding” relationship with consumers by celebrating both participation and outcomes with their members.

These activities are helping payers power up their relationship and the health of their population. Consumers will soon view their insurers as health advocates guiding them through an increasingly complicated healthcare system and toward a healthier way of life. 

Scott Rotermund is co-founder and chief growth officer of Welltok of Denver, CO.

Morning Headlines 8/6/14

Cerner to Acquire Siemens Health Services for $1.3 Billion

Cerner announces that it will acquire the health IT division of Siemens for $1.3 billion, confirming rumors that have been circulating since late April.

Premier, Inc. continues growth trajectory with acquisition of Hospira’s TheraDoc

Premier announces that it will acquire TheraDoc, Hospira’s clinical surveillance business, for $117 million in cash. Hospira acquired the business themselves in 2009 for an undisclosed sum.

MModal Completes Financial Restructuring, Emerges from Chapter 11

After nearly five months, MModal officially emerges from Chapter 11 bankruptcy, reducing its debt by 55 percent in the process.

New California Not-for-Profit to Operate Statewide, Next-Generation Health Information Exchange

California will launch a state-wide HIE, founded through $80 million in seed funding from Blue Shield of California and Anthem Blue Cross. The funding will sustain the exchange for its first three years of operations, after which it will charge subscription fees to providers and insurers to fund continued operations.

News 8/6/14

Top News

Cerner announces its intention to acquire the assets of Siemens’ health information technology business, Siemens Health Services, for $1.3 billion in cash. Cerner Chairman and CEO Neal Patterson told HIStalk that “the broad driver is the post-Meaningful Use era” and the large R&D budgets of both companies. The combined organizations will have 20,000 employees, 18,000 client facilities, and $4.5 billion in annual revenue. Cerner expects the transaction to close in Q1 2015.

Lorre took notes during the announcement call:

• The Siemens customer attrition rate has been improving. Cerner will give them a clear path to a stable future and help get them there. Some percentage of those customers would have ended up with Cerner anyway.
• When asked why the Siemens business is worth acquiring now when it was shopped previously with no takers, Cerner EVP/CFO Marc Naughton implied that Siemens cut the price and was waiting for a strategic buyer that wouldn’t leave its customers hanging.
• Two Cerner executives will join the leadership team of Siemens. Only the client experience and administrative functions will be combined in the short term.
• Siemens has had flat revenue for a couple of years and Cerner will boost that. Siemens has invested a lot of overhead in an unnamed project that didn’t accomplish anything – it will be cut immediately.
• Neal Patterson, asked why this acquisition will work when so many other large ones haven’t, said Siemens knows what it’s doing and can expand, especially in population health management, specifically with regard to interoperability and openness.
• International support will be evaluated country by country.
• Asked why he was suddenly open to an acquisition, Neal said that IT is now ubiquitous and government incentive money is running out. IT will be pressured to meet mandates and provide measures. Cerner will evolve to population health and become a bigger part of the new middle. Cerner is building the most integrated EHR with integrated revenue cycle. Neal said he didn’t have a lot of enthusiasm about the transaction initially, but he went back to the two questions (would it slow Cerner down and can Cerner win over Siemens customers).
• Neal said much of the industry’s healthcare IT talent comes from Cerner, so they have resources to draw from.
• Neal said Siemens is a good asset with great talent at a fair price. They are passionate about innovation.

Reader Comments

From Anon: “Re: Siemens. I read that the company is the largest application hosting vendor in healthcare. Any truth to that? It might add credence to Cerner’s bid.” I wouldn’t be surprised since they’ve been running remote hosting (or is that “offering cloud-based SaaS solutions?”) since the timesharing 1970s. That would provide a guaranteed revenue stream, at least until clients move off those legacy platforms, the pace of which might well be accelerated by the change of ownership.

From Black-Scholes Supermodel: “Re: Cerner acquiring Siemens. If that happens, I will take you to the biggest steak dinner ever at Gibson’s at HIMSS, wear a pink tutu, and dance on the table until I get thrown out.” That’s from a July 23 email to me from a very good equities analyst joking about my running the improbable Cerner-Siemens rumor yet again on HIStalk (going back into May). Now that I have both dinner and entertainment to look forward to at HIMSS, I’ll share the analyst’s logic: (a) Cerner says they don’t need to buy market share because their products are good enough on their own; (b) Cerner  integrates everything except a few ancillary plug-ins and doesn’t want more product lines; (c) Cerner already has ample opportunity in the rip-and-replace market, which it estimates at 2,000 customers, so it doesn’t need a fast track into the Siemens legacy business. The analyst concludes that Cerner buying the old SMS means that Cerner’s growth is stagnating and it needed to ignore its long-held principles to feed the beast.

From HIS Junkie: “Re: Cerner acquiring Siemens. Looks like the John G magic could not work. He gave it a good try, but this was a sinking ship for over a decade. Let’s see, Siemens bought it for about $2 billion, gets 1.3 back … that’s only about $100 million per year loss! ..and it’s a great opportunity for Epic. Adds another 500 or so prospective clients to the mix.” Siemens destroyed quite a bit of corporate value, not to mention it paid way too much for SMS in the first place back in 2000, a 73 percent premium over SMS’s share price at the time. The division’s annual revenue today is the same as it was in 2000 and Siemens was anxious to unload the company for just 1x revenue.

From HealthITPundit: “Re: Cerner acquiring Siemens. So Judy Faulkner got Neal to bite! It was her plan all along that if Cerner bit more thank it could handle, Epic would be the last vendor standing. This will be an interesting corporate integration as any in this space. If Cerner is successful, they bought their market share. If they crash and burn, Judy is a genius. All the other verboseness about the win-win-win is a diversion from the truth. It’s all about stopping Siemens clients jumping to Epic. Gosh, I wish I thought of it!” That’s a solid observation. Cerner gains inside access to a large contingent of prospects who are sitting on primitive platforms. Cerner will be whispering “Millennium” in a soft and sexy voice while Epic bangs on the outside door. They won’t all go Cerner and some of the existing recurring revenue they contribute is already built into the $1.3 billion acquisition price, but they should be less-expensive customers to get onto Millennium and some of them are outside the traditional big-hospital demographic of both Cerner and Epic, plus both Cerner and Siemens offer hosting and operational support that is Epic’s weak point. 

From Dave Lancaster: “Re: Cerner acquiring Siemens. What impact might this have on smaller systems where both companies have competing products, such as their integration engines (Cerner OPENEngine vs. Siemens OPENLink)? Soarian and Siemens Rx et al. have some form of OPENLink embedded in them as their messaging services applications.”

From Kermit: “Re: Cerner acquiring Siemens. Nice HIStalk shout-out on this story.” That was nice – a few sites get their ideas from HIStalk and virtually none of them admit it, so thanks to Forbes.

From Old Malvernian: “Re: Cerner acquiring Siemens. Who do you think will be laid off beyond those from last month? John Glaser will probably get a big payday, as did Marv when he closed the Siemens deal in 2000. The other top execs will get an easy letdown, as most contracts have a nice acquisition clause. The Germans will be repatriated and employed. Those left hold the flaming bag of poo will be the H1B staff, offshore contractors, and worldwide rank and file. Siemens is the third largest employer in Chester County, PA. I wonder what the revised ranking will be?” Corporate support departments are sure to take a quick and painful hit: HR, marketing, and finance. The technologists and support people should be OK until product decisions are made. Those working in the hosting group should be in great shape. Sales could go either way – the company doesn’t seem to be selling much, so it’s tough to make an argument to spare sales from a shakeup. Every acquiring company says “business as usual” while drawing up long lists of those to be executed.

From Himster: “Re: MModal COO Ronald Scarboro. Word on the street is that he has resigned effective immediately. No official statement from the company.” MModal verifies that Ron has left the company.

From SQSUX: “Re: Sunquest. I’ve heard that more tenured folks are out the door. VP of HR is out and global client relationship manager has resigned.” Verified.

Vince Ciotti told me in late April that he was hearing rumblings about Cerner acquiring the health IT business of Siemens. He apologized for being wrong when it didn’t happen the following week, then emailed later to say he was hearing it again. I thought he might be right, so I saved this piece he sent me a couple of weeks ago so he could get the appropriate recognition when it happened.

Cermens? Siener??
By Vince Ciotti

Now that Siemens has officially announced that their HIT division is up for sale, the rumor about Cerner being a potential buyer becomes more interesting. The potential deal represents a huge shake-up in the HIS industry. Below are a few implications of what this deal could mean to the many parties involved.

Cerner

• ProFit. After the $106M settlement with Trinity Medical Center in North Dakota at the end of last year, Cerner might have started looking for a replacement for its ProFit patient accounting system. When Siemens put its HIT division on the market, Soarian’s revenue cycle system must have seemed like a dream come true. Soarian’s clinicals still face several challenges (e.g. in the EDIS and ambulatory EHR arenas), but the revenue cycle module is relatively complete and working reasonably well, so for Cerner, the billion euro ($1.4B) price tag Siemens is asking might be reasonable in light of potential future litigation.
• Data center. To its credit, Cerner has built two large data centers in Kansas City, many miles apart, which gives them reasonable protection against Midwest tornados. However, students of history might remember the New Madrid earthquake of 1812 that literally shook the whole state of Missouri. There was no Richter scale then, but scientists estimate it was between 7-8 points, and a re-occurrence today would cause unimaginable damage throughout the region. Acquiring Siemens’ super-modern data center in a different seismic zone would give Cerner the best backup protection of any US remote hosting vendor.
• Sales team. Between them, Cerner and Siemens have the two best sales and marketing organizations in the industry. Both firms have grown to over a billion dollars in annual revenue thanks not only to their powerful new sales teams, but equally potent “account executives” who manage clients after the sale and sell new modules and systems, implementation assistance, consulting (totally objective, of course…), outsourcing, etc. These two combined teams would be able to sell screen doors on submarines, let alone HIS systems and services.
• #1 vendor in revenue. We have been tracing the top HIS vendors’ annual revenue for many years for several leading HIS journals, and by our calculations, adding Cerner’s $2.9B in 2013 revenue to Siemens’ ≈$1.4B (what they’re asking for their IT division is probably about equal to its annual revenue) would create a $4.2B giant, a billion dollars larger than current industry leader McKesson. The merger would put Epic in third place, at “only” $1.7B

Siemens Clients

• Soarian clients. One could imagine an interesting face-off between Millennium HNA and Soarian Clinicals at new prospects, but HIS-tory tells us that Cerner will probably stick to its Millennium HNA core system for future hospital sales, building an “integrated” interface to Soarian Revenue Cycle. What the deal means for Soarian clinical clients is an interesting question – Cerner would eventually try to convert them to Millennium, probably as individual contracts (from 10-12 years in duration) come up for renewal.
• Invision and Medseries4 clients. Siemens recently assured the hundreds of clients on these aging HIS systems that Malvern would be supporting them for many more years, but will Kansas City? Again, the contract duration would probably determine how long they offer to support these individual hospitals: long-term contracts with many years to run would be supported the longest, while shorter-term agreement might get pressured to convert off of them earlier, lowering Cerner’s costs to support these legacy systems and increasing Millennium sales.

Competition

• Epic. Should stand to gain enormously in future competitive situations as Siemens’ clients go to market, as Epic’s tidal wave of victories over the past five years continues. This is especially true at IDNs with large physician practices, where Epic still rules with its extremely functional and totally integrated ambulatory EHR and PM systems. Siemens had promised to add an integrated ambulatory EHR and PM system to Soarian, but the slow delivery of this costly R&D project could be one of the main reasons the parent company is selling its HIT division.
• McKesson. The sunset of their large-hospital Horizon system has left them out of most large hospital sales for years and they are only beginning to make headway with Paragon in the mid-sized hospital market of 300-500 beds. The real question is how long it will take them to upscale Paragon to compete with Cerner and Soarian in the high-end market of 500+ beds. I should be fully retired (and maybe even deceased!) before that occurs, so I’ll leave that prediction to other pundits.
• Allscripts. Would now rank in fourth place in terms of annual revenue at ≈$1.4B. Their solid ambulatory EHR and PM systems should sell well under Paul Black’s ex-Cerner leadership. However, the lack of true integration with the Eclipsys-based hospital EHR will be a weakness that the Cerner/Siemens sales reps will hammer upon.
• GE. Oddly, their recent victory over Siemens in the bidding war for the French-based Alstom may have been a contributing factor in Siemens’ decision to sell its US HIT division to deepen its capital reserves. GE’s ambulatory solutions continue to perform well, but they have not made a hospital sale with their ex-IDX Centricity Enterprise system in recent memory, but rather have lost clients to Epic repeatedly. Now if Alstom has an EHR system…

Historical Precedents

Ironically, the only vendor acquisition of this size was when Siemens itself acquired SMS in 2000 for ≈$2B, not a bad profit for Jim and Harvey, who started SMS in 1969 with a $5M loan from savvy Wall Street investors. Prior to that, it was McKesson’s acquisition of HBOC in 1998 for a $14B stock swap that had topped the charts, although the subsequent financial scandal caused that stock value to drop precipitously. Aside from these two mega-deals, other large acquisitions that put the Siemens bid in perspective include include:

• Allscripts buying Eclipsys for $1.35B
• NTT Data acquiring Keane for $1.2B
• GE gobbling up IDX for $1.2B

However, these other deals didn’t involve one HIS vendor buying another, each with a competing array of HIS products and services. That’s what makes the potential of Cerner acquiring Siemens’ HIT division an unprecedented industry shake-up, in that it will impact over 1,000 hospitals with these two vendors’ complex array of systems installed. Should make some interesting reading on HIStalk for many years to come!

Acquisitions, Funding, Business, and Stock

Premier, Inc. will acquire clinical surveillance software vendor TheraDoc from Hospira for $117 million in cash. TheraDoc has 1,000 facility customers. The price reflects around 10 times the company’s operating earnings, according to the announcement. Hospital acquired TheraDoc in 2009 for $63 million. Premier’s SafetyAdvisor is similar in analyzing data for hospital-acquired infection and for antimicrobial stewardship programs.

MModal exits Chapter 11 bankruptcy following financial restructuring and debt reduction of 55 percent.

Imprivata announces Q2 results: revenue up 34 percent, adjusted EPS –$0.81 vs. $0.01, falling short on earnings expectations.

The slide continues for the wildly hyped Castlight Health, with shares closing down another 4 percent Monday to $11.70 vs. March’s IPO day close of around $40. That’s a stunning 70 percent drop in less than five months. Above, it’s (obviously) CSLT in blue and the Dow Jones Industrial Average in red. Even at the fire sale price, the company is frothily valued at $1 billion, or 36 times revenue. The company announced last week that two of its directors have quit and the COO is leaving at the end of September, coinciding with its Q2 report that listed a $22 million quarterly loss.

McKesson shares closed Monday at an all-time high. You would have made 10 times your investment had you bought shares in the post-HBOC disaster days of 2000.

Sales

Providence Health & Services (WA) and Greenville Health System (SC – above) choose Infor Healthcare, which includes supply chain management and execution.

The Navy Medicine Operational Training Center (FL) selects AtHoc for mass notification and command-wide communications.

People

PatientSafe Solutions names Peter Longo (Health Gorilla) SVP/chief revenue officer.

Jason Jobes, associate director of revenue cycle solutions at The Advisory Board Company, is named to the Board of Examiners for the 2014 Malcolm Baldrige National Quality Award, which is managed by NIST.  

Genome informatics vendor DNAnexus names David Shaywitz, MD, PhD (Theravance) as chief medical officer.

David Levin, MD (Cleveland Clinic) joins Nordic as chief medical officer.

Announcements and Implementations

DataMotion launches Direct Community Web Portal, which allows hospitals to meet Meaningful Use Stage 2 transition of care objectives by securely transferring PHI from one care setting to another. Affiliated providers aren’t required to use Direct or to run a certified EHR – the portal include a CCD viewer.

American Heart Association launches an Open Innovation Challenge for Midwestern startups with ideas about how to help people prevent or manage cardiovascular disease or stroke. The 10 best ideas move on to a crowdfunding competition and the top three then pitch to judges and investors in Chicago in November. The winner gets a $20,000 grant and whatever crowdfunding money they raise. Applications are due on September 12.

EHNAC releases new criteria for its HIE Accreditation Program that include the Texas program. EHNAC is a non-profit organization that accredits HIEs on their use of standards to achieve quality and trust.

California Integrated Data Exchange, funded by $80 million from Blue Shield of California and Anthem Blue Cross, announces plans to develop the Cal Index statewide HIE. Cal Index says it will go live in late 2014 with 9 million records online. The initial funding covers the first three years of operating expenses, after which the HIE plans to sell subscriptions. Note the business model: insurance companies are paying, which makes sense since they get access to data and their costs should go down with better care coordination. Finally there’s a business case for running an HIE.

IMedicor launches a cloud-based dental EHR.

Mississippi Medicaid launches a clinical data repository, provider portal, and MPI using technology from MedeAnalytics.

Government and Politics

Vermont ends its relationship with CGI and gives Optum a no-bid contract to take over Vermont Health Connect, saying CGI repeatedly missed deadlines and the site still isn’t fully functional. The state says the cost of the insurance exchange will probably exceed the $83 million CGI was to be paid, of which Vermont has already written checks for $57 million (97 percent of which comes from federal taxpayers). The state’s chief of health reform said in response to questions about hiring Optum without bidding out the work, “The state RFP process takes forever … we are undoubtedly going to get hammered. I don’t care.”

The Affordable Care Act is boosting the bottom lines of both for-profit and non-profit hospitals as newly insured patients use more orthopedic, oncology, and maternity services. Insurance companies are spending more than they expected, with Cigna’s CEO saying that health insurance exchanges aren’t sustainable unless more people, especially healthier ones, sign up through them.

CMS temporarily suspends use of its Open Payments system that shows payments made to doctors by drug and medical device companies. CMS found that a batch of payment records from an unnamed company had assigned payments to the wrong doctor by including an incorrect state medical license number. The system isn’t live yet, although doctors are able to verify their information.

An HHS OIG review finds that ONC’s former temporary certification program (ATCBs) didn’t ensure that certified EHRs were retested, didn’t include a training program to ensure that  testers were qualified, and didn’t look hard enough at security-related issues such as password complexity and user privilege changes. ONC replied that ATCBs are extinct and full certification now features improved security and privacy features, to which OIG commented, “We do not agree that the 2014 Edition EHR Certification Criteria sufficiently address our security concerns regarding the Temporary Program.”

Habersham Medical Center (GA) is struggling financially after voting in September 2013 to pay back $1.5 million in HITECH EHR incentive money it found it hadn’t qualified for and for borrowing $37 million for expansion and facility improvements. The CEO found that the 53-bed hospital had attested for the first incentive payment without having the necessary software despite having spent $3 million upgrades, leading to his dismissal of the IT director and sending CMS its money back.

Innovation and Research

Accenture and Philips develop proof-of-concept software that allows people with ALS and other nerve diseases to control Philips products using their brainwaves, along with existing capabilities to use voice and eye commands.

More promise of using technology in cancer treatment: a startup that develops oncology drugs by artificial intelligence and big data gets its first drug into human trials.

Other

The AMA tweeted the above graphic that references a magazine’s survey. The survey’s methodology wasn’t stated, which would have been nice since some of the percentages involve subsets of other questions and the devil is in the details. It also wasn’t stated if the survey involved self-selected online respondents, the validity of which is nearly zero.

In England, The Royal Free Hospital uses OpenText’s content management product to import paper-based progress notes and link them to Cerner Millennium.  

A crematorium in England installs a Digital Autopsy center run by software company iGene London. It uses a multi-slice CT scanner to create a 3D image that a pathologist can examine on a tablet.

A Russia-based crime ring is found to have stolen 1.2 billion Internet username/password combinations and 500 million email addresses using botnets.

Local governments in China say GE Healthcare’s telemedicine projects are floundering because their equipment is too expensive at over $300,000 per installation, adding that GEHC tried to sell less-expensive equipment to take market share away from Siemens but ended up competing with its own distributors.

Weird News Andy performs a literature review of robot nurses. Around 150 “welfare facilities for the elderly” in Japan are using Palro robots that remember names, faces, and previous conversations. Gizmodo profiles the RIBA-II robot nurse. Pittsburgh-based robotics firm RE2 releases a new line of robots that can mimic human movement to perform repetitive processes and lift heavy objects. The upcoming Disney movie “Big Hero 6” features an engineer who transforms a robotic nurse into a fighting machine with pop-out wings and a projectile fist (which could be useful for robotic nurses assigned to urban EDs.)

Sponsor Updates

• Beacon Partners will exhibit at the Siemens Innovation Conference August 10-13 in Tampa, FL.
• A blog post by Brad Levin of Visage Imaging addresses how radiology can improve productivity and quality.
• Health Catalyst CMO Bryan Oshiro shares his wake-up call that solid data can save lives.
• Greenway extends special pricing for Engage14 in Dallas September 4-7.
• Greenway suggests how to select the clinical quality measures for a primary care practice.
• ICSA Labs certified HIStalk sponsors Medfusion and Wellsoft in July.
• HealthTronics posts its event schedule through the end of the year.
• InstaMed launches its bi-coastal billion transaction infrastructure.
• Premier Medical PC (AL) selects McKesson Business Performance Services.
• Craneware and Shriners Hospitals for Children are co-presenting this week at AHRMM14 on automation of supply and pharmacy management processes.
• Allscripts announces speaker information and agenda for ACE 2014 in Chicago August 12-15.
• Valence Health is moving into larger office space in Chicago with plans to hire an additional 500 employees by 2019.

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.

Cerner To Acquire Siemens Health Services for $1.3 Billion

Cerner announced this afternoon that it will acquire the assets of Siemens’ health information technology business, Siemens Health Services, for $1.3 billion in cash.

According to a statement from Cerner Chairman and CEO Neal Patterson, “We believe this is an all-win situation for the clients of both organizations and all of our associates and shareholders. Through more than $4 billion of cumulative investments in R&D, Cerner has established a strong market standing and is positioned for continued growth. Siemens’ health care IT assets provide additional scale, R&D, an impressive client base, and knowledgeable and experienced associates who will help Cerner achieve our plans for the next decade. In addition, the alliance we’re creating will drive the next generation of innovations that embed information from the EMR inside advanced diagnostic and therapeutic technologies, benefitting our shared clients.”

I spoke to Patterson ahead of the announcement. He said, “Siemens could not keep up with the need to innovate across the continuum,” adding that Cerner looked carefully at how its business would fit into Cerner’s. “If it slowed us down, we weren’t going to touch it. If we didn’t think it would have a huge value proposition, we weren’t going to touch it.”

Patterson added, “The broad driver is the post-Meaningful Use era” and pointed to the $650 million combined annual research and development spend between the two companies. The companies will also jointly fund a $100 million alliance to perform development activity around diagnostic and therapeutic medicine. “IT systems are important to Siemens’ healthcare modalities,” he told me. “We will go much deeper than the workflow level.”

Patterson summarized, “This is a win-win-win across the board. Siemens clients will get a lot of value. We will partner on their core healthcare business. Lots of our clients use both systems in different capacities.”

Cerner says it will continue to support Siemens’ platforms and will support Soarian “for at least the next decade.”

John Glaser, PhD, CEO of the Siemens unit, said in a statement, “We are excited to join with one of the most competitive companies in health IT today, and a recognized leader in innovation. Siemens cares deeply about its clients and believes Cerner is the best organization to fully support their health IT needs going forward. The knowledge and strength of our combined resources opens up great possibilities for future collaboration and development, which is exciting for all of us. And our clients will benefit from our alignment with a company that has such a strong historical and future commitment to rapid innovation.”

The combined organizations will have 20,000 employees, 18,000 client facilities, and $4.5 billion of annual revenue. The transaction is expected to close in the first quarter of 2015.

HIStalk has featured rumors of the acquisition going back to early May, when Vince Ciotti was the first to tip me off to the rumors.

Morning Headlines 8/5/14

The Office of the National Coordinator for Health Information Technology’s Oversight of the Testing and Certification of Electronic Health Records

An OIG investigation finds that the ONC’s EHR testing and certification standards do not test EHR security features enough to adequately ensure that patient information is protected.

State will replace CGI, health exchange vendor

Vermont is the next to join a growing list of states that have fired CGI as their primary health insurance exchange firm. Starting in September, development responsibilities will be handed over to Optum as part of a $5.7 million deal.

Actionable Recommendations in the Bright Futures Child Health Supervision Guidelines

A new study published in Applied Clinical Informatics finds that only 20 percent of the preventative health care guidelines followed by US pediatricians are defined in a way that would allow them to be integrated into EHR clinical decision support tools.

DeSalvo says providers, hospitals on track for EHR Stage 2

With just 10 eligible hospitals attesting for Stage 2 MU thus far, national coordinator Karen DeSalvo, MD, reports “We know from past experience with meaningful-use Stage 1, for example, that people wait to attest until the eleventh hour,” adding “It seems on track with where we expect it to be, and we’re watching it closely.”

Curbside Consult with Dr. Jayne 8/4/14

I took some much-needed time off this week to try to gain perspective on where my career is going. What was once a pretty fun job has become a bit of a grind.

Ten years ago, we felt like we were doing cutting-edge work to transform patient care and help physicians deliver better outcomes. We were in the EHR business for the all the right reasons and were able to implement systems and functionality we needed when we needed them.

A good chunk of my responsibilities have been taken over by Meaningful Use. In our world, this has caused us to take workflows that were already improving patient care and then micromanage them to death. Maybe it’s the actual Meaningful Use certification requirements or maybe it’s the way our vendor has implemented them, but we may never know which is to blame. It’s probably a combination of both.

Either way, physicians and end users are unhappy with the volume of documentation they now have to do. They complain that it’s not really helping them in daily patient care.

As the CMIO, I take those concerns seriously and often personally. Although I have workflow experts and an advisory board backing me up, I’m the one who ultimately approves all clinical workflows before they’re implemented and all clinical system changes before they’re coded. If our vendor’s workflow is clunky and we don’t identify the potential problem before it goes out the door, that’s on me.

Our administration understands that sometimes we’re going to miss problematic content. They also understand that some of the MU requirements are so specific there’s just not a way to make them less annoying.

Our physicians are less understanding, however. I’m the one who has to deal with their concerns, complaints, and threats to quit. That’s not something they really train us to deal with anywhere along the CMIO training path, assuming we’ve actually been trained other than in on-the-job fashion.

I’m still relatively early in my career, but I’m wondering if I can take another 10 or 15 years of this. Considering my particular hospital situation, the bloom is definitely off the rose. I’m thinking about throwing my hat into the ring at another health system. The thing that makes me somewhat hesitant, though, is the thought that it could be just the same, if not worse, anywhere else.

How do you truly screen a potential employer or supervisor to know if they’re really visionary or just saying what they need to in order to get a position filled? I’ve had a couple of bosses that I would walk through fire for. It’s difficult to top that. At this point, however, I’d settle for someone who knew what he was doing and had the conviction to do the right thing rather than the easy thing or the politically expedient thing.

We’re in the middle of evaluating vendors for a massive system overhaul. I’m not sure our current leaders will survive, depending on which vendor is selected. That could be an opportunity for me to help move the remaining players around in a way that will rejuvenate some of our key players. Or it could be a reason for team members to jump for fear that they won’t make the cut. I’ll know more about what this is going to look like in six or eight months. Right now, we’re in a special kind of limbo.

It was good to get away, but increasingly difficult to completely unplug. There’s so much going on that it’s tempting to just peek at email, but I know better. One minute will quickly become one hour if you let yourself look.

When I got back in town last night, I had multiple voice mails from one ambulatory director with increasing anxiety in her voice because I wasn’t calling her back or returning her emails. Apparently she didn’t listen to my outbound message or pay attention to my out-of-office message that I wasn’t going to be on the grid.

I picked out two books before I left and they were an interesting contrast. I like southern fiction and the first one, The Hurricane Sisters, was available from my library’s e-book site. I checked it out for my iPad. It started with a lot of key southern elements, but I was shocked when I reached the point where Google Glass played a role as a significant plot device. Times are certainly a-changing! It was a quick read, not the best book ever, but good in the moment. I was pleased with my choice and it took my mind off things as I headed out of town.

The second one, On Call in Hell: A Doctor’s Iraq War Story was not exactly your typical beach read. It’s pretty graphic as only a book about Marines in combat can be, but I was amazed at the ability of the author and his colleagues to maintain their humanity and occasionally a sense of humor in the ultimate adverse conditions. Regardless of your feelings about war in general, reading about the experience puts everything in a different perspective.

One of the ideas that author Richard Jadick emphasizes is to be constantly improving one’s situation, whether it’s basic survival (sandbagging the forward aid station so you don’t get shot while caring for casualties) or figuring out better techniques to treat the wounded. It’s a powerful concept. It’s not about finding solutions to the chaos all around, but about figuring out your own sphere of influence and improving what you can within that space.

I’m taking that thought back to the office with me this week to see what I can do with it. I’ve already got a list in my head of what’s in my sphere of influence and what’s not, and some ideas on what we might be able to change for the better. I’m feeling pretty rejuvenated, but all that will change Monday morning when I finish tackling my inbox.

Have a transformative vacation story? Email me.

Email Dr. Jayne.

HIStalk Interviews Jan De Witte, CEO, GE Healthcare IT

Jan De Witte is president and CEO of GE Healthcare IT.

Describe your job.

I run our healthcare IT business globally. I would summarize it as four big categories. Enterprise imaging. Care delivery management — care pathways inside the hospital in the departmental areas and ambulatory care. Population health management, our joint venture with Microsoft in the Caradigm company. Then financial management, revenue cycle management, and cost analytics or margin management. 

We have different global product managers that run these categories. We commercialize and implement our systems pretty much across the world, with the US as the main market. The US makes up more than 60 percent of our business activity.

What is the status is of the Healthymagination project?

Healthymagination started several years ago. It is a focus of GE and GE Healthcare to drive outcomes in healthcare, specifically cost, productivity, and clinical quality outcomes.

As of two or three years ago, that program has matured in the sense that it has changed, shifted how we do product management on our equipment and our software. Our product managers start with outcomes in mind and then develop technologies that drive those outcomes. Before, we often — like many other companies — developed great technology without necessarily touching the outcomes that our customers needed. 

That’s how I would say Healthymagination has morphed from initiative several years back to today — a different culture and capability within our project management.

Siemens is another multi-national conglomerate and they apparently want out of the healthcare IT business. How do you see GE Healthcare IT positioning itself going forward against competitors that focus exclusively on healthcare IT?

On the Siemens-specific question, I’ve gotten questions from both customers and our employees.

There’s two elements to be asked. First, GE Healthcare, my mother company, is fully committed to driving outcomes in healthcare. If you look at the challenge for healthcare, it’s information technology that is going to be the big enabler to drive both productivity and quality. Going back to what we said on Healthymagination, we’re more than ever committed to building out our healthcare IT capabilities to fulfill that mission to make a difference in healthcare.

For the second dimension, I’m sure you’ve heard about the industrial Internet and Jeff Immelt’s commitment to building out GE’s software capabilities. What’s true in healthcare is true in many other industries. The next generation of driving improvement is going to be linked to data, analytics, and using those insights to drive better processes. From Jeff Immelt down, there’s more commitment than ever to be a significant player in software.

Those two together — my direct manager and Jeff Immelt — are fully committed to building out our healthcare IT capability. Close to half of GE’s software activity. Getting a lot of help and support from our San Ramon center of excellence to build out capabilities.

Describe how the industrial Internet fits into what you’ll be doing differently within your software areas.

Let me start with the vision of the industrial Internet. The way we put it is minds to machines can bring intelligence to machines or through machines that generate data, no matter which industry you look at. Process improvements, if you only take one percent, it’s tremendous value you can generate.

The vision of GE is, let’s complement our deep capabilities in developing excellent machines with deep software capabilities to complement those machines, take the data that comes off these machines, and make either the machines or the process around the machines more efficient. This can go from reading data from jet engines and understanding how to make them operate at higher fuel efficiencies to taking planning information from train scheduling and optimizing, planning, and routing and asset utilization in railway operations.

I’ll come to healthcare in a minute, but the commitment of GE is translated into our center of excellence in San Ramon on the West Coast, where we have about a thousand engineers today building out a cloud-based platform which we call Predix. Essentially it is all the next-generation cloud-based platform capabilities that either myself or colleagues of mine in other GE businesses will leverage to build analytics and workflow solutions on.

Very concretely, the industrial Internet initiative of GE is providing me, as a healthcare IT leader, with next-generation platform capabilities that over time will be reflected in the re-platforming of some of my current legacy applications, or brand new analytics applications that we’re building on the Predix platform right away.

How do you see the role of Centricity and how will that change with the industrial Internet?

Centricity is essentially the umbrella brand across the breadth of our portfolio. A couple of years back, we made a decision to focus the Centricity portfolio on what internally we called the next innings in healthcare. It’s clear over the past five-plus years that the whole healthcare industry has been focused on digitization — turning film into digitized information, turning paper into digitization with fax systems and with EMR systems. That’s only the first stage in any industry that goes through an industrialization phase.

We decided, from an R&D perspective, to start focusing on the next innings, which is going to be about analytics and workflows. We start to see today the next inning taking shape. 

Within the Centricity portfolio, if I  look at our Centricity enterprise imaging solutions, today those solutions are focused on enhancing diagnostic speeds and diagnostic confidence. Not just within one department, but across the enterprise, even across regions or countries. The same for our care delivery management, whether that’s Centricity anesthesia or peri-op solutions or ambulatory EMR. They are increasingly becoming systems to enable predictive care pathways. Our revenue cycle management solutions are increasingly becoming risk and profitability management tools.

With our products, all of them, our R&D is focused on providing analytics capabilities and workflow capabilities in these tools rather than digitizing. The Predix platform is a service-oriented cloud-based platform that is enabling us to build out the analytics capabilities, to build out the right user interface and user experience, and to build out the security capabilities that we are needing in that next generation of IT solutions for healthcare.

Are we in a post-EMR era and moving to analytics, connectivity, and the power of the network?

The short answer is yes. We are, definitely. I hear that from many of our customers. It started one or two years back when they said, we’ve invested a lot of money in bringing in a great EMR. We have realized today that we are not really changing our operation yet. In fact, in some cases, our physicians are less productive than we thought because they spend more time inputting data into systems.

There’s a little bit of a disappointment of the realization that the EMR is, I would call it, the necessary evil to enable the real phase of information technology, which is turning all of that data into actionable insights, and then using those insights into different workflow applications that enable caregivers to collaborate with each other across the different departments and even across geographies.

I see and I hear from my customers that there’s need for next generation. Everybody at this point is talking about population health management, which I think is the ultimate of workflow and analytics at the healthcare system level.

Along those lines, the work that GE Healthcare was doing with Intermountain was going to result in a lot of that, but they’ve moved to Cerner. What was the result of that partnership and why didn’t it continue?

The results or the intellectual property of the partnership today is to a large extent sitting into Caradigm. If I look at the models around clinical data structures, analytics, and protocol adherence type applications, all of that is in Caradigm.

The choice of Intermountain to go to Cerner, frankly I will not comment too  much on. It was essentially a choice on how they wanted to implement some of the intellectual property into their operation. The work that we’ve done over the years with Intermountain, the intellectual property, is sitting into Caradigm today, with many of the leaders that were on the project now in Caradigm.

Is GE Healthcare IT happy with Caradigm’s progress?

We’re very happy with Caradigm. Caradigm today is still, to a large extent, what we call the Caradigm Intelligence Platform. The ability to get to the data, wherever it is. Then you have the Caradigm analytics and the Caradigm population or care management suite of applications.

When we started Caradigm, we had all three components in mind. The first two go back to what we were doing with Intermountain. The population or the care management part, at that point already we were co-developing with Geisinger — care management applications for the Geisinger Health Plan. When we started Caradigm, we never gave too much visibility to it, although it was part of Caradigm on the formation of the company.

Over the past two years, much to our surprise and probably delight, the need for population health management has taken off way faster than what we assumed. We were well positioned. We have stepped up our focus on building out that suite of applications.

We’re very happy with Caradigm because it feels like we were at the right time in the right place in the industry. It’s very early days for population health management. We feel we have a very good and broad set of applications that enable population health management, from getting to the data to understanding your cohorts to setting up care management programs and linking into wellness and home health.

At the same time, when I look at population health today, there’s a lot of people who are claiming to have solutions. I consider 2014 and 2015 as the period where there’s going to be the selection made between PowerPoints and proof points. I see Caradigm as a company that will have the proof points. Everybody has the PowerPoints today. Over the next 12 months, we’ll figure out who has the real proof points of having solutions, analytics, and workflow that enable population health management and tremendous impact on the cost of healthcare.

Are your health system customers asking you to help guide them in operational improvement and population health management?

There’s a mix. I’m pleasantly surprised that many of the integrated delivery networks, which are the first ones getting on board, have brought on board people that have the right vision and the right capability.

My perception is that the need for consulting is lower than what I would have said three years ago. We bring with our technology the basic implementation consulting, but from a strategy consulting — how to set up population health management — I perceive most of the leading implementers today, having brought on board good people, smart people that know how to do that. Many of them have been experimenting. They now want to leverage technology to enable the rollouts on a broader scale.

What are the most innovative projects you’re working on that will come to fruition in the next two or three years?

We are very much focused at this point on building out our cloud capabilities, specifically in the imaging area. This is the area where we’ve leveraging to the fullest the new capabilities that GE has built in San Ramon.

At the last RSNA, we launched Centricity 360, a case exchange capability that complements our imaging capabilities. We’re further building out that case exchange capability to true collaboration capabilities that seamlessly enable institutions to collaborate together, to collaborate with affiliated and non-affiliated caregivers. First in the imaging diagnostic space, but with the technology, the platform itself is extendable to any form of collaboration. That’s one where we have the first betas.

At the next RSNA, we’ll come out with the next generation. It has the promise of bringing true cloud capabilities to healthcare and being a big enabler of allowing a very flexible way for caregivers to collaborate with each other.

Do you have any concluding thoughts?

On top of our vocabulary is outcomes. With your question on Healthymagination, what this industry needs is outcomes, not necessarily more technology. Specifically in the US, a lot of money has been spent putting technology in place. The industry has not fully gotten the outcomes for that yet in terms of productivity and quality. That’s where we’re focused.

At GE, we have the benefit of seeing different industries, also seeing how different industries have gone through different phases. I see today a lot of parallels in healthcare versus what I saw happen in airlines in the ‘90s. I’m 15 years with GE, all of it in healthcare. Before I joined GE, I was in other industries. It’s exciting to see that healthcare today is going through the same transition that other industries have gone through. Digitization and then using all that information to enable networks to operate as networks and to turn data into insights and better decisions.

I think the next 10 years in healthcare are going to be probably the most exciting ever. For those people working in the IT side of healthcare, it’s probably the best job in the world for the next decade, using technology to totally change the industry for the better.

Forums like HIStalk … the more we can enable and pump up people in IT to drive the healthcare industry, the more we’ll be part of something beautiful. This industry will not look the way it looks today 10 years from now. That’s a given.

Morning Headlines 8/4/14

Kaiser Permanente, Johns Hopkins Medicine Announce Enhanced Strategic Collaboration

Johns Hopkins and Kaiser Permanente announce a partnership that will focus on “sharing evidence-based best practices, advancing population health programs, collaborating on education and research endeavors, and exploring how the organizations can work together to create better health care models.”

Berwick believes he has a healthy chance in race for governor

Democratic candidate for Massachusetts governor Donald Berwick, MD, says in a recent interview that healthcare costs, which make up 42 percent of the state’s budget, “are just eating the state alive.” He is calling for a single-payer health care system instead.

Hospital wants back CEO charged in scheme to steal $158 million

Riverside Hospital (TX) is asking a local judge to allow one of its healthcare administrators, recently charged with $158 million in Medicare fraud, to return to work at the hospital as an unpaid consultant where he would help them address their financial issues.

Monday Morning Update 8/4/14

Top News

Johns Hopkins Medicine (MD) and Kaiser Permanente announce a collaboration in which they will share EHR best practices, develop technology to deliver personalized medicine, and create better and cheaper care models.

Reader Comments

From HIS Geek: “Re: Siemens. To understand Siemens’ lack of smooth integration, you need to go back to the SMS roots. In the 1980s and 1990s, SMS technical groups were organized internally based on hardware loyalties — DEC, IBM, PCs, networks –not customer or market needs. Silos of technology, support, and sales added more problems. Siemens failed to fix the SMS legacy. It added its own agendas on top of it all and ignored the EHR market trends.” Big vendors trying to juggle legacy products always have that problem – segregation of their expertise by product line and destructive internal infighting for executive attention. Both McKesson and Siemens bet their credibility on new showcase products that failed – Horizon and Soarian – although I respect Siemens for at least trying to build something new even though their stodgy German leadership and SMS’s mainframe mentality made it unlikely to succeed. The best full-spectrum vendors – Epic, Cerner, and Meditech – are healthcare-only and focus on a single product line that they built themselves, and even with Cerner and Meditech their weakest products are ones they acquired. Big corporations dabbling in multiple vertical industries usually populate the bottom rungs of healthcare IT user satisfaction and innovation; prospects they convince otherwise are likely doomed to repeat history.

From DenverDermPA: “Re: Greenway. We had a PrimeSUITE upgrade to 17.0 two weeks ago. The system has slowed to a crawl – it takes 2-5 minutes just to change patients. Greenway support advised that it’s a known issue documented in the 30-page release notes. The impact has been an extra 1-2 hours charting after hours every day, extra time to respond to critical lab results, and an extra day to respond to refill requests. Should I consult with legal counsel? Are other users having this issue? Can I report EHR issues to the government?” Two weeks is a long time to live with a crippled system, but Greenway is your only hope of fixing the problem. Assuming you’ve escalated to a high level and are continuing a dialog that suggests they’re working on it, I wouldn’t call a lawyer or complain to the federal government – you might feel good about lashing out, but that’s going to create a barrier between you and the only people who can improve your day-to-day existence. I’ve forwarded a high-level Greenway-provided contact who promises to look personally into your issue. If the problem is yours alone, a few hours of tech time should figure out a solution, but if it’s not (which I agree would then indicate poor QA on Greenway’s part, and I’d be interested in hearing from anyone else having the same problem), the developers need time to develop an all-client fix that doesn’t break something else. You also mentioned that you don’t have a test environment and didn’t read the release notes, which I understand as a very small practice, but that’s a lesson learned – you and your vendor bear equal responsibility for making sure new releases work in your particular environment and that you are ready to go live with the changes — including training, required configuration, and testing every critical function regardless of whether or not the vendor says they changed them (the functions programmers didn’t mean to change are usually the ones that elude QA). SVP of Product Management Mark Janiszewski provided this response to my inquiry:

Many of our Greenway PrimeSUITE customers recently upgraded to our Meaningful Use-certified release in order to attest for Meaningful Use. This release contains a number of new and changed workflows made necessary by MU 2014 requirements and also includes improvements to our lab orders module. We’re working with our customers every day to answer their questions regarding the many new capabilities of 17.0. Also, we’ve identified several areas where the workflows and tools can be enhanced to improve efficiency, and have our development team focused on getting those to our customers as quickly as possible – currently every few weeks.

HIStalk Announcements and Requests

Respondents were split 50-50 on whether EHR vendors influence government policy too much. New poll to your right: should the federal government define and mandate EHR interoperability requirements? Click the “Comments” link on the poll box after voting to elucidate further.

Welcome to new HIStalk Platinum sponsor WeiserMazars. The New York-based accounting, tax, and advisory company, founded in 1921 (!), offers providers and health plans IT consulting (planning, review, governance, network planning, system selection, contracting, project management, and facilities management), financial advisory services, revenue cycle services (assessment and transformation, revenue integrity, point-of-service collections, charge master, charge capture, and collections improvement), and full service options for managed care related services. A recent client survey found that 98 percent would recommend the company to others. Ken Fischer, who ran his own firm Smart Solutions for Health Care and worked for KPMG’s healthcare practice before that, is in charge of the healthcare group. I noticed that the company announced Friday its acquisition of pmpm Consulting Group, a California firm that offers managed care services. Thanks to WeiserMazars for supporting HIStalk.

It’s interesting that the significant percentage of Americans who are fat, don’t exercise, and ignore the instructions of their doctors can’t fixate enough about the media-hyped transfer of two Ebola patients to the US, accompanied by the embedded TV talking head doctor Sanjay Gupta.

Listening: the stunning Scotland-based heavy metal progressive (Rush meets Spock’s Beard) band Pallas, which has been around intermittently since the early 1980s.

Last Week’s Most Interesting News

• CMS issued a rule setting October 1, 2015 as the enforcement date for ICD-10.
• McKesson turned in great quarterly numbers, but its earnings were hurt by an accounting change involving the sale of its European healthcare IT business. Revenue from the Horizon product line that’s being phased out dropped as expected.
• A GAO report found that Healthcare.gov will end up costing taxpayers nearly a billion dollars, much of that due to CMS mismanagement of the project.
• Congress moved quickly to approve giving the VA $16 billion to hire more staff, open new clinics, and pay for the outside care of veterans who can’t get prompt VA appointments.
• The Senate Appropriations Committee directed ONC to identify and decertify EHR vendors that “proactively block the sharing of information.” Meanwhile, big vendors continue to proclaim themselves as “open” and criticize their competitors – namely Epic – as “closed.”
• The companies that acquired Sunquest and Encore Health Resources say they are contributing strongly to their bottom lines and are growing.
• National Coordinator Karen DeSalvo wrote a letter to the Boston Globe expressing disappointment at its article that criticized EHR-related oversight and patient safety, adding her pitch for ONC’s proposed health IT safety center.

Acquisitions, Funding, Business, and Stock

Outpatient surgery software vendor SourceMedical acquires Encircle Healthcare, which offers a surgical eligibility and registration patient portal.

From CPSI’s earnings call Friday:

• The company implemented its new ED system in three hospitals and has two more scheduled next quarter.
• The new Medical Practice EHR is live in 10 practices.
• Ten hospitals completed Meaningful Use Stage 2 attestation and another 13 are ready. The patient engagement requirement is the big stumbling block.
• The Meaningful Use delay hasn’t impacted sales since it was really only a three-month delay – deferring to 2015 requires a full-year attestation starting October 1, 2014 instead of attesting for a 90-day period.
• Scheduling the user conference in Q2 rather than Q3 moved a $500,000 expense up one quarter.
• Chairman and CFO David Dye said that rural hospitals are struggling, but added, “I can hardly think of any time in the 25 years that I’ve been here that I wouldn’t have said the exact same thing.”
• President and CEO J. Boyd Douglas said in response to an analyst’s question about Cerner reporting small-hospital gains with CommunityWorks that CPSI isn’t seeing Cerner in any significant way after a slight uptick a year ago.
• Dye said that while CPSI might consider acquiring a population health management systems vendor, they’ve never done an acquisition and have written all products themselves.

People

Tomas Gregorio (HealthEC) is named senior executive director of healthcare systems innovation of New Jersey Innovation Institute. He was VP/CIO of Newark Beth Israel Medical Center from 2006 to 2010.

PM/EHR vendor MedEvolve names Michael Schiller (Streamline Health) CEO.

Announcements and Implementations

Carolinas HealthCare (NC) releases The Amazings, a free game app for kids 7-12 who have asthma. It helps them avoid triggers such as pollen and cigarette smoke. That’s a pretty cool project for a health system to take on.

Wisconsin-based Anthem Blue Cross and Blue Shield provides subscribers access to LiveHealth Online, which provides mobile-based, two way video telemedicine sessions with US-based doctors to residents of most states. Visits average 10 minutes and cost $49 by credit card without insurance. Doctors can generate prescriptions from the visit in many states. Users can choose a doctor by viewing their profile and their online ratings. LiveHealth Online is WellPoint’s rebranded version of American Well.

Government and Politics

Massachusetts gubernatorial candidate and former Institute for Healthcare Improvement President and CEO Don Berwick, MD says that “healthcare costs are eating the state alive” at 42 percent of the state’s entire budget, or $15 billion per year. Berwick says administrative overhead makes Massachusetts “the most expensive state for healthcare in the most expensive country in the world” and proposes a single-payer system that would create transparency and public accountability. The Democratic primary is September 9.

Other

Stanford Medicine (CA) launches the first ACGME-accredited clinical informatics fellowship, directed by Stanford Children’s Health CMIO Christopher Longhurst, MD, MS.

A federal claims court overturns the VA’s ICU systems award to Picis, finding that the VA relaxed its standards in choosing its products over those of CliniComp, which filed suit.

Richard Cope, president of specialty EHR vendor Boston Advanced Analytics (formerly Coping Systems), is fined $1,000  by the city of Quincy, MA for renting his home on Airbnb. The city’s inspector confided to reporters, “We believe there are others.”

A Tucson, AZ urology practice notifies 3,000 patients of a data breach after finding that employees don’t always remove stick-on labels from urine sample cups before throwing them away. The labels contained patient name, date of birth, chart number, physician name, and date of service.

The management team of Riverside Hospital (TX) asks a US district judge to allow its former administrator — who is charged with leading a $158 million Medicare fraud ring at the same hospital and is banned from working in healthcare — to return as an unpaid consultant to save the hospital from financial peril. The state had previously stopped sending patients to the hospital because of widespread fraud, but the former administrator contacted Congresswoman Sheila Jackson Lee, who successfully demanded that the state give the hospital another $3 million. The hospital paid “recruiters” $300 for each Medicare patient they brought off the street to one of the hospital’s six psychiatric clinics, where the senior citizens hung around all day as the hospital billed Medicare $116 million for therapy sessions.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 8/1/14

Deadline for ICD-10 allows health care industry ample time to prepare for change

CMS confirms in a press release that the ICD-10 switchover will take place on October 1, 2015.

When ‘Hacktivists’ Target Your Hospital

In a New England Journal of Medicine article, Boston Children’s Hospital SVP/CIO Daniel Nigrin, MD discusses his experiences defending the hospital’s network against cyberattacks from the hacker group Anonymous. The group was retaliating over a very public child custody dispute between a Boston Children’s physician and a child’s parents.

McKesson adjusted profit, sales rise above expectations

McKesson reports Q1 results: profit dropped slightly to $425 million, but revenue and sales were both up significantly, EPS $2.49 vs. $2.11, beating expectations.

Novant Health to roll out electronic medical records system at Triad hospitals this weekend

Novant Health will go live with Epic across four of its NC-based hospitals this weekend. The go-live is part of a $600 million system-wide transition and follows its successful install across 300 physician offices last year.

News 8/1/14

Top News

A new CMS rule officially confirms October 1, 2015 as the new ICD-10 deadline. The announcement adds a bit of unintentional humor in saying the revised date “allows health care industry ample time to prepare for change.”  

Reader Comments

From The PACS Designer: “Re: Apple iTime. TPD’s sleuthing of US Patent Office new approvals has uncovered the iWatch patent. Apple iTime is the name given to patent # US 8,787,006 B2 for the wrist-worn device. Apple’s stock price has been rising since the patent was issued, probably some employees adding stock to their portfolios before any announcement from Apple.” It’s actually a three-year-old patent that was just approved, and like any good patent, is maddeningly vague to ensure covering as much intellectual property as possible. It mentions a GPS, heart rate monitor, accelerometer, and touch screen as options that are contained in the strap.

Siemens Products
By Quiet One

In response to Chester of Malvern’s post on “What a Cerner Acquisition of Siemens Health IT Would Look Like.”

As much as I criticize Cerner, at least they have an integrated system. Siemens Health Services’ systems might as well all be from different vendors.  It seems like they deliberately made them difficult to integrate so they could sell more services. Or maybe that was the result of them laying off people in Malvern and outsourcing work to India.  

I can’t imagine why someone would want to buy this set of assets other than for the customers and the data center. I doubt that Cerner would maintain the products, which is unfortunate since having lots of choices is good for all and Invision and MedSeries4 are good systems that got neglected due to the Soarian fiasco.

• "Soarian sites are happy with their financials, which are better than Cerner’s." I would seriously question this. Hardly anyone implemented Soarian Financials and they put even less effort into this product than they did Soarian Clinicals. It would probably be true to say Invision customers are happy with their financials, although that incidentally is the oldest part of Invision, based on IBM’s SHAS, and is batch oriented with sort of a CICS-based overlay so it’s not the most ideal product in my opinion.
• “Love the Soarian business process manager — the rules engine is quite impressive." If you’re impressed with their rules engine, which is a separate product on a separate box with its own implementation fees, you’ve obviously never worked with Epic, or for that matter, Cerner.
• "Siemens RIS…" Actually, this is one of their better products and is relatively stable. It has a pretty well designed Unix/DMQ/Sybase backend. Siemens is big in radiology because of their medical equipment business. The RIS product was moved out from under Siemens Health Services, so I wonder if it would be part of the sale.
• "Siemens Lab is a legacy system that customers love. KLAS rating is high even though they do not really manage pathology very well (lab is standalone)." This astonishes me more than anything and makes me question KLAS’s methods (Siemens does actively encourage customers to submit KLAS questionnaires). To say that it does not manage pathology very well is a big understatement. It does not have any pathology functionality at all, nor does it have blood bank functionality, or even instrument interfaces. It does offer a single outgoing and incoming instrument interface to connect to a broker like Data Innovations that you get to buy separately. It’s built on top of the Siemens RIS platform, but it seems like they gave up midway. So what does it do? Not much. In fact, for the administrative/setup functions, they use forms on a Microsoft Access MDE file linked to the Sybase back end.
• "Siemens Pharmacy and MAK works with Soarian – different platform, but functional." This is a DSM/Cache-based product built on top of their discontinued Unity system and has a lot of baggage from that. It actually is standalone and is often used by Invision and Soarian sites due to integration hurdles that Siemens imposes to prevent them from going with competing products. That said, integration between Siemens Pharmacy/MAK and Soarian is surprisingly difficult. You’ll also need to purchase the rules engine separately (again a separate box and separate implementation costs) and will probably need to purchase a third-party label printing system.

HIStalk Announcements and Requests

This week on HIStalk Practice: UNC-Chapel Hill researchers develop the FutureDocs physician shortage forecasting tool. Colden & Seymour ENT and Allergy, and Children’s Healthcare Massachusetts go live on the Wellport HIE. The American Academy of Family Physicians rebrands its Center for Health IT. The Children’s Health Alliance implements the Wellcentive Advance population health management platform. The Global Partnership for Telehealth conducts successful telemedicine consultations in Honduras. 23andMe secures new funding from the NIH. Take the HIStalk Practice reader survey. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers Benedict Evans’ most recent podcast, connecting the proliferation of smartphones with the inevitable scaling of mHealth use cases. Proteus Digital Health extends its Series G funding round to make room for more investors, closing the round at $172 million. Google announces a new health-focused X Labs project that aims to capture as much data as possible on human health, down to the genome and molecular level.

Acquisitions, Funding, Business, and Stock

MedAssets reports Q2 results: revenue up 2.7 percent, adjusted EPS $0.30 vs. $0.30, meeting revenue expectations and beating consensus earnings expectations of $0.29.

McKesson reports Q1 results: revenue up 37 percent, adjusted EPS $2.49 vs. $2.11, beating expectations on both. Meanwhile, an employee McKesson fired four months after the company’s last annual meeting in which the man asked CEO John Hammergren to improve employee wages and benefits was back at this this year’s meeting, hoping to persuade shareholders that Hammergren’s $292 million change-of-control golden parachute is unreasonable. The former employee and the union he works for were unsuccessful – shareholders vote down a proposal to reduce the amount, which McKesson’s board explain as “an important tool for motivating our executives in the face of a potential change in control transaction.”

From the McKesson earnings call:

• The company’s sale of its McKesson International Technology was reclassified from discontinued operations in 2014 to continuing operations in 2015, causing a charge of $34 million ($0.11 per share) to GAAP earnings.
• McKesson won’t rebid its UK workforce solutions business when it expires late next year.
• Technology Solutions revenue dropped 8 percent because of already-expected poor Horizon Clinical revenue, the divested foreign business, and “planned elimination of a product line.”
• John Hammergren is pleased with RelayHealth’s growth.
• He talked up CommonWell, which he says will be expanded and commercialized after the pilots are completed. He didn’t say what “commercialized” means.

From Merge Healthcare’s Q2 earnings call:

• The company says it, along with other enterprise imaging system vendors, is being hurt by indecision, mergers, and a preoccupation with ICD-10 and Meaningful Use Stage 2 among providers.
• Merge says it signed seven new iConnect customers in the quarter, iConnect Cloud Archive is growing rapidly, and Merge eClinical OS increased user count by 27 percent.
• The company expects hospital mergers to trigger new VNA and universal viewer sales.
• Merge is offering per-transaction contracts with no minimums.

In the Quintiles Q2 earnings call, CFO Kevin Gordon says he expects the acquired Encore Health Resources to contribute services revenue of $40 million. CEO Thomas Pike adds of the acquisition with regard to its pharma customers, “With our new acquisition of Encore, we also see this real flow of interest into the electronic health records and how our customers can really understand the practice of medicine taking place out in hospitals and in clinics associated with their drugs. I think the capabilities we’re assembling just give us unique insights for those customers.” Quintiles is a big pharma services vendor headquartered in Durham, NC with 29,000 employees and a $7 billion market cap.

CPSI announces Q2 results: revenue flat, EPS $0.81 vs. $0.77.

The Advisory Board Company reports Q1 results: revenue up 15 percent, adjusted EPS $0.30 vs. $0.31.

Vocera reports Q2 results: revenue down 9 percent, adjusted EPS –$0.16 vs. $0.01.

Sales

Healthcare Data Solutions will provide its US healthcare databases and business intelligence services to aPureBase, a Denmark-based life sciences data supplier.

Michigan Health Information Network selects DataMotion to provide Direct Secure Messaging services.

Capital Women’s Care (MD) enters into a 10-year agreement with NextGen Healthcare to provide RCM services for its 45 locations.

Bon Secours Health System (MD) will deploy Premier’s PremierConnect Enterprise data warehouse and business intelligence platform.

People

Vocera names Justin Spencer (Symmetricom, Inc.) as EVP/CFO.

Avery Cloud, CIO at New Hanover Regional Medical Center (NC), will leave the organization this week to take a position with an unnamed Houston employer.  

Announcements and Implementations

Several Novant Health (NC) hospitals will go live on its $600 million Epic project this weekend. Novant says it hopes to avoid the Epic-related problems experienced by its Triad competitors Wake Forest Baptist Medical Center and Cone Health.

Navicure added 272 new accounts in Q2, a 76 percent jump over a year ago.

Geneia launches its Theon analytics platform.

Medical animation vendor Nucleus Medical Media joins the Greenway Marketplace.

Levi Ray & Shoup launches PageCenterX/Satellite to provide downtime reporting capabilities for system outages.

PMD launches its Observation Result interface to streamline cardiology test interpretations and charge capture.

Microsoft names Allscripts its “US Health Provider Partner of the Year.”

In Germany, the government will create an eHealth council to promote the exchange of digital healthcare information.

CHIME launches a new membership organization, the Association for Executives in Healthcare Information Security (AEHIS), as a professional organization for healthcare chief security officers. CSOs who are accepted by December 31, 2014 will be recognized as founding members and will receive a year of membership free.

Providence Health & Services partners with Patrick Soon-Shiong’s molecular medicine institute to buy a $10 million population-scale genomic sequencing system best known for breaking the under-$1,000 test barrier. Providence will use the genetic information to tailor cancer treatments to individual patients, processing the information on Soon-Shiong’s supercomputer array run by the NantOmics division of NantHealth.

Government and Politics

A GAO report concludes that Healthcare.gov has cost taxpayers $840 million so far and warns that continued CMS mismanagement, including sloppy contracting practices and poor oversight, will cause problems in the upcoming November open enrollment period. Accenture’s initial contract for $91 million to replace the fired CGI has already swelled to $175 million through June due to design revisions. CMS agreed with the report’s recommendations that they get their act together, which would have been nice a few hundred million dollars ago. Surely nobody other than the federal government could roll out a billion-dollar website. Maybe we taxpayers should develop our own Meaningful Use performance standards (with GAO’s help) and cut HHS’s budget for failing to meet them.

The Cover Oregon health insurance signs a $70,000 contract its former CIO Aaron Karjala, who resigned in March after the $134 million system’s failure. The state hopes he will help them build a case in their lawsuit against Oracle.

The CIA admits that its officers hacked into the computer network of the Senate Intelligence Committee, which oversees the agency.

Technology

George Takei gets a smartphone physical in Boston, although he seems more amused than impressed. 

Other

Dan Nigrin, MD, MS, SVP/CIO of Boston Children’s Hospital (MA), publishes an article in the just-released issue of The New England Journal of Medicine called “When ‘Hactivists’ Target Your Hospital.” It describes the orchestrated distributed denial of service (DDoS) attacks launched against the hospital by the hacker group Anonymous, which was upset about a child custody case. Data traffic jumped 40 times normal, although the hospital blunted nearly all of its impact by working with a DDoS defense vendor, which rerouted traffic to is filtering center and sent only legitimate web page requests through to the hospital. The group also tried direct network attacks and blasting phishing email hoping an ill-advised employee click would give it access. Dan urges hospitals to inventory their Internet-dependent systems and develop contingency plans if connectivity is lost, such as in their case where prescriptions could be created but not sent electronically to pharmacies. The hospital also temporarily shut down its email systems to figure out how to handle the phishing challenge and found quite a few undocumented internal processes that require email.

I’m trying not to swear at a writer’s incorrect summary of a predictably pro-EHR study from HIMSS Analytics (and published in two HIMSS-owned publications). It found that hospitals that are higher up the EMRAM ladder had better patient outcomes in some areas. For the zillionth time, correlation doesn’t equal causation. I have no doubt that hospitals that can run and afford Stage 6/7 EHR implementations can deliver better outcomes for specific diagnoses and procedures. However, that doesn’t mean the EHR contributed to the result just because it’s there. I bet there’s a similar correlation between patient outcomes and hospitals whose cafeteria features a sushi bar, but that doesn’t mean that adding sushi bar will improve heart attack survival rates. I would be more impressed with a vertical study that compares a single hospital’s results before and after EHR implementation. Don’t blame HIMSS Analytics since they were careful to use the word “association” – it’s writers who have never worked a day in healthcare or healthcare IT who are declaring authoritatively but inaccurately as they try to explain topics way over their heads.

A woman sues her plastic surgeon after finding before-and-after pictures of her face on his website with the label “cocaine nose.”

Weird News Andy calls this story a triple threat. A Michigan man dies when a medical problem causes him to crash his car into an abandoned house, which turned out to be full of swarming bees that kept rescuers from reaching him.

Sponsor Updates

• Six hundred Aprima users have signed up for the company’s user conference, which will be held August 8-10 in Dallas. ONC Deputy National Coordinator Jacob Reider, MD will deliver the keynote address.
• PerfectServe publishes a blog post called “TeamSTEPPS – Building a Support System for Safety.”
• CitiusTech is profiled in Forbes.
• Azam Husain discusses the importance of identity management for protecting patient health information on Caradigm’s blog.
• IHT2 shares a graph displaying the top 10 challenges faced by EHR users.
• Sagacious Consultants donates $10,000 to Wounded Warrior Project, Camp American Legion, the Legacy Fund, and the Aaron Grider Foundation in support of veterans.
• HIMSS Analytics Data reports that Imprivata OneSign is used by 51 percent of hospitals using McKesson’s Paragon or Horizon EMRs.
• Encore Health Resources CEO Dana Sellers discusses the company’s acquisition by a Fortune 500 company.

EPtalk by Dr. Jayne

I’m always on the lookout for any product or service that can make patients’ lives a little easier when they have to navigate the crazy healthcare world in which we live. I was excited to learn about CoPatient, which offers free audits of medical billing documents. The patient provides the bills and insurance information and they review and provide a no-charge report with a list of itemized costs and potential errors. From that point, patients can try to resolve the problem themselves, or CoPatient will handle the appeal for a fee.

They offer a “Negotiator” level, which is a flat 30 percent of the savings obtained. The “Guardian” level offers historical review or processing of regular medical bills through a monthly individual or family subscription. The Guardian level also includes use of their mobile bill pay app, but it’s full so you’ll have to go on a waiting list. I just finished fighting with my insurance company over an erroneous biopsy charge (I think I’d know if I had one). Based on my hourly salary and the time it took to resolve the issue, it would have been worth letting them handle it.

I had fun this morning doing a project for the urgent care where I moonlight. Although we use paper charts, many of the physicians work at other facilities where EHRs are in use. The lack of a way to electronically check medication prescriptions for patient safety and drug interactions has been a concern for several of them. I brought it up when I joined and offered to help find a system when they were ready.

We had a situation Monday night where I needed to urgently sign a Family and Medical Leave Act form that a patient brought by the office at the last minute. I’m on a belated birthday trip this week and had no access to a printer, let alone a fax machine. I signed it electronically using DocuSign (incidentally a new HIStalk Gold Sponsor) and emailed it back. Our managing partner was impressed that I knew to do that and emailed a few hours later asking me to look into eRx systems.

I knew of a couple of standalone systems but visited the Surescripts website to compare features. I was surprised by the sheer number of prescribing systems out there, whether freestanding or part of an EHR. I narrowed it down to a handful and started gathering information.

I’m planning to do a trial of the National ePrescribing Patient Safety Initiative product from Allscripts. The fact that it’s free is certainly a draw. It looked easy enough to register for the system and I’ll hopefully have time to do that in the next couple of days. I’m not scheduled to work at the urgent care until next week so we’ll have to see what I know by then.

Have you used a stand-along eRx system? Any advice? Email me.

Contacts

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

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Morning Headlines 7/31/14

Healthcare.gov: Contract Planning and Oversight Practices Were Ineffective Given the Challenges and Risks

A GAO report concludes that Healthcare.gov cost taxpayers a total of $840 million, including $150 million spent fixing the site after its failed launch.

Merge Reports Second Quarter Financial Results

Merge reports Q2 results: revenue is down 5.9 percent to $53.8 million for the quarter, EPS $0.05 vs. $0.01, beating analyst estimates on both.

Full-time Health IT Workers Aren’t As Happy As Consultants

A new employee satisfaction survey finds that consultants working in health IT are more satisfied with their job (43 percent vs. 19 percent) and their pay (40 percent vs. 18 percent) than traditional health IT FTE’s.

PCORI Board Approves $54.8 Million in Funding for Patient-Centered Comparative Effectiveness Research Projects

PCORI today approved $54 million in new grant awards that will support 33 new research projects. The new funding of brings its total contributions to $549 million, spanning 313 research projects.

Readers Write: From Rice Fields to Big Data

From Rice Fields to Big Data
By Ping Zhang

My journey into technology was a long road. The first 15 years of my life were spent in the Hunan province in rural southern China. My family had no running water, and more often than not, we went to bed hungry.

At five, I started working with my father in the rice paddies. I planted rice seeds while my father manually built rice rows and dug irrigation canals. Everything was done by hand. It wasn’t until I was 11 that I saw my first technological advancement — a tractor — on my way to school.

At age 15, I rode on a train for the first time on my way to college. It was only then that I realized the promise of technology and how it could save my father’s back and hands from the brutal years of manual labor.

My passion for mathematics helped me earn my bachelor’s degree at 19 in China. After the 1989 events in Tiananmen Square, I decided to try to migrate to the United States. In 1990, I landed in Fayetteville, Arkansas with only my bags and a hundred American dollars to pursue my PhD at the University of Arkansas at Fayetteville. My wife followed soon after.

Eighteen months after moving to the US, I had my first experience with the American healthcare system. Early one Friday evening in 1992, my wife suddenly felt a sharp pain in her stomach. We rushed to the emergency room. We waited and waited – and waited some more. Three hours later, she was finally seen by an OB/GYN doctor.

It turned out that she had an ectopic pregnancy. She had been pregnant, but the fertilized egg had become lodged in one of her Fallopian tubes. Two liters of blood had accumulated as she waited for treatment. She had come close to losing her life.

The next day, the doctor cleared her for discharge with a clean bill of health, leaving us with a bill of a few thousand dollars. One of her Fallopian tubes had been torn open and the other had become so clogged with lost blood that it would likely permanently block any egg. We were told the chances of her ever having a child were slim.

The experience was shocking, scary, and life altering. Thankfully, after years of infertility treatments, she was able to give birth to two beautiful boys.

That horrible experience was over 20 years ago, but I still remember it like it was yesterday. Part of the reason is that I have spent many of those past 20 years working within the healthcare system to change it myself. I want to share three key lessons I have learned over this long journey.

The quality of healthcare is too low

The state of service in American healthcare is far below where it needs to be and where it could be, especially with its skyrocketing costs. But what if our healthcare system operated under a free competition model, much like the retail industry? No department store would ever have its customers regularly wait for hours in line to buy its products – because no one would go to that store any more (and they would book it in the other direction with haste).

Under a similar system for healthcare, providers would have to work much harder and more effectively to attract and adequately serve consumers. Open competition would lead to greater efficiency, lower cost, better quality of service, and more choices for consumers.

More innovation and disruption

Innovation and disruption must be encouraged. Over the past two decades, I learned about the underlying principles of world-class innovation from Silicon Valley. I had mentors who constantly encouraged me to break out of the box, experiment, and try something new and different. Healthcare is clearly not where it should be. We must find a better solution for something as vital to societal and individual wellbeing. Healthcare still needs a Steve Jobs and Apple-like innovation revolution to make it more clinically effective for the consumer and cost effective for all.

For example, what would healthcare look like if we could receive updates and monitor our health through a Fitbit device or health app the same way we receive ESPN notifications on an iPhone today? What if technology motivated us to pay the same amount of attention to our health as we do with our social media networks, and with the same ease? These are the simple concepts that will help us all live longer and save hundreds of lives.

Top-down is not enough; consumers need to become more invested

Consumers themselves must do more to control their own outcomes. As an immigrant to the US, I knew that I had to work much harder than my peers to succeed. Consumers today should adopt a similar drive and approach to their health. Rather than waiting for doctors to treat and prescribe “fixer” medications, we need to work more diligently to lead healthier, more proactive lifestyles – and we have the information and technology to do so at our fingertips.

What was once monopolized by professionals with years of training (and extremely costly) is now available at the nearest Best Buy or app store for just a couple of hundred dollars — or nothing at all. Look to wearable biometric devices as an example; those gadgets can accurately monitor an individual’s health, diagnose risky behaviors based on behavioral research from big data findings, and provide information on how to live a healthier, lower-risk life.

I am thrilled that my sons get to reap the benefits of a wonderfully innovative country that is slowly, but surely, transforming its healthcare system for the better. Sooner rather than later, as my boys grow into husbands and fathers, we will move past the times when emergency care is almost as painful as the medical ailment that necessitates the visit. And if we don’t, we’re doing something very wrong.

Ping Zhang, PhD is SVP of product innovation and chief technology officer of MedeAnalytics of Emeryville, CA.

Readers Write: 20th Century Man

20th Century Man
By Barry Wightman

"I work in healthcare during the day, then I go home to the 21st century."

Dave Levin, MD, founder/CEO of Tres Rios Group (@DaveLevinMD), uttered these stinging words at last week’s OnBase + Epic User Forum in Cleveland. Thanks to our friends at Nordic Consulting (@Nordicwi), who tweeted this in real time on the jungle network raising, I’m sure, a knowing smile on many a grey-haired regular Joe technology type such as myself in health IT-land. Now, I’m not here to comment Dr Levin’s presentation, but with that tasty, snarky comment, he hit on something I’ve been wanting to get off my chest for a while now.

It’s all déjà vu all over again.

And it starts with an old Kinks song.

No, really.

Good old Ray Davies, on the fine Muswell Hillbillies elpee of 1971, sang, “I’m a 20th century man but I don’t want to be here….” (cue chiming guitars and thumping drums.)

And here we are in healthcare’s 2014 and those words still ring true. And we’re faced with vast data centers that don’t interoperate well, processes and workflows that haven’t changed much since, well, let’s say the ‘90s.

Some folks complain about EHRs, saying they’ll never work – which is like attacking the telephone as a useless gadget in 1910. Yes, healthcare is conservative, slow to change, and it is a vast, terribly complex industry. But still.

See, I come out of the high-end computing and communications world of the last 40 years and we all know about the technology revolutions that came out of that time.

And it all had to do with the decentralization of power.

Power to the people.

Here’s what happened:

• Big iron, mainframe computing was overthrown, or, at least changed forever by personal computing. The data center data processing IT gatekeepers of the ‘60s/’70s, the men in the white coats (not docs) lost their complete control. Big mainframe data centers were then called “glass houses” – complex and unknowable, sealed safely away from the actual user rabble. Then user peasants with pitchforks began throwing rocks.
• Distributed processing was invented in the ‘70s/‘80s – in which mini computers and personal computers were bought by company departments, who, fed up by the long delays and general stick-in-the-mudness of corporate IT, took matters into their own hands. Lotus 1-2-3! Excel! WordPerfect! Soon, IT was surrounded. Some bit of chaos ensued. Luddites were outraged.
• Interoperability became an issue. Can I get my 1980s IBM 3081 mainframe or Cray supercomputer to talk with all these blazingly fast minicomputers and those crazy PCs and their newfangled servers? Can I get this application to communicate with that application on a batch or maybe even real-time basis? Will this data jive with that data? Oh man. There was even a huge Silicon Valley trade show called Interop. Big business. You can look it up.

And, over time, it all began to work. Standards emerged: TCP/IP, the Open Systems Interconnection (OSI) Model, designed to facilitate application-to-application communications. Forums and user groups were founded. Requests for comments solicited. Hardware and software vendors cooperated. Open systems mostly won. Proprietary systems mostly lost. Not bad.

And new business empires were built. Microsoft, Cisco, Apple, and an endless army of startups who followed in their wake disrupted markets as they went, changing the world.

Fast forward to now. Healthcare. We’ve been there before.

Thing is we’re still there. Maybe about 1990. EMR/EHR monsters have emerged: Epic, athena, Cerner, et al. The big payors – you know the list. Crazy startups in new markets are bubbling under – population health, mhealth. And there are user revolutionaries out there – visionary clinics and system departments who are moving ahead on their own, confounding CIOs and IT (with whom I have much sympathy – which reminds me of another old tune).

And just like in 1990, with the World Wide Web just around the corner, then gestating in gov, mil, and edu domains, everything changed.

And we won’t have to live in the 20th century with the Kinks. (Not that that’s a bad thing.)

And Dr. Dave Levin will be happy.

And so will we.

It’s gonna happen.

Barry Wightman is VP of marketing of Forward Health Group of Madison, WI and the author of Pepperland.