Morning Headlines 7/22/14

HealthEquity Sets $100 Mil IPO Terms

HealthEquity announces IPO plans that will raise $100 million through the sale of 9.1 million shares valued at between $10 and $12. The offering is being underwritten by JPMorgan and Wells Fargo Securities.

UNC Health Care bounces back from operating loss

UNC Health Care is forecasting a $53 million profit next year, up from last year’s $12.2 million loss which CFO John Lewis attributes to expenses related to its system-wide Epic implementation.

Big Data Peeps At Your Medical Records To Find Drug Problems

NPR covers the FDA’s $116 million mini-sentinel project, a data analytics initiative aimed at uncovering unknown side effects in post-market drugs and medical devices.

iEHR redefined: DOD’s top 3 tactics in VA turf war detente

Government HealthIT traces the remaining funding allocations for the defunct iEHR program, highlighting the various modernization and interoperability projects now being pursued instead

.

Curbside Consult with Dr. Jayne 7/21/14

A lot of people are talking about the recent JAMIA article that looked at whether Stage 2 Certified EHRs are ready for prime-time interoperability. It concluded that four key areas need to be addressed to improve CCDA quality. One area is “terminology vetting” for the multiple vocabularies used including SNOMED, LOINC, and RxNorm. Another area is reducing the amount of data that can be “optional” with a product still receiving certification.

I agree with both of those, as well as the paper’s assertion that document quality needs to be assessed in “real-world clinical environments.” However, it’s highly focused on the technical aspects of document exchange rather than the actual intellectual quality of the document being exchanged. I wrote about the quality (or lack thereof) of some physician notes a couple of weeks ago. Unfortunately, there are more elements besides the provider’s narrative and abbreviations that are problematic.

My health system is the ultimate best-of-breed nightmare, so I can attest to the fact that some vendors’ incorporation of the clinical problem list into the CCDA reads like one of those “choose your own adventure” novels. Is it an active problem, chronic problem, recurrent problem, or something that just happened once in the past? With some of our documents, I just cannot tell what it is trying to depict. I often feel like I have chosen a path to nowhere, just like the books.

There are fundamental differences between how physicians and other clinicians are trained to sort information. When I trained at a fairly “classical” medical school, we were taught that all of the patient’s problems were part of the Past Medical History, even those that were not truly past such as chronic hypertension, diabetes, obesity, etc. When I helped bring our organization into the EHR universe more than a decade ago, it took while for providers to get used to the idea of a chronic problem list being different from the PMH because many providers still wanted to include everything in the PMH.

Now we’re at the point where we have to educate them on the SNOMED-codified Problem List and how it differs from the ICD-10 Assessment List, even though there may be two codes that represent a single disease. I have finally gotten over it, but many of our physicians are still struggling with the concept despite having been trained two or three times.

Some of the CCDAs seem to comingle the two. It’s maddening. I’m tired of opening vendor support tickets to try to figure out if they’re functioning as designed or just messy. They must meet the letter of the law to receive certification, but that doesn’t necessarily mean they’re good for patient care or educating the patient on the conditions noted in his or her record.

Whether or not Eligible Providers are meeting the letter of the law or the spirit of the law with Meaningful Use is another hot topic. Lately, my running habit has been taking a toll on my feet, which prompted a trip to my favorite foot specialist. He’s a good friend of mine and part of a husband and wife team practice. They’re fiercely independent and have successfully deployed a Certified EHR over the past couple of years. We always chat about EHRs and where they stand.

I knew they were getting ready for attestation when the rooming technician came in with a wrist blood pressure cuff. In practice, I’ve found those kinds of cuffs to be notoriously unreliable, so I asked him if he wanted me to just self-report some numbers that would be accurate. He declined my offer and proceeded to document the 141/87 that the cuff read out. My blood pressure hasn’t ever been that high, but now it’s in my chart. When my colleague came in, I asked him what he thought about it. He wasn’t thrilled and said it sounded like some coaching was in order.

We talked a little bit about integrated vital signs monitors that would make things easier. He then he admitted that they’re thinking about throwing in the towel on MU. Their vendor has been doing a good job helping them dot the Is and cross the Ts, but the thought of an audit scares them. With all the points that must be perfect for an honest attestation, they are wondering if it’s worth the risk. Right now their patients are happy, their staff is happy, and their practice is running well enough from a business standpoint, so why upset the apple cart?

I don’t disagree with them. At times it doesn’t seem like it’s worth it. A lot of practices are just operating out of fear of future penalties or fear that commercial payers will adopt the CMS standards. Fear isn’t really a healthy way to run a business, however.

Since we’ve been friends for a long time, I offered to do a peer audit for them using my knowledge of MU to see how close to compliance they are. There are plenty of professional consulting firms that will do practice audits and they may want to ultimately do that, but are interested in seeing where they sit from a friendly point of view.

In the olden days (or in a truly free market economy) we could have traded some consulting for a free cortisone shot or something like that, but the insurers would take a dim view of that, I’m sure. Given my CMIO role, I also have to be careful about doing anything that could be interpreted as a donation from the health system so I don’t run afoul of any anti-kickback rules. When all is said and done, it will be interesting to see how many providers end up opting out of MU and what percentage of them are independent physicians.

Are any of your providers opting out of MU? Email me.

Email Dr. Jayne.

HIStalk Interviews Amy Abernethy, MD, PhD, Chief Medical Officer, Flatiron Health

Amy Abernethy, MD, PhD is SVP/chief medical officer of Flatiron Health of New York, NY.

 

You’re going from ivory tower research and patient care to work for a start-up run by a couple of twenty-something Internet millionaires who have no healthcare experience. What do you hope to accomplish at Flatiron Health that you couldn’t do at Duke?

For the last decade or so, I’ve been working under the basic premise that a fundamental challenge in better bridging research and clinical care was the lack of interoperable or real-time data. I’ve been working on this problem from every direction, usually with cancer care and research as my demonstration model. Sometimes my approach was to focus on how to create the data stream. Sometimes I focused on cyber infrastructure. A lot of other times, my focus was from the point of view of, “If you have the data, what would you do with it next?”

In this vein, I thought about the context of clinical use as well as other problems like storing the information for research, quality, etc. in the future. It has been clear over and over again that a key bottleneck to solving the problem has been in creating the right kind of data infrastructure that is large enough and represents a broad enough footprint of the whole population.

About a year ago, I started learning about what Flatiron was trying to do. It’s interesting the words that you described, “Internet millionaires who didn’t know anything about health IT or healthcare.” That’s exactly where I was when I first started talking to them. They would call me and I would give them a hard time on the phone, and then otherwise that was the end of the conversation. But every single time I said to them, “OK, here’s what I think you need to solve and here’s what I think you need to do next,” and then, a month or two later, they would call me back up and they had done it.

Over the course of about six to eight months, they advanced a series of what I thought were critical steps to solving this problem, at least within the cancer space. By March, the convergence of those steps got me to the point where I said to myself, ”If I’m going to truly work on this problem, solving it and taking it to the next level, then I need to not be watching from the ivory tower, but right in the middle of it. I need to help lead it forward.”

It sounds as though you’re buying into their premise that oncology needs to be disrupted.

I am absolutely buying into that premise. From the standpoint of being an oncologist, I have sincerely believed that it needed to be disrupted for a very long time. But I feel like I have been playing around with how to disrupt it and have been more nibbling on the edges rather than getting into the center of the story.

As this year has progressed and I’ve been talking more and more to Flatiron, working with important groups like the American Society of Clinical Oncology, laying out a roadmap for learning healthcare, etc. it became clear that solving this problem was part of the major disruption action.

Oncology is more patient-centered and longitudinal in treating patients for years. In your TEDMED talk, you talked about using data both from providers and from patients themselves more effectively. How do you see all of that feeding together and what’s the patient’s role in creating this data?

I’m going to take that question into two parts. On one side, I’m going to talk a little about why I think oncology is a unique space, then also talk about what I think the role of patients is.

From a standpoint of oncology being a unique space, in 2009 or so there was a paper in Health Affairs by a guy named Lynn Etheredge that set out the premise that if we’re going to solve the Medicare dilemma — in other words, making Medicare sustainable — we need to attack it from the point of view of oncology. My point is that I’m not the first person to say what I’m about to say, but it has started to crystalize and become clear over the last three to four years.

Oncology is unique because of some of what you said, which is there’s a longitudinality to it. We follow patients very intensely and have very close connections over time. It’s also a space where the science and the clinical care meet.

If you want to solve problems in learning healthcare where the science is as visible and as expected to be a part of the clinical space as the rest of clinical medicine, oncology is a good place to do that. Its a place where the conversation around a patient being involved in clinical trials is a given, not an extra conversation on the side. Then there’s an inherent urgency to cancer care and research; an inherent patient and family centeredness to it.

Then, frankly, it costs a lot of money. The expense of cancer care is going up both because it’s now becoming one of the dominant causes of death, if not the leading cause of death, worldwide. Interventions are getting more and more expensive.

We’ve got this confluence of reasons that make oncology a good use case, a demonstration model. It’s not the only place we’re ultimately going to need to solve this problem, but it’s a good place to start.

The other question that you had was something that I really believe in, which is that patients shouldn’t be a sideline in the story, but need to be central to the story. When we talk about learning health systems, it’s as if the unit of goal optimization is the health system itself. But shouldn’t it be that we’re optimizing healthcare because it’s better off for people and for patients? Instead of optimizing healthcare so that the hospital makes more money or the health system is financially sustainable, let’s focus on better care for patients, with improvement of the health system as a byproduct. That’s a much better model.

I always start off my thinking about how to tackle these problems with the patient at the center of the model. An interesting thing happens when you do that. One of the big issues in learning health systems is data linkage — the ability to take care of populations, the ability to follow people longitudinally over time. When you center the conversation on the patient first, it is much easier to think about how to solve some of those problems.

I have found that by disrupting even our way of thinking about learning health systems so that the patient is the central unit of what we’re thinking about as opposed to the health system being the central unit of what we’re thinking about, we approach solving a lot of problems much differently and smarter.

We’re also in an interesting place where the kind of data sets that we’re going to have in the future aren’t just going to be, for example, electronic health record data or administrative data. It’s going to be data generated by patients, by people, wherever they are.

I started off doing this work in patient-reported outcomes and thinking about how we ask about their symptoms, their quality of life, what is meaningful as it relates to health and healthcare. It turns out that technology enables us to imagine a world where you can ask a patient about symptoms sitting in the clinic waiting room or you can ask about symptoms when the person is sitting in their home in Asheville, North Carolina. You can follow people in between the visits, etc., gathering a much clearer picture of the longitudinal story and implications of different health interventions. 

The land of patient-generated data is getting more and more interesting. The ability to use biometrics and sensors and understand what our world looks minute to minute and day to day from an individual person viewpoint really changes the landscape of how we use big data to solve problems in healthcare. The ability to think of glucose data not just as a data point being generated by the hospital lab, but as glucometer-based data that’s coming from the home.

We’ve been collecting these kinds of data for a long time. The home glucometer is nothing new. Pain became the fifth vital sign in the 1990s. But we haven’t really systematically thought about how this is a part of our national data set in order to solve the problems of learning healthcare. When it comes to patient centricity, it shouldn’t just be a byline, but part of the way you think about designing and developing our systems.

When people think of oncology data lately, they’re probably thinking about applying genomic information to treatment decisions or sharing protocols from major cancer treatment centers. How do you see all that fitting together, particular on the genomics side?

The genomics side again is a really nice use case. I don’t think you or I believe that genomics is going to be the only scientific story in the future. There’s going to be a lot of other ones. But if we can start to get our head around how we merge what’s happening within the context of life sciences and basic sciences with clinical annotation of basic science data putting biological discoveries into context of what happens for individual patients, our science will be much better.

Those two pieces need to come together. In order for that to happen, we need to do a lot of things. One is we need the cyber infrastructure that allows that to happen. It’s the combination of bioinformatics as we’ve classically thought about it plus clinic informatics and applied informatics and the emerging combination of these, including dealing with everything from the storage, data quality, and data use issues. Also starting to think about how much information do you really need to store for this particular patient, how do we analyze it, what is the right research to conduct, and what should that look like.

Another example of what we’re going to need to deal with is trying to get our heads around if we did have a cyber infrastructure, how do we thoughtfully manage the security, confidentiality, and privacy issues? If we are bridging between questions in clinical research and healthcare quality, how do we deal with questions of permissions, consent, and human subjects protections? These pieces are starting to crystallize, but we have a long way to go.

The genomics use case also takes us into the clinical applications side. As we start to have more genomics-informed cancer care, for example, how do we help clinicians and patients make snap, very quick, well-informed decisions at point of care so that we’re surfacing in real time the right combination of this person’s genomic profile, coupled with what we know are the right drugs for that particular clinical scenario, and understanding that there are limitations to what’s possible depending on reimbursement scenarios? It needs to be the complete complement of data in order for clinical decision support systems to be truly useful and not annoying. As a very basic example, if we surface genomics plus drug information independent of reimbursement, we’re not doing anybody any good.

Ultimately, solving these problems for genomics and, along those lines, next-generation sequencing, within the context of cancer care, presents us with a great use case that’s going to be replicated multiple times.

Oncology is a lightning rod is from a societal perspective. Hospitals that suddenly start treating oncology patients as outpatients because they mark up their visit higher than oncologists in the office, for-profit cancer chains, oncologists paid to administer or incented to administer more expensive drugs, a lot of pharma influence, the pharmacoeconomics of expensive drugs versus what benefit the patient gets. All those are issues interfere with the pure science and medicine of how cancer is treated. Do you see that being something that Flatiron will help resolve?

This is the reason why data is the bridge. All of those problems have as a foundational or fundamental underpinning — the need for discrete, interoperable data that can be reused to address each of those things simultaneously. Whether or not you’re actually trying to get the science smarter or you’re trying to optimize reimbursements, you need essentially the same data points to do so.

One of the reasons that I made the jump from academia to industry is to try and figure this out. Resolving all of these problems means that first you’ve got to deal with the data bottleneck. But at the same time, you need to be doing R&D work, imagining a world when the data bottleneck is solved and answering the question of “and what do I do next.” You have to be ready to work through all of those different, as you said, lightning rod questions, which is going to take a lot of work and practice.

While ultimately the data are substrate and producing the data streams that can be analyzed to solve those different problems is a fundamental underpinning, after that you still need to advance the work in the analytics space, align culture, sand out processes including scientific methods in order to pull all of the pieces together, etc. I have this one talk that I always give on the convergence of personalized medicine, comparative effectiveness research, healthcare quality, healthcare optimization, and patient centricity. If you take all of those, the one common element is interoperable data.

Along those lines, along with the announcement of the Google Ventures investment in Flatiron was its acquisition of Altos Solutions and its oncology EMR. Was that done as a way to get quick access to a lot of oncology information without having to do individual integration with the varieties of EMR systems that are used by oncologists and hospitals?

There’s a couple of pieces of an answer here, so I’m going to take it separately. First of all, the way that Flatiron is doing its work is EHR independent. The idea is essentially to extract the data from the back end use a process of technology-enabled chart abstraction and other techniques to make it to a common data model. This dataset can then be integrated with other data feeds like the Social Security Death Index. It doesn’t matter if it’s Varian or iKnowMed or Epic Beacon from an oncology EHR standpoint.

The addition of Altos revved the engine, because at least now there’s one cloud-based oncology EHR that has essentially a single instance and doesn’t require a different setup for every single site. But is really essentially one additional extraction to an overall model. That’s the first point of efficiency.

It also catalyzes or adds a jump to the next level in terms of acceleration of footprint for the number of oncologists and therefore their patients represented in the national footprint for Flatiron. Those two things are important and near-term wins for why Flatiron bought Altos, but now you’re going to hear Amy’s part of the story.

If you take what I just said — and I love the way you said it was a lightning rod – oncology is a lightning rod for all these pieces coming together, not just solving the science and genomics, but it’s the comparative effectiveness research, figuring out how to optimize healthcare, etc. As I mentioned, data is the fundamental substrate, but then you have got to learn what to do with it next.

A lot of that also is clinical decision support for personalized medicine and other interfaces directly in the clinic at the right time with doctors and patients to make healthcare more efficient, patient centered, and of better quality. For example, better allocation of care along predefined evidence-based pathways and monitoring of whether the care provided actually aligns with the evidence. The availability of real-time education.

Altos as a cloud-based EHR will provide Flatiron with a beautiful, national scale living laboratory to try out all the different ways of using and reusing data in the context of what EHR can do for you. It’s a near-term win in terms of data sets and efficiency, but the real big win here is in terms of a national living laboratory where Flatiron and clinical partners can work together to use technology tools to make cancer care better. Now that’s a use case.

Other than that acquisition, $130 million is a pretty big investment for a startup. How will that money be used?

A key aspect of the focus of Flatiron for the next two years or so is going to be making sure that the corporate philosophy is well attended. This includes building the tools that are needed, making sure that clinical practices are well served in terms of having their data extracted and getting them meaningful processed data back that’s actionable at point of care, and the scale from the technology development side in order to support key data partners like the life sciences. We need to ensure that this happens efficiently and with the right kind of engineering focus. That’s going to be a big piece of it.

There’s also ongoing work on how we surface this information, optimal data visualization solutions, how to help clinicians and practice administrators understand the information as efficiently as possible, how do we optimally interface with patients. There’s already a current product, OncoAnalytics, that allows practices to see their data in a dashboard format. It’s really good and certainly much better than anything they’ve already got. But how do you really rev that engine up for data users of all types? That’s going to be a place of substantial investment as we think about how we can get more and more information to practices, life science partners, health systems, researchers, professional bodies, etc.

Why is that so important? We need to see all users of the data, doctors and patients and health systems and sponsors, as key constituents. To create a national data set, it needs to be sourced from many, many places and those different contributors need to see value as to why they want to keep participating and contributing. And it needs to be used. Data quality improves when data are used, not hoarded. Servicing those places is a critical focus.

Do you have any final thoughts?

One of the things that’s been interesting to me and for me is personally making this jump. I haven’t left academia entirely. I still have a 20 percent footprint at Duke, which I maintain so that I can keep working with clinicians and others on solving the problems that we will be able to solve when the data bottleneck is resolved, on mentoring, on other aspects of R&D.

While it’s clear to me that Flatiron is the right vehicle with the scale and talent needed solve this data bottleneck, it was also important to continue to develop the future talent that will be needed to support the next steps in the vision. That’s where my Duke job comes in. Academia offers a unique place for growing the next generation. We all must keep our eye on the big vision, hammer home hard on the key tasks that have to be sorted out, and prepare for the exciting future.

Morning Headlines 7/21/14

The Leapfrog Group: Hospital Survey Report

The Leapfrog Group publishes its annual hospital report which says that while CPOE adoption is on the rise, the systems being implemented are failing to alert physicians far more often than expected, with “ the proportion of all orders that did not receive an appropriate warning remaining at 36% and the number of potentially fatal orders that did not receive an appropriate warning falling from 14.2% in 2012 to 12.5% in 2013.”

New York City Health and Hospitals Corporation Selects QuadraMed  for QCPR Meaningful Use Eligible Professional Software

The New York City Health and Hospitals Corporation, which selected Epic last year and was subsequently sued by Allscripts over the decision, announces that it has selected incumbent QuadraMed to provide software to its practice offices.

GE Healthcare 2Q profits increase slightly

GE Healthcare announces Q2 results: revenue fell 0.7 percent closing at $4.48 billion for the quarter, however, profit climbed one percent to $730 million up from $726 million for the same quarter in 2013.

Monday Morning Update 7/21/14

Top News

The Leapfrog Group’s just-released 2013 survey finds that 43 percent of the 1,400 responding hospitals entered at least 75 percent of medication orders in a CPOE system with clinical decision support. However, a third of the CPOE systems tested by 931 hospitals failed to failed to warn physicians of serious ordering problems.

Reader Comments

From Veteran SQ Vendor: “Re: Sunquest. I just returned from SUG and Matt Hawkins was a brilliant choice by Roper. The culture change is discernible and Hawkins is approachable, involved, listening, and leading – which have been missing for a long time. I hope it’s not too late.” Sunquest previously violated one of my key predictors of success – its top executive refused to move to its headquarters city (Tucson). The company also had some defective Misys DNA in its gene pool, put quite a few inexperienced aptitude hires in jobs they’ve failed at, runs a questionably integrated office in India (was that redundant?), and in typical lab analytical fashion thinks everything important can be measured and managed from a spreadsheet. Sunquest’s overall problem is that it’s a market leader in a saturated niche in which Epic and other vendors are nibbling away at some of the decreasingly sexy core LIS business and its lab customer has to take one for the (integrated) team, which makes it an expiration-dated cash cow unless it can figure out how to innovate again. Also, hungrier companies are going after the genomics and personalized medicine business where the company should be strong. All of that is fine as long as Roper doesn’t expect a lot of future growth for its $1.4 billion investment — you can only squeeze the existing base of cash-strapped customers so much. Matt needs to take a firm hand in re-establishing the connection between his office and the troops, try to compensate for all the private equity BS the remaining employees have had to deal with, clear out the management deadwood, articulate a position of where the company is going beyond the comfortable box in which it works, and put together a team that can handle an acquisition or two in the not-too-distant future. That’s the unsolicited advice I would give most new CEOs, and at least Sunquest doesn’t need to make reactive changes quickly since Roper seems patient.

From NP: “Re: NantHealth. SVP and former iSirona CEO Dave Dyell is the latest in the ranks of departing execs. He was working to integrate Patrick Soon-Shiong’s myriad acquisitions and deliver on the good doctor’s immense (but confused) vision for healthcare, but fell victim to Nant’s micromanagement and acquisition indigestion.” Dave verifies that he has left NantHealth, which will probably be concerning to iSirona users who don’t care about PSS’s grand plans as long as their medical device connectivity keeps working.

From Sugar Sister: “Re: vendor demos. I viewed several lately. Epic may not have a marketing department, but they must have a showmanship department given their slick show with Wisconsin jokes. Their software is also slick – it reminds me of Apple in its attention to detail. You only get a product to that level if someone in authority demands it. Athenahealth is not a cloud-based solution. ‘Cloud’ means your data can be stored anywhere and your instance could be running anywhere. Athena knows exactly which specific database server has a particular customer’s data and which server it will fail over to. That works, but investors are right to question the cloud marketing spin. Athena has so many customers that have attested to MU2 compared to other vendors because those other users haven’t upgraded their systems yet. Epic has way below 50 percent of customers running the latest production version. Athenahealth is like a Greyhound bus – if you don’t want to worry about anything but seeing patients, leave the driving to them. Epic is a Cadillac limo – a beautiful ride if you hire a driver who knows the roads.”

HIStalk Announcements and Requests

Poll respondents said their success comes from hard work and building relationships rather than education, luck, and planning. New poll to your right: do you own stock or other equity in a healthcare IT-related company?

I hit an internal buzzword-and-hype limit the other day after reading too many overwrought press releases. I was thinking that if a hospital report writer wrote a cool list of diabetic patients who hadn’t been seen in six months, a vendor’s marketing team would be announce it as, “Cloud-based business intelligence and population health management analytics, powered by a comprehensive, scalable patient engagement and clinician workflow platform whose real-time alerts and actionable insights support the Triple Aim of improving patient experience, advancing health, and reducing costs.”

Listening: new Finnish operatic metal from Amberian Dawn, with new singer Capri and without (thankfully) the background grunting often found in so-called “Beauty and the Beast” female-led Northern European metal. I explain the genre thusly: ABBA backed by Black Sabbath.

BOSS Award Winner – Amy Thomas

Our first Beacon of Selfless Service award winner is Amy Thomas, interface architect at Edward Elmhurst Healthcare, Naperville, IL. VP/CIO Bobbie Byrne commends Amy for leading a conversion of 120 physicians from NextGen to Epic, using NextGen CCDs from three separate database instances as summary documents and writing extracts to copy patient demographics, future appointments (which Bobbie says “sounds easy but is really hard”), lab and rad results, progress notes, immunization histories, and vital signs. Amy did this while supporting live hospital interfaces and working on ICD-10 and population health management projects. Congratulations to Amy.

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

Acquisitions, Funding, Business, and Stock 

From the athenahealth earnings call:

• Athenanet added 2,500 providers in the quarter, raising the total to 55,000.
• Half of the company’s transaction volume is still paper-based.
• The Epocrates acquisition has created new leads, but its revenue is dropping and the premium version is struggling because it’s too hard for subscribers to renew online. According to Jonathan Bush, “We’re hammered pretty hard by Epocrates which had a very big miss … Epocrates is about half what we thought we would get by now.”
• The company has high hopes for the upcoming Epocrates secure messaging functionality
• Bush says that hospitals have 40 percent unused capacity that could be used to offset their cost of fixed assets. The company has partnered with Accenture to help hospitals open up that capacity with the goal of selling athenaCoordinator Enterprise, which now has three customers.
• Bush says it failed last year in its goal of having its account managers bring in 1,000 new leads, saying, “We knocked out a good, solid 78 leads during 2013, so we had to retrain and reorient our account management teams.”
• Asked about promises to inpatient prospects about athenaCoordinator, Bush said, “Nobody wants to be the first guy on athena’s inpatient thing and nobody wants to be the last guy to drop a quarter billion dollars on Epic, so they’re sitting and trying to figure out which wolf to feed when they come out of their tepee. I pity them. It’s a hard decision.”
• Asked about the company’s More Disruption Please program, Bush described it as, “The leading edge, the exciting new bubbling up from the primordial venture capital ooze is of generation of companies that are performing on the cloud across many clients in a single instance, activities that used to sit in a hospital information system. So suddenly entrepreneurs are saying, ‘These giant enterprise software companies, these single-instance software companies, actually won’t make it and they are old and there’s going to be an opportunity to sell into the nurses and the pharmacists and the inventory management people at the hospital.’ So you’re seeing a collection of cloud-based athena architecture, but more like a Salesforce business model, a monthly user rent type business model community of apps that represent in total kind of 80 percent of the surface area of a complete hospital information system in API connected independent little cool apps.’”
• On fitness tracking and related personal health apps, Bush said that 91 percent of people aren’t patients until some event happens, calling it “100 million conscientious objectors” who care about their weight, body, love life, and people they’re are caring for. He adds that athena looks forward to connecting to Apple’s Health “despite Apple’s decline” and “the quickly rising Samsung stuff.” 
• Bush says that people are recognizing that Obamacare  is “a huge rise in deductibles” and the company will focus on helping its users get the “love and money in equal measure” from their customers.

Above is the one-year performance of athenahealth (blue) vs. the Nasdaq (red), which it trails after a nearly 50 percent ATHN haircut in a two-month period starting in March 2014.

Your money would also have been better off invested in an Nasdaq index fund (red) a year ago than in Allscripts (blue), but at least MDRX shares are moving back up over the past month.

GE Healthcare’s Q2 results: revenue down 0.7 percent, net profit $730 million vs. $726 million.

Sales

New York City Health & Hospitals Corporation chooses Constellation Software’s QuadraMed Affinity QCPR. I assume this is just a renewal since they’ve been running Affinity and then QCPR since the early 1990s. Toronto-based Constellation Software, which sells all kinds of unusual vertical market software, acquired QuadraMed from Francisco Partners in June 2013. It put QuadraMed under its Harris Operating Group, which sells public utility and public safety software. Its other healthcare IT company is ERP software vendor MediSolution.

Other

I missed this from a couple of weeks ago: the private equity fund of former National Coordinator David Brailer, MD, PhD has flopped and its biggest investor, California Public Employees’ Retirement System, reportedly wants to cash out its investment. CalPERS pledged to invest $700 million in Brailer’s Health Evolution Partners seven years ago after he promised returns of 20-30 percent despite his zero experience in private equity and the marginal success of the one company he formed and sold, CareScience. Instead, their money is dead with a 2.6 percent annual return and the only company HEP has sold was for a loss. CalPERS also put $200 million in a money-losing HEP “fund of funds” focused on healthcare. Some of CalPERS’ board members questioned in 2012 the decision to put hundreds of millions of dollars into no-experience company that didn’t actually invest their money until 18 months later. CalPERS also paid $5 million for a 15 percent equity interest in HEP and paid it $52 million in fees in its first five years. Despite Brailer’s stated investment focus in healthcare IT, HEP shows no active investments in healthcare IT companies among its seven portfolio positions. Calpers was initially  HEP’s only investor and the company has declined to say if it has obtained others.

A Stanford biophysicist develops an easily shipped microscope made of folding paper that’s as powerful as a desktop instrument yet can be produced for $1. The Gates Foundation-supported FoldScope project hopes to get the devices to third-world countries for faster diagnosis of infectious disease. It’s one of few TED talks in which the audience breaks out into applause at several points and gives a standing ovation at the end.

Weird News Andy notes that 20-bed Three Rivers Hospital, a Critical Access Hospital in Brewster, WA, has been evacuated due to the 169,000-acre Carlton Complex wildfire that has destroyed 100 homes and shut down power to most of the Methow Valley.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 7/18/14

CVS Caremark Announces New Clinical Affiliations with Four Major Health Care Providers

CVS announces that its MinuteClinic services will partner with ProHealth Physicians in Connecticut, Texas Health Resources in Texas, Palmetto Health in South Carolina and The Baton Rouge Clinic in Louisiana to bring additional chronic disease management services to the population, and to collaborate on medication adherence initiatives.

athenahealth, Inc. Reports Second Quarter Fiscal Year 2014 Results

AthenaHealth announces Q2 results: revenue is up 27 percent to $185 million but  Epocrates-based earnings fell 23 percent to $11.3 million. Adjusted EPS $0.32 vs. –$0.08, beating expectations for both.

Subcommittees Team Up To Learn How 21st Century Technology Can Improve 21st Century Cures

During a joint hearing between the Subcommittees on Communications and Technology and Health focused on the future of technology in healthcare, Rep. Phil Gingrey, MD (R-GA) called out Epic for its resistance to interoperability, saying that the company has indirectly collected billions in incentive payments but is still selling closed platforms.

Starting to Evolve Our Organization and Culture

Microsoft will layoff 14 percent of its workforce, or 18,000 workers, primarily from its Nokia division, as it works to rebrand itself as a “productivity and platform” company.

News 7/18/14

Top News

CVS Caremark signs a clinical affiliation agreement with four healthcare providers (ProHealth Physicians, Texas Health Resources, Palmetto Health, and The Baton Rouge Clinic) whose patients will gain access to clinical support, chronic disease monitoring, and wellness programs at CVS drugstores and MinuteClinic retail clinics. MinuteClinic will send electronic medical histories and visit summaries to each patient’s PCP and CVS will share messages and alerts. CVS announced in February 2014 that its MinuteClinic division would move from its homegrown EHR to Epic’s EpicCare, saying it needed a platform that would allow it to share information with other providers more quickly and give it patient portal and analytics capabilities.

Reader Comments

From Pop Counter: “Re: EHR vendors counting patients. Epic touts 50 or 60 percent coverage of the US population. How do they arrive at that number and how does it align with market share?” It’s an arguably flawed SWAG that doesn’t have a lot to do with market share, but it is a great marketing point from a company that claims to employ no marketing people, where huge marketing billboards magically appear on its HIMSS booth walls without human intervention. The “percentage of the US population” claim is also being used to impress the Department of Defense in its EHR selection. I’ve heard that Epic simply asks its customers (even the non-live ones) to estimate the number of patients they serve, applies some mysteriously derived percentage of potential overlap with other Epic sites, and then just adds it up. But let’s look at it from the point of view of an EHR company engineer being asked by the marketing department to arrive at such a number. Being objective and pedantically pragmatic as engineers often are, you would point out these challenges:

• We don’t host every client system, so we can’t just run some super-query of unique medical record numbers. We have to ask the hospitals to report the number back to us.
• Even though an individual health system may have successfully applied the one-patient, one-record rule, there’s no easy way to de-dupe overlapping patients across multiple clients without some kind of master person index algorithm. As a vendor with multiple health system clients in the same geographic area, we can’t easily account for patients who have information in all of them.
• We would be counting imported CCD record from someone else’s system. Should we really count that as a complete patient record in our system when it wasn’t even created there?
• We have a massive number of old patient demographics that we imported from our legacy system during conversion and we haven’t seen some of those people for 10 or more years.
• Some patients in our database have died, quite likely elsewhere so that we don’t have a record of it.
• Since we have an ambulatory system, we get an easy “credit” for a patient who merely drops by for a one-time ophthalmology consultation or lab test with no plans to return. The “record” in our system is minimal, containing (if we’re lucky) allergies, chronic conditions, and medication reconciliation. Almost everything of value is stored by other providers.
• We as a vendor who sells primarily to large academic medical centers can boast of more patients because of higher churn from referrals, specialty clinics, and large ambulatory practices, all of which see patients who are also in the EHR databases of many other providers. Ambulatory visit patients greatly outnumber hospital inpatients, so the numbers are artificially skewed to favor vendors with many active sites in both, and in fact a large ambulatory EHR vendor may have more unique patients than any hospital vendor.
• It’s not a zero-sum game. The market-leading system might claim 50 percent of US patients, the runner-up could have 45 percent, the third-place vendor might count 40 percent, and so on. That doesn’t mean we’ve sold more systems, have more users, process more active patients, or house complete data on more patients than anyone else.
• As an engineer, I think we need to be careful about implying that having a high percentage of the population covered reflects attributes of our system or our company that are important to prospects. It’s more accurately a reflection on the size and patient diversity of our existing customers.

From The PACS Designer: “Re: BlackBerry. It’s not seen much in the healthcare setting, but that could change if it becomes a takeover candidate. With its shares selling below $10, BlackBerry might soon become a division of Apple since consolidation in the mobile space is starting to happen. The real question is would that be practical for Apple to pursue.” BlackBerry’s market capitalization is down to around $5 billion after a big drop following the Apple-IBM enterprise announcement, which threatens BlackBerry’s one bright spot of mobile device management revenue. However, the company has $3 billion in cash, an enterprise user base that has no instantly appealing alternative, and a bunch of patents, so someone should be interested.

From Point Taken: “Re: GE Healthcare. Any idea of substantive outcomes from the bold 2012 aspiration from GE, saying that it will invest $3 billion in R&D in the Healthymagination program to foster at least 100 innovations to lower healthcare costs by 2015?” I will leave it to GE to respond if they like. I know they’ve done a lot specifically to develop lower-cost medical technology (not IT) in India, but I haven’t heard otherwise. The few press releases on the Healthymagination site are old, the most recent annual report posted is from 2012, and the newest video on their YouTube channel is from 2012.

From Sext Machine: “Re: doctor sexting during surgery. Thanks for the post – we got a kick out of that at our company. Do you know of other physicians who have gotten in trouble for using SMS messaging to share patient data?” I will defer to readers since the “trouble” involved is likely to be more related to internal discipline rather than being formally charged with violating HIPAA. I will say that I talked to a CIO today who implemented a secure messaging system to avoid users sending PHI via text messaging, but then found additional benefit in using the system to coordinate care among physicians.

From CEO: “Re: social media. We’ve been writing a weekly company blog but haven’t gotten Twitter and LinkedIn followers. How can we get better social media visibility?” I should mention that this was an actual (paraphrased) question I received today from the CEO of an HIStalk sponsor. Here was my excerpted answer, which I figured I might as well share in case anyone else is interested:

Company blogs rarely say anything fresh or insightful, often being cranked out by a marketing person or ghostwriter. They also try to appeal to every kind of reader, from newbie to old pro, programmer to CEO, with content that nobody hates but that nobody loves either. As a result, they aren’t going to get a lot of social media attention because they don’t say anything new. I don’t think your tweets will be all that compelling to Twitter users since they are infrequent, mostly link back to company material on your website, and don’t have much personality. People with big Twitter followings tend to be passionate about a subject other than their employer and that enthusiasm shines through. However, the question is whether that even matters. Companies tend to get wrapped up in the number of followers or retweets without having any idea whether that translates into more business.

HIStalk Announcements and Requests

Reminder: you can nominate a non-management employee, co-worker, or vendor person for the HIStalk BOSS (Beacon Of Selfless Service) award. It’s for people who went above and beyond during a specific incident, such as downtime, an IT crisis, bug fix all-nighter, or anything else in which your nominee sacrificed their own self-interest to fix a problem.

We like Niko Skievaski, the former Epic guy who produced “Struck by Orca,” an entertaining book about ICD-10 (he dropped off autographed copies at our HIMSS14 booth). He’s working on a new book, MU2i (MU2 Illustrated), which will ship in September. Artistic types who are willing to contribute a picture can contact Niko.

This week on HIStalk Practice: Mostashari’s Aledade venture works to set up an ACO in Arkansas. Healthcare IT sees its first billion-dollar acquisition quarter. CVS announces new clinical affiliations and a $1.5 million community health center grant program in partnership with IBM. A new independent practice study finds EHR workarounds are used for three main problems. Takeaways from the recent eHI webinar on ONC’s 10-year vision for interoperability. Providers and consultants are welcome to share an “Idea of the Day” with the HIStalk Practice audience. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers the growth of ZocDoc, benchmarking its success against his early predictions for the company. Google announces that it will commercialize its glucose monitoring contact lenses through a partnership with medical device manufacturer Novartis, which hopes to have the non-invasive glucose reading lenses on shelves within five years. Apple teams up with IBM to target the enterprise mobile markets. 

Listening: new from the 60-something metal gods Judas Priest, who sound great even with the album’s horrible production. Also: new Linkin Park.

Acquisitions, Funding, Business, and Stock

Athenahealth announces Q2 results: revenue up 27 percent, adjusted EPS $0.32 vs. –$0.08, beating expectations for both.

Microsoft announces that it will cut 18,000 jobs in the next year – 14 percent of its workforce – with the former Nokia unit taking most of the hit. Like all companies desperately ditching headcount to keep Wall Street happy, the Bill-less and Balmer-less Microsoft says it will simplify processes, increase accountability, reduce management layers, and make itself faster and more agile. I don’t recall hearing the announcements when it made processes more complicated, reduced accountability, added management layers, and let itself get slower and fatter. Microsoft paid $7.2 billion for Nokia in September 2013, which was probably the polite thing to do given that Nokia’s demise was hastened by hitching its teetering wagon to Windows Phone.

Behavioral EHR vendor Valant Medical Solutions receives an $11 million private equity investment.

Medical image exchange platform vendor DICOM Grid gets $6 million in funding from Mayo Clinic and Canaan Partners.

Online doctor search vendor BetterDoctor closes $10 million in Series A funding.

Sales

Texas Health Resources (TX) chooses LogicStream Health’s Intelligence Platform to manage and optimize its clinical decision support. I’ve pored over the company’s site for several minutes and I still can’t figure out how its product works given the maddeningly high-level non-detail it provides in abundance.

Desert Imaging (TX) chooses IDS AbbaDox RAD to manage its radiology workflow.

Children’s Hospital Los Angeles (CA) and Wisconsin Statewide Health Information Network sign four-year contracts for Orion Health’s Rhapsody integration engine.

The FHP Health Center (Guam) selects the eClinicalWorks EHR.

University of Kansas Hospital selects Health Catalyst’s data warehouse.

People

Susannah Fox (Pew Research Center) is named as an entrepreneur in residence at the Robert Wood Johnson Foundation.

Informaticist and former ONC Deputy National Coordinator Charles Friedman, PhD is promoted to chair of the Department of Learning Health Sciences at the University of Michigan Medical School. 

Paient satisfaction and physician reputation vendor SayAh names Warren Dodge (Creekside Healthcare Consultants, Altos Solutions) as CEO.

Announcements and Implementations

TeraMedica completes the implementation of its Evercore VNA for the public health system of New South Wales, Australia, saying it’s one of the world’s largest VNAs in covering 7 million patients, 110 facilities, and nine PACS that process 3 million imaging procedures each year.

The Central Texas division of Baylor Scott & White Health goes live on API Healthcare’s ShiftSelect.

Government and Politics

Two subcommittees of the House Energy & Commerce Committee held a joint meeting Thursday to discuss the use of technology to advance medicine. Above is Rep. Phil Gingrey, MD (R-GA) calling out Epic for selling a “closed platform” whose users have received more than half of the $24 billion in HITECH payouts, asking if taxpayers should be subsidizing the purchase of products that are supposed to be interoperable but aren’t. Gingrey says it may be time for the committee to look at the practices of EHR vendors, saying “fraud may be perpetrated on the American taxpayer.”

Three Arkansas Medicaid patients sue the state for refusing to pay for a cystic fibrosis drug that costs $300,000 per year. The patients meet FDA’s treatment criteria, but the state says the patients must first prove that older and cheaper drugs don’t work for them. According to the executive director of the National Association of Medicaid Directors, “We have this public health mentality that all people have to be cured no matter what the cost, and also let the innovators charge whatever they want. Those are fine theories independently, but when you combine them together in a finite budget environment, it’s not sustainable.”

Innovation and Research

In Canada, Telus Health opens an innovation center in Toronto.

Technology

A physician reviews a $3.99 iPhone app that claims to measure blood pressure using only the iPhone, with the developer suggesting it’s a Johns Hopkins product. The physician reviewer  talked to the CEO (who graduated from Hopkins but is otherwise unaffiliated) who says the app is “for entertainment purposes only” and shouldn’t actually be used to measure blood pressure. He says he’ll consider adding that disclaimer, which should not exactly boost sales.

Other

Medscape surveys 18,000 self-selected physicians about their EHRs. My observations:

• The survey asked, “Are you using an EHR?” which is a horrible question given that (a) it doesn’t distinguish between a practice EHR and a hospital EHR and most physicians practice in both settings, and (b) it doesn’t define “using.” All but 7 percent of respondents said they’re using an EHR or planning to do so within two years.
• The most widely used EHRs (again subject to the limitations of failing to distinguish between practice vs. hospital) are Epic (23 percent), followed by Cerner, Allscripts, eClinicalWorks, and NextGen. Three percent or fewer reported using well-known systems such as Practice Fusion, the VA’s VistA, athenahealth, Greenway, and McKesson.
• The top-rated system was the VA’s VistA, which also had the highest reported user satisfaction. However, the VA’s physician users are all employed and use only that EHR, so they’re probably going to be happier than a community-based doctor who has an EHR in the office plus different EHRs at each hospital in which he or she sees patients.
• VistA and Epic were top rated for connectivity.
• Only 42 percent of respondents said they are satisfied with their EHR vendor, and 16 percent say they’ll be replacing their system (it’s not clear how the hospital-based doctors could have answered this since it’s not their call).
• Overall, the survey’s results are questionable in its failure to distinguish among the multiple settings in which the average physician uses EHRs and its lack of definition of “using” (Entering orders? Having a clerk create a bill? Looking at a hospital rounds list on an iPhone?) For that reason, I would characterize its conclusions as entertaining but hardly authoritative. However, I doubt that will stop vendors and lazy writers from crafting clickbait headlines and swaggeringly wordsmithed stories about the results.

In the UK, Homerton University Hospital NHS Foundation Trust goes live with RFID technology that will track the movement and location of paper charts within the facility. The hospital says it won’t even bother to file patient notes alphabetically since they can just be shelved and located later by RFID. Paper records were tracked previously using Cerner Millennium.

An article in Health and Human Rights Journal profiles New York City’s jail system, which tweaked its eClinicalWorks EHR to help protect the rights of high-risk inmates (the article fails to note the difference between jails and prisons, the former being local facilities housing both those awaiting trial as well as those serving short sentences, so calling their occupants “prisoners” isn’t correct). EHR templates were created to identify injury patterns in vulnerable populations (LGBT, mental illness, injured, held in solitary confinement) consistent with inmate wrongdoing, officer misconduct, sexual assault, and self-harm.

Weird News Andy simply titles this story as “Smile.” Police arrest an upstate New York man for flying a $1,300 video-recording drone in front of the windows of a medical facility’s exam rooms. “Front Row Dave” says he made a mistake but won’t stop “droning.” His Facebook page has a picture of his drone, which appears to be a DJI Phantom 2 Vision+ Quadcopter with FPV HD Video Camera and 3-Axis Gimbal. The video above was made by a guy on a cruise using that same drone, which must be a voyeur’s delight. I’m thinking about flying one over HIMSS conference airspace in Chicago, or perhaps in the exhibit hall.

Sponsor Updates

• Orchestrate Healthcare posts a blog entry, “Healthcare Business Intelligence: Harness the Power.”
• PerfectServe’s VP/Chief Clinical Officer Leigh Ann Myers, RN writes a blog post, “Changing the Culture for SBAR Communications.”
• Kareo opens an operations center in Las Vegas, NV.
• Regenstrief Institute joins ConvergeHEALTH by Deloitte’s real-world evidence and analytics consortium.
• AirWatch by VMware opens registration and lineup of analyst speakers for the Airwatch Connect Global Tour 2014 in Atlanta, London, and Sydney.
• McKesson launches Benchmark Analytics, which provides reports and consulting services to optimize performance.
• GetWellNetwork’s CEO Michael O’Neil discusses the CDC Morbidity and Mortality report on the cost of cancer survivorship with a local journal.
• Kareo and Falcon EHR partner to provide cloud solutions to nephrology practices.

EPtalk by Dr. Jayne

HIMSS15 is looking for proposals for preconference symposia. We’re returning to Chicago this year, so dig out your winter boots and scarves. I’m not convinced that moving to April is going to allow the meeting to escape winter’s wrath. I seem to be cursed any time my travel remotely involves Chicago, so I’m not sure I’m looking forward to it.

Continuing the Open Payments saga from earlier this week, I was finally confirmed as a real, live physician so that I could access my data. I don’t have any data listed for the 2013 program year and that’s probably accurate, plus or minus a martini. I know I provided my NPI to one device manufacturer when we had drinks, but the reporting threshold is $10 and I’m not sure I topped that even though the cocktail in question was good.

Speaking of money, AMDIS released its annual report on CMIO salaries. There were 120 respondents and average compensation was up, according to the report. Based on the compensation of CMIOs I know well, the range isn’t terribly reflective of our reality in the trenches. The report also noted that although salaries have increased, job satisfaction is on the decline. I would agree that job satisfaction is an issue. It could be that my role has matured or perhaps it’s all the government regulations, but the job isn’t as much fun as it used to be. I’m the kind of CMIO that enjoys rolling up my sleeves and digging into cool projects, so every time I have to sit on another committee or address another regulation, it sucks a little bit of my life away.

I was surprised to see that more than 70 percent of respondents maintain a clinical practice. It’s getting harder and harder to do so. I’m one of the CMIOs whose own organization doesn’t support administrators who want to continue seeing patients. My clinical opportunities are cobbled together at a variety of facilities, which makes scheduling a bit of a challenge.

It’s hard to interpret the data with the relatively small sample size, however. I’m not sure how many CMIOs there are in the US, but there are many more people doing CMIO-type roles without the title and often without the compensation. Of respondents, 25 percent are certified in the subspecialty with another 25 percent considering it. Unfortunately many of my strongest colleagues are unable to sit for the exam since they didn’t maintain a primary board certification. I’m somewhat ambivalent about that personally and hope that those physicians who are certified but don’t see patients any more aren’t required to keep up a primary certification for no reason.

On the other hand, I had an email this week from a recruiter looking for a board certified physician to fill a locum tenens job in the US Virgin Islands, so maybe that primary certification is a good thing after all. They actually said “soaking in the sun with beverage in hand” in the opening paragraph, so they get full credit for that one. Doubtful that the actual experience would live up to the hype, like so much in healthcare these days.

I love some of the headlines I see: recently “MU drives patient savings” has been my favorite. Based on the duration of the program and what was actually involved in Stage 1, coupled with the relatively small numbers of providers attesting for Stage 2, I’m not sure we can arrive at this conclusion. Did they factor in the time cost of visits running late because providers were playing catch-up with the ever-increasing and burdensome requirements? Interestingly, the study in question had data provided by HIMSS.

Another great one cited Stage 2 EHRs as not being ready for data sharing. I don’t disagree with this one, although I think they focused too much on the technical problems of CCDA exchange and not enough on the philosophical problems. Some of the documents I see coming into our system are technically correct, but really don’t tell the clinician what he or she needs to know. For example, a patient who was seen in the emergency department for a laceration. I’d rather have the physician’s pen-and-ink sketch of the wound than any syntactically correct description, but there’s no room for that in the game of data exchange.

It’s probably a good thing that I can’t keep up with all the news that hits my inbox because it would just aggravate me. If I’m going to be aggravated, I’d rather be annoyed by the challenges of my latest pastry therapy project. For those playing along at home, this week’s specimen is the Blueberry-Lemon Bundt Cake from my good friend Martha Stewart. And thanks to YouTube for videos on how to zest a lemon without going insane. The picture doesn’t do it justice, but I loved the cake pan.

Got a favorite Bundt cake pan or recipe? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 7/17/14

Acting head of VA says agency needs $17.6 billion to fix problems

Interim VA Secretary Sloan Gibson testified before the Senate Veterans Affairs Committee today, reporting that the VA would need $17.6 billion in additional funds over the next three years to fix the departments problems.

Program Evaluation of Remote Heart Failure Monitoring

A study published in Telemedicine and e-Health finds significant reductions in overall hospitalization rates followed the implementation of a remote patient monitoring system, but equivalent drops in hospitalization were also seen within the studies control group, leaving researchers with little choice but to conclude that remote monitoring seems promising, but additional research is needed.

States shirking Medicaid fraud reduction: report

An OIG report finds that 14 states are still not reporting enrollment data used to fight fraud within the Medicaid Interstate Match program.

Readers Write: Medication Electronic Prior Authorization, the Next Big Thing for EHRs

Medication Electronic Prior Authorization, the Next Big Thing for EHRs
By Tony Schueth

Electronic prescribing (ePrescribing) has surpassed the tipping point, where more prescriptions are being written electronically than on paper. Now the industry must start thinking about the next big thing that will take ePrescribing to the next level and address one of healthcare’s most inefficient processes: prior authorization (PA) of prescriptions.

With ePrescribing considered table stakes in an electronic health record (EHR), software developers should be thinking about innovations that will take ePrescribing from a humdrum utility to a must-have. Electronic prior authorization (ePA) for the pharmacy benefit offers that innovation opportunity.

EPA is the #1 ePrescribing capability desired by physicians, according to market research conducted by NCPDP’s ePA Task Group. In order to foster a standardized approach to satisfy this demand, NCPDP approved an electronic data interchange (EDI) standard for ePA last year.

By design, the ePA transaction can be integrated with the EHR ePrescribing work flow, enabling prescribers to complete the prior authorization process within two minutes as compared with the manual process, which involves many phone calls and faxes that can take days to weeks to complete (15 days, on average). Considering that specialty medications dominate the drug pipeline and require prior authorization up to 95 percent of the time, the need for ePA is urgent.

Seven states have mandated the use of ePA beginning in late 2014 and eight others are engaged in ePA regulatory activity. In May, the National Committee on Vital Health Statistics (NCVHS) recommended that the Department of Health and Human Services adopt the NCPDP transaction as the standard for medication PAs. NCVHS recommendations regarding ePrescribing and related transactions often become requirements for payer participation in Medicare Part D.

The coming regulatory mandates afford EHR vendors the opportunity to be ahead of the curve. Rather than scrambling to meet multiple state regulatory deadlines at the last minute, vendors can take advantage of the interval between Meaningful Use (MU) Stages 2 and 3 to begin development of ePA functionality while there is still breathing room to concentrate on work flow enhancements.

The availability of ePA may sway some physicians in their EHR choice. Recently, Surescripts found that 28 percent of physicians surveyed would switch their EHR for one that supports ePA. While this percentage may be exaggerated based upon a single feature, there is no question that a robust replacement market for EHRs exists. Many physicians are looking to transition from early purchases of basic EHRs to more sophisticated solutions.

EDI networks such as Surescripts have begun offering ePA connectivity, while such established ePA services vendors as CoverMyMeds have introduced APIs to ease EHR integration. Some service providers offer connectivity for all ePAs – even if a pharmacy benefit manager or other payer isn’t electronically enabled, electronically initiated ePAs are delivered via fax.

The time is right. EPA is a logical and useful enhancement that physicians desire. A transaction standard that ensures compatibility is in place. Regulators are beginning to mandate its use. The number of PAs is growing. EDI networks and service vendors are eager to ease integration.

With the rare opportunity posed by the MU Stage 2 delay, vendors can roll out a new feature that is a “win-win-win-win” benefit for physicians, patients, payers, and EHR vendors.

Tony Schueth is founder, CEO and managing partner at Point-of-Care Partners of Coral Springs, FL.

Readers Write: Data Exchange with C-CDA: Are We There Yet?

Data Exchange with C-CDA: Are We There Yet?
By Brian Ahier

Do you think you have all the interoperability criteria to meet current and future stages of the EHR Incentive Programs? A new study published in JAMIA found that most providers don’t.

The study concluded that providers likely are lacking critical capabilities. It found that some EHR systems still don’t exchange data correctly using Consolidated Clinical Document Architecture (C-CDA), which may prevent providers from receiving future Meaningful Use (MU) incentives.

After sampling several platforms used to produce Consolidated Clinical Document Architecture (C-CDA) files, the research team from the Substitutable Medical Applications and Reusable Technology (SMART) C-CDA Collaborative — funded by the ONC as part of the SHARP research program — found a number of technical problems and obstacles which prevented accurate data exchange between different EHR systems.

There is already wide-scale production and exchange of C-CDA documents among healthcare providers this year due to the EHR incentive program and for meeting Meaningful Use requirements. Indeed, live production of C-CDAs is already underway for anyone using 2014 Certified EHR Technology (CEHRT). C-CDA documents enable several aspects of Meaningful Use, including transitions of care and patient-facing download and transmission.

Stage 2 Meaningful Use requires that providers be capable of producing C-CDA files, which contain both machine-readable and human-readable templates used to exchange patient data between EHRs during transitions of care. While all 2014 CEHRT must have the ability to create these files, some vendors are unfortunately not using the basic XML and HL7 technology correctly.

To find out how these variations affect providers and their participation in Stage 2, the researchers sampled 107 healthcare organizations using 21 EHR systems. They examined seven important elements of the documents: demographics, problems, allergies, medications, results, vital signs, and smoking status, all of which are required to be included in the C-CDA for Stage 2. They found errors in the XML that conflicted with HL7 standard usages, rendering the document ineligible to meet the Stage 2 rules for interoperability.

One key takeaway from this research is that live exchange of C-CDA documents is likely to omit relevant clinical information and increase the burden of manual review for provider organizations receiving the C-CDA documents. Common challenges included omission or misuse of allergic reactions, omission of dose frequency, and omission of results in interpretation. Unfortunately, only some of these errors can be detected automatically.

The team found 615 errors and data expression variation across 11 key areas. The errors included “incorrect data within XML elements, terminology misuse or omission, inappropriate or variable XML organization or identifiers, inclusion versus omission of optional elements, problematic reference to narrative text from structured body, and inconsistent data representation.”

"Although progress has been made since Stage 1 of MU, any expectation that C-CDA documents could provide complete and consistently structured patient data is premature," the researchers warned. The authors also note that more robust CEHRT testing and certification standards could prevent many of these troubling errors and variations in the technology and that the industry may also benefit from the implementation of data quality metrics in the real-world environment.

The researchers recommended several steps to improve interoperability: providing richer, more standardized samples in an online format; requiring EHR certification testing to include validation of codes and vocabulary; reducing the number of data elements that are optional; and improving monitoring to track real-world document quality.

The researchers make the case for using a lightweight, automated reporting mechanism to assess the aggregate quality of clinical documents in real-world use. They recommend starting with an existing assessment tool such as Model-Driven Health Tools or the SMART C-CDA Scorecard. This tool would form the basis of an open-source data quality service that would:

• Run within a provider firewall or at a trusted cloud provider
• Automatically process documents posted by an EHR
• Assess each document to identify errors and yield a summary score
• Generate interval reports to summarize bulk data coverage and quality
• Expose reports through an information dashboard
• Facilitate MU attestation

"However, without timely policy to move these elements forward, semantically robust document exchange will not happen anytime soon," the authors stated. “Future policy, market adoption and availability of widespread terminology validation will determine if C-CDA documents can mature into efficient workhorses of interoperability,” the report concludes. It would seem that if policy changes are not put in place, there could be risk in the Meaningful Use program not actually being all that meaningful.

This month CMS released the proposed 2015 Physician Fee Schedule. Among other things,it includes proposals to revise the physician supervision requirements for Chronic Care Management (CCM) services and proposes to require CCM practitioners to use EHRs certified to meet at least the 2014 Edition Meaningful Use criteria, which require the ability "to capture data and ultimately produce summary records according to the HL7 Consolidated Clinical Document Architecture standard."

Since this new proposed rule includes expanding the use of the certification program beyond Meaningful Use and specifically mentions the C-CDA standard, I thought I would ask Joshua Mandel, one of the authors of the study, for his thoughts.

"It’s not too surprising that CMS’s efforts to improve chronic care management would build on Meaningful Use requirements," he said. "In the section you’ve quoted, CMS, is simply saying that Eligible Providers would need to use MU-certified systems (just as they must use MU-certified systems to attest for MU incentive payments). And so C-CDA capabilities come along for the ride in that decision. I can certainly say C-CDA is better than nothing; and C-CDA 1.1 is a specification that exists and has been implemented today, so it’s a natural choice here."

While there are challenges in implementing and making good use of C-CDA documents, there is little doubt that HHS is continuing to drive the use of these standards forward through various policy levers. The ability to exchange relevant clinical information for transitions of care is a key enabler in transforming our healthcare system to paying for quality instead of quantity.

Despite these challenges, we are beginning to see success in the marketplace. Building on this success and continuing to improve content standards is critical if true interoperability is to become a reality.

Brian Ahier is director of standards and government affairs for Medicity, A Healthagen Business of Salt Lake City, UT.

CIO Unplugged 7/16/14

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Abdication of Authority and the Poets

I used to write a fair amount of poetry in my early teens. I continued writing for about 10 years, but stopped shortly after marriage and after the birth of our first child. Julie remarked one day that my poetry had lost its romantic flair and creativity, reading more like a stuffy business letter. As I re-read some of the stuff I wrote, she was absolutely correct. “Dear Julie,” I would begin, and then end with something akin to, “With all due respect.”

Actually, even as I review some of my earliest material, I become increasingly critical of my writing. I think of how I might rephrase specific stanzas using today’s vernacular. Then again, sometimes when you mix the old and new, the outcome is not all that much better. I finally came to accept that while imperfect with today’s eyes, the poems of old were indeed perfect for the time in which I originally wrote them. A zeitgeist sort of thing, I suppose.

As I rummaged through old online files, I found several presentations I’d done around IT governance. I was shocked to find myself in disagreement with many of my original suppositions. But, as with my retrospective with poetry, those governance models were possibly the best for that point in time.

Or were they? With this historical vantage point, I noticed a disturbing trend that not only led me into a long-term malaise, but many of my peer group as well. Subconsciously, we ceded more and more control of IT to our customers, unknowingly setting the stage for a silent yet unintended overthrow.

Today, we are scratching our heads and wondering where the power of the CIO has gone. As I’ve said before, many of us are downright impotent, and I’m ringing the bell loudly to awaken the sleeping spirit.

My findings were disturbing. At one point, I want to cry, and then in the next second, laugh. We often blame our customers for uncontrolled IT costs and say crazy things like, “There is no such thing as an IT project.” We load governance councils with individuals who are unqualified to help make technology decisions and yet complain about the insufficient funds for infrastructure. Giving away control only doomed us to the Tragedy of the Commons.

From a historical perspective, the pendulum has swung a full 180 degrees. I applaud inviting others into the tent. Absolutely it was and remains the right thing to do. But somewhere along the line, we left the tent. We maintained our responsibility but abdicated our authority. We abandoned our leadership rights.

Many are now outside the tent looking in, running IT by title only. Not influence. Not leading. Just reacting. Yuck!

Do we want to swing all the way back? No! I suspect for most of us we need to shift more toward center. The governance continuum will vary by the culture, organizational challenges, environmental factors, and ultimately our individual leadership capabilities. We need to appreciate the journey, learn from it, and modify.

Let’s reconnect to our mantle of authority and lead governance. Not be ruled by governance.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Morning Headlines 7/16/14

M*Modal Receives Approval to Emerge From Chapter 11

MModal confirms that it will emerge from bankruptcy within three weeks as its Plan of Reorganization is approved by the courts.

Novartis and Google to Work on Smart Contact Lenses

Google and medical device manufacturer Novartis have entered into a licensing agreement to commercialize Google’s recently unveiled glucose monitoring contact lenses.

Best Hospitals 2014-15: Overview and Honor Roll

US News and World Report publishes its 2014 Top Hospitals list with Mayo Clinic taking first place, followed by Massachusetts General Hospital and Johns Hopkins.

New challenge for team that passed Turing test: health insurance

Three computer scientists from the team that recently claimed to have beaten the Turing Test are leaving the artificial intelligence field and heading to a Santa Rosa company where they will help build a website designed to help consumers shop for Medicare plans.

News 7/16/14

Top News

IBM and Apple announce a partnership to develop business applications for iPhones and iPads. IBM will also sell Apple products and provide on-site services to business clients, while Apple gains business credibility and a tie-in to IBM’s big data capabilities that will make its devices decision-making tools. The deal also gives Apple’s iOS more enterprise credibility against the more widely used Android operating system. The companies say more than 100 business apps will be available by fall.

Reader Comments

From Baron Schkinn: “Re: Siemens. The rumor is surfacing again that Cerner will buy the health IT division of Siemens and close the deal by the end of the summer, coming from an inside source who I trust. That would give Cerner a replacement for its failed ProFit, a backup center in another earthquake zone, a shot at selling to the significant number of Invision and MedSeries4 clients, and would make Cerner the #1 vendor over McKesson in revenue. They would still be left with two poor ambulatory solutions that would make them non-competitive with Epic.” Unverified, other than the seemingly solid rumor that Siemens is shopping the business it describes on its website in a predictably confusing fashion as “the Siemens Healthcare Information Technology business of Health Services, Siemens Healthcare” (which offers several humorous acronym-powered punning opportunities.) Cerner might be willing to pay the rumored $1.4 billion just to get the Siemens customer base and a few worthwhile niche-filling nuggets (MobileMD, although nothing else comes to mind given Soarian’s minimal-and-dropping competitiveness) but it would seem to be a better fit for private equity. Cerner doesn’t do a lot of acquisitions and one that size might spook Wall Street, which Cerner doesn’t like doing, but anything can happen when it comes to acquisitions.

From BadBuy: “Re: Sunquest. Significantly behind full-year sales target, with the top two reps at just over 50 percent. Vista/Huntsman Gay made out like bandits.” Unverified. Roper Industries acquired Sunquest in July 2012 for $1.42 billion after what I’ve heard was shockingly minimal due diligence. I would assume that former owners Huntsman Gay Global Capital and Vista Equity Partners did indeed do quite well for themselves given that the former paid only $208 million to acquire 51 percent of Sunquest in December 2010, with Vista holding on to 49 percent. That means Roper paid more than three times that valuation just 19 months later. Roper executives talked up Sunquest’s revenue growth and implementation improvements in the company’s most recent earnings call, adding that Sunquest will have “quite an exceptional year in 2014.” Roper’s diversified growth is steady – share price has more than tripled in the past five years. The longer you work in this or any other industry, the more you realize it’s the generic money guys, not the deep subject matter experts or passionate advocates, who do really well. “Owning” has more potential reward (and risk) than “doing.”

From Binge and Purge: “Re: Johnathan Samples. You’ve probably already heard, but he has left Greenway after 13 years and started a new company.” Samples, who was Greenway’s chief innovation officer through last month, threw in with former Greenway Chief Product Strategist Jason Colquitt at Across Healthcare, which offers what appears to be an unfocused array of consulting and software development services.

From Yalie: “Re: Yale-New Haven. Anything in writing about their hard Epic downtime system-wide for two days last week?” The local paper says a network switch went down Friday for a handful of hours, requiring the hospital to cancel elective surgeries. Epic information was still available from cached copies.

HIStalk Announcements and Requests

I’ve confirmed that Epic’s FDA 510k submission was for a bedside matching system, not a blood bank system.

We hear a lot about the suits in the healthcare corner offices, but not enough about the cube-dwellers who perform the actual work that pays for them. I am offering the HIStalk BOSS (Beacon of Selfless Service) Award to recognize those trench warriors (provider or vendor) who toil without bonuses, reserved parking spaces, or the ever-present validation of company-paid butt kissers. The BOSS Award isn’t a trophy or cash, but rather recognition in HIStalk of a non-management employee who went above and beyond during a specific event (downtime, sales demo, screaming surgeon demanding a new laptop, etc.) to save the day. Anyone who observed the individual’s laudable effort firsthand can nominate someone – a supervisor, peer, or customer. Submit your candidate here.

We like to keep in touch with HIStalk’s sponsors and we just sent an e-mail to all the contacts on our list. Let Lorre know if we missed you.

Acquisitions, Funding, Business, and Stock

The US Bankruptcy Court approves MModal’s reorganization plan, allowing the company to emerge from bankruptcy in August as it had originally announced.

The Teamsters Union urges McKesson’s shareholders to approve its proxy proposal to eliminate the company’s change-of-control terms that will give its top executives $283 million if new owners fire them, including $140.5 million for John Hammergren alone.

Craneware announces $70 million in sales in the first half of 2014, up 80 percent year over year.

Sales

Saint Mary’s Hospital (CT) selects Wellsoft’s EDIS.

Wheeling Hospital (WV) adds Sunrise Financial Manager to its Allscripts systems.

Carrus Hospitals (TX) will deploy Medhost’s clinical and financial solutions via the company’s hosted Medhost Direct platform.

People

Rob Lipowski (Cleveland Clinic) joins Perceptive Software as director of healthcare solutions.

Perry Lewis (McKesson) is named VP of industry relations of CoverMyMeds.

“Inc.” profiles Beyond Lucid Technologies Founder and CEO Jonathon Feit, who has Tourette Syndrome. It points out the difficulty he has in performing company pitches and recorded videos without the characteristic twitching. His company sells an electronic patient record system for first responders.

Announcements and Implementations

Summit Healthcare announces that 26 facilities are live on its Summit Care Exchange technology, which allows providers to send CCDs to a Health Information Service Provider via Direct to meet Meaningful Use requirements.  

EHNAC and WEDI launch an accreditation program for practice management systems, announcing GE Healthcare, Medinformatix, and NextGen as pilot participants.

Elsevier Clinical Solutions announces its Clinical Documentation Improvement Reference App, which provides clinical term look-up and medical necessity information with an emphasis on ICD-10.

New Orleans-based startup Clinicate launches its clinical file-sharing solution for providers and patients. It also contains some unrelated tools such as drug lookup. It’s free for patients and a single provider can use the system free for up to 100MB of storage.

Healthcare Data Solutions announces availability of the HealthcareData360 EHR market intelligence database, which allows looking up EHR decision-makers both within and across connected provider organizations.

Government and Politics

NIST and OCR will co-host “Safeguarding Health Information: Building Assurance through HIPAA Security” on September 23-24, 2014 at the Grand Hyatt in Washington, DC. Onsite attendance runs $345, while Webcast attendees will pay $200.

The FCC’s 17-year-old system crashes under the weight of 800,000 comments filed regarding net neutrality, forcing it to extend the comments deadline until midnight Friday. Comments can be filed (and read, in the case of the most recent 10,000 comments) here.

Eighty-nine House lawmakers sign a letter requesting that CMS remove penalties for clinical laboratories that perform tests for Medicare patients, explaining, “Pathologists have limited direct contact with patients and do not operate in EHRs. Instead, pathologists use sophisticated computerized laboratory information systems (LISs) to support the work of analyzing patient specimens and generating test results.” CMS granted pathologists a hardship exception for 2015, but the College of American Pathologists wants the requirement to be eliminated permanently.

Innovation and Research

Three computer scientists who developed the first program that passed the Turing test — convincing a human that they are interacting with another human rather than a computer — have joined startup Wholesale Change, which will develop online tools to help consumers choose Medicare insurance plans.

@Cascadia tweeted about Israel-based Tyto Care, which offers a handheld device and cloud platform that allows patients to do their own physical examination while being guided remotely by their doctor.

Chicago-area researchers query the EHRs of 23 primary care practices to identify patients likely to have undiagnosed hypertension based on their historical pattern of in-office blood pressure readings, inviting those patients to follow up with a more comprehensive series of readings. The practices not only alerted patients, but also turned their work into a quality improvement project by continuing to remind both patients and physicians of the need for follow-up until an ICD-9 code was entered indicating that hypertension had been either confirmed or ruled out.

Technology

The Alcon division of Novartis AG licenses Google’s smart contact lens technology that will measure and report blood glucose levels. Meanwhile, the former Google X director who led the development of the contact lens as well as Google Glass announces his departure from Google and his excitement at going to work for Amazon. He made headlines last week by saying that Glass is “not necessarily the definitive answer” for wearable technology.

Welch Allyn adds customizable patient scoring to its Connex vital signs monitor, allowing hospitals to use their own Early Warning Score to identify deteriorating patients. The company’s clinical surveillance system can send the results wirelessly to the hospital’s EMR and can also monitor for falls, pressure ulcers, and respiratory distress.

Other 

A new HIMSS Analytics report says “germ-related hospital applications” have high growth potential. That oddly phrased category (clinicians never say “germs” unless talking slowly to laypeople who possess limited medical comprehension) includes systems for infection surveillance, patient acuity, and laboratory outreach.

HIMSS14 is named the fourth-largest medical meeting of 2013 with its 36,5325 attendees, following the FIME (Florida International Medical Expo) trade show in Miami, the Greater New York Dental Meeting, and RSNA.

Two surgeons from UNC Hospitals (NC) open a burn center in Malawi, which has 14 million people and only 20 surgeons. One of the UNC surgeons added that UNC’s new Epic electronic medical record and potentially the addition of telemedicine services will help it treat patients in their local areas of North Carolina rather than transporting them to Chapel Hill.

Let’s hope Massachusetts isn’t the national healthcare model everybody brags on: healthcare will eat up almost a third of the new state budget vs. the 20 percent it consumed in 2001.

An article describes how 25-bed Cottage Hospital (NH) became one of the first hospitals to attest for Meaningful Use Stage 2. It’s a Medhost facility and hired an informatics nurse to keep things moving along.

“US News & World Report” lists its “Best Hospitals 2014-15”: (1) Mayo Clinic; (2) Mass General; (3) Johns Hopkins; (4) Cleveland Clinic; (5) UCLA Medical Center; (6) New York-Presbyterian; (7) HUP; (8) UCSF; (9) Brigham and Women’s; (10) Northwestern Memorial; (11) University of Washington; (12) Cedars-Sinai, tied with UPMC; (14) Duke; (15) NYU Langone; (16) Mount Sinai; and (17) Barnes-Jewish. 

“The Wall Street Journal” reports that the ambitious $54 million biotech facility created from the converted Brooklyn Army Terminal stands nearly empty, reportedly because of squabbles between its two developers, SUNY Downstate Medical Center and the city’s Economic Development Corp. The project’s former executive director, who left last year, said public agencies are lousy at running speculative developments because they have too much bureaucracy behind them and lack the mindset to get it done. The project is limping along by renting space to non-biotech companies at a discount despite its mission of boosting the city’s biotech presence.

Madison, WI’s weekly hippie newspaper covers Epic’s purchase of wacky artwork at the summer art fair run by the Madison Museum of Contemporary Art, saying that Judy Faulkner brings an employee team armed with a “generous budget” (some of it in cash) to find big, bold, and whimsical pieces.

A father whose six-week-old daughter died of a liver tumor after spending her entire life in the hospital posts a request on Reddit asking for help to Photoshop the only photos he had of her, all of them showing her with tubes in place since she had never been without them. His post generated 2,700 comments of support and many photographs and drawings. He called attention to “Now I Lay Me Down to Sleep,” whose volunteer photographers take portraits of families with their dying or deceased child.

Sponsor Updates

• The Sunquest User Group conference is being held this week at the JW Marriott Desert Ridge Resort in Scottsdale, AZ.
• HealthMEDX sponsored the “Prescription for Change” technology discussion for long-term and post-acute care providers, with CEO Pam Pure and Medical Director Charles Rogers, MD participating.
• Laura Argauer of CTG co-presented “Using Transformational Data Analytics to Improve Care Valuation, Management and Outcomes of Chronic Kidney Disease Patients” at the Healthcare Analytics Symposium & Expo 2014 this week.
• Health Catalyst shares a case study on Crystal Run Healthcare (NY), explaining why they bought rather than built a data warehouse.
• Predixion CEO Simon Arkell will discuss the explosion of connected devices and predictive analytics challenges in healthcare during the Microsoft Worldwide Partnership Conference in Washington, DC this week.
• Kari Bunting, RN of MedStar Franklin Square Medical Center (MD) will present her research on reducing excessive uterine contractions aided by PeriGen’s PeriCALM Patterns EFM at the Summer Institute in Nursing Informatics in Baltimore, MD this week.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 7/15/14

E-Prescribing Trends in the United States

E-Prescribing rates in the US have climbed dramatically since 2011, according to new data published by ONC. In 2011, just seven percent of providers were live with e-prescribing, compared to 70 percent that use the technology today.

New resources improve states’ abilities to advance Medicaid payment and delivery system reform

HHS unveils a new program called the Medicaid Innovation Accelerator Program which will work with state agencies to award $100 million in federal funding help promote innovation aimed at advancing Medicaid-specific delivery system improvements.

MMRGlobal Subsidiary Receives Clinical Trials Patent

MMRGlobal receives a US patent titled “Electronic Health Records in Clinical Trials” which the company’s press release says will “opens the door to completely new revenue generating opportunities,” likely by demanding license fees from research organizations and pharmaceutical companies using EHR data within clinical trials.

British Government Picks Illumina to Sequence 100,000 Genomes

US-based gene sequencing firm Illumina lands a $160 million deal with the British government to sequence 100,000 human genomes.

Curbside Consult with Dr. Jayne 7/14/14

I wrote a few weeks ago about my adventures with the CMS physician portal. Since the reporting of payments and gifts from drug and device manufacturers to physicians is now mandatory, physicians are wise to make sure the information is accurate because it is going to be released to the public.

I had gone on the site and registered for basic portal access in June, but had read that I would have to return in July to register specifically for access to the Open Payments data. Once I went to the Open Payments link (thank goodness the website at least has a decent breadcrumb trail at the top), it asked me to create my profile. It also allows physicians to nominate “authorized representatives” to handle physician information.

It also requires entirely too much other information that CMS should already know about us from our NPI, Medicare, and other applications: NPI, license number, practice type, specialty code, DEA number, etc. The first words that popped into my head (of course in a snarky voice) were “administrative simplification.”

Rather than have the specialty codes on a pick list, I had to launch a 359-page PDF to figure it out. Finally, Page 212 had a link to Appendix C, where the answer was still nowhere to be found; the appendix had a link to the CMS taxonomy crosswalk. I’m not sure why they couldn’t have hooked up the link on the actual application to the crosswalk in the first place.

Even though the crosswalk lists my specialty code as “08” in the column that says “Medicare Specialty Code,” what they actually wanted was the code in the “Provider Taxonomy Code” column. Don’t bother trying to cut and past the 10-digit code into the form because it won’t work right. I was able to finally get through all the steps, only to learn that I won’t be able to do anything else until my profile is “registered” after my identity as a physician is confirmed. I’m surprised they didn’t ask for my blood type.

When I write about my initial experience, I also asked for a good martini recipe to help me get through it. Weird News Andy was happy to oblige with one that plays to my literary passions:

Charles Dickens Martini

1) Make a martini as you see fit

2) Add an olive or twist

I’m still laughing. There are so many Dickens titles that seem appropriate for healthcare IT: Great Expectations, Hard Times, and Bleak House, to name a few. It looks like my attempts to see my Open Payments data are turning into either a serial or a novel.

Have a literary suggestion that meshes with our lives in the IT trenches? Email me.

Email Dr. Jayne.

HIStalk Interviews Susan DeVore, CEO, Premier

Susan DeVore is president and CEO of Premier, Inc. of Charlotte, NC.

Describe what Premier does, especially with regard to healthcare IT and data.

Premier is, I think, the largest healthcare improvement alliance in the country. We are integrating data from hundreds and thousands of hospitals on our platform to solve the cost, quality, safety, and population health or outcomes problems.

We’ve got a 59 percent footprint. We’re serving 3,000 hospitals in various ways. We have about 110,000 non-acute care sites. We have insights with data on one in three patients in the country.

It’s a massive business intelligence platform that we’re wrapping around services and capabilities to help these healthcare systems transform from the inside.

Premier was a hospital group purchasing alliance and is now a publicly traded informatics company that offers solutions for supply chain, labor management, population health, and quality. How does that all fit together to help hospitals as payment models change?

We’ve been building these data assets and this supply chain capability for a long time. Over the last three or four years, we’ve fundamentally rebuilt our entire foundational infrastructure. It was clear to us that all of these one-off solutions and individual vendor solutions aren’t going to solve the complexity of healthcare problems.

We decided a while back that providers needed to be able to connect the data, have the business intelligence come from all vendors and all payers, and be normalized and cleansed and standardized. We needed a social business capability on the front end so that we could accelerate the best practice sharing, content review, and knowledge transfer among these healthcare systems. We decided this was going to be the only way you could really solve the cost, quality, and outcomes problems.

As a provider, knowing where you stand in the continuum and not just how well you improve on your own is a pretty big deal. Will vendors struggle to compete as the market finds that their single tools may not offer enough?

The problem for any single vendor is that they only have a piece of the picture. Even EHR vendors. In our mind, they’re only one system of probably 12 or 13 different sources of data that you need to solve the problem. Any one payer that tries to solve the problem, or comes from a payer, has a view into only the payer population.

When we set out to do this, we said, we’ve got to be vendor agnostic and we’ve got to be payer agnostic. Health systems want to change the way patients get cared for, regardless of which EHR system they use or which payer they have a contract with. They want to change the way care is delivered for a patient population.

We think it’s a differentiator. We think that it will be critical that vendors are required to make their information exchangeable and not require that our health systems have to pay every time they want to make the information exchangeable.

How do you see that happening? It’s been a sore spot with providers that systems are supposed to be interoperable, yet they often aren’t unless you write a check and probably accept less functionality than you want.

I think there are three things that are going to drive it. The first is that providers are going to drive it, a coalition of providers who need the information to be more effective at what they do. Providers are increasingly dissatisfied with the lack of the exchangeability or the interoperability, so I think they’re going to require it.

Secondly, I think consumers are going to require it. Consumers are going to say, I need to make the decisions. I need the transparency to the information. I want it.

Thirdly, we need policy change. The thing that will accelerate it is if policy makers start to realize we can’t solve the cost, quality, and outcomes problem in healthcare without it. Those three things could push it faster.

Hospitals are trying to figure out what role they will play in the retooled healthcare system. How can information help them determine their business model?

Because we have this 59 percent footprint and we cover basically every geography, we see health systems that have been morphing now for several years. They have affiliated physicians. They have affiliated nursing homes. They have partnerships in the community. They’re building virtual IDNs, virtual ACOs, real IDNs, and real ACOs and have been for a long time.

They also usually have in those community markets more sophistication, maybe, and more capital to help build the integrated capabilities and to help access the integrated capabilities.

From our perspective, if and when the healthcare system moves to a more bundled payment world — whatever form that takes — this integrated data is going to be extremely important. It doesn’t have to all come from the source system. Many of our health system’s big IDNs are saying, do I really have to switch everything out? Or in an open data, big data, cloud-based, shared infrastructure world, can I find ways to go get the data and put it together?

These health systems are going to be an integral part of what healthcare looks like in a future state world. They’ve been starting to build this capability and put these pieces together for a long time.

If the pie gets bigger for our healthcare system, and they have a lot of pieces as opposed to one singular hospital piece, I think this is a pretty natural evolution.

Are providers jumping too quickly into ACO arrangements?

I think they’re experimenting with ACO models. As opposed to jumping all in, they’re trying it on a population. They’re now receiving data from CMS, which was something healthcare systems had never historically been able to do. They’re learning a lot. They’re figuring out how to manage the provider risk.

What we say to them, and what they say to us is, we’re trying to future-proof them and they’re trying to future-proof themselves. Whether it’s an efficiency measure that is measuring cost three days before acute care stay and then post, a bundled payment program, an ACO, or Medicare Advantage — if you’re able to connect data and you’re able to turn that data into business intelligence, pulling it from all vendors and all payers and putting it in the hands of your providers and change the way care is delivered, then there may be multiple models for a while we’re in the transition. That infrastructure is going to position you to navigate through those various models.

How will it be different for an academic medical center versus a community hospital?

They have different challenges. Community-based systems are integrating physicians very significantly. They have to have data and connected information in order to influence the practice of medicine.

In an academic center, you’ve got a more employed model that you can deal with, but you have other challenges. How do you fund research? How do you fund all the other activities and pay for and compete in the community healthcare system?

We have them all. We have academics. We have small. We have large. We have big IDNs. Some of our academics will tell us it’s easier for small community systems to drive change. Our community systems will say it’s easier for academics because they’re larger with more funding and more resources.

The truth is, this is performance improvement. You need the data. You need the data connected. You need to operate and change your operation. Whether you’re an academic or whether you’re a community health system, we can see the change happening in both and in neither. It has more to do with the culture, the measurement, the data, the infrastructure, and the willingness.

You’ve suggested the possibility of acquisitions. What areas interest you?

We report publicly in two segments — a supply chain segment and a performance services segment, which is where all of our HIT assets, informatics, and consulting and collaborative activities are.

We have said, and continue and to say, over on the performance services side, we are interested in ambulatory data acquisition and connectivity of ambulatory data to acute care data. We’re interested in all kinds of population health and data analytics technologies and capabilities for our members to build this population health capability. We’re interested in major things in both of those buckets.

We’re also interested in the area of patient-reported outcomes and in the implementation of standardized, more cost-effective, clinically-effective healthcare. We’re looking at all kinds of things in those areas.

On the supply chain side, we think there’s still a ways to go in changing supply chain capabilities in healthcare systems. We’re looking at workflow kinds of capabilities, alternate site capabilities, and the connectivity for supply chain between all the alternate site locations and the hospital or health locations. We have a specialty pharmacy. We think it’s a critical element to population health, so we have some interest there also on the supply chain pharma side.

Do you have any final thoughts?

It’s a very dynamic time. Integrated information that’s vendor agnostic and payer agnostic is critical.

Health systems have spent hundreds of millions of dollars installing EHRs. They’re increasingly dissatisfied with the inability to exchange information. They’re not so interested in spending hundreds of millions more to build data warehouses.

We think there’s a real opportunity for shared infrastructure and shared integrated data management capabilities. We are making significant investments there.

Morning Headlines 7/14/14

WellPoint CEO: Insurer readies for technology wave

Joseph Swedish, CEO of the insurance company WellPoint, says in an interview that he will drive the company to adopt new technologies to reduce health costs, including telehealth, workplace health kiosks, and participation on insurance exchanges.

Verona’s Epic Systems adding employees

Epic adds 600 employees since February, bringing its total to 7,400. Epic has seen tremendous growth in the past three years when, in June 2011, the company’s head count sat at just 4,200.

Duke Medicine’s Big Data Plan to Improve Population Health

Ex-NASA Geospatial Scientist Sohayla Pruittan launches Duke Medicines new location-centric population health platform that will analyze health trends down to individual neighborhoods. She says, “When we visually map a population and a health issue, we want to give an understanding about why something is happening in a neighborhood. Are there certain socioeconomic factors that are contributing? Do they not have access to certain things? Do they have too much access to certain things like fast food restaurants?”

Key statistics for Summary Care Records

In England, the Health & Social Care Information Centre announces that nearly 41 million Summary Care Records have been generated by 5,454 practice offices thus far.