Curbside Consult with Dr. Jayne 6/22/15

A reader commented on last week’s Curbside Consult asking about effective leadership teams:

I would love to hear about effective leadership teams and how they become that way. I am not part of our organization’s leadership, but occasionally interact with them and also hear info from people who more frequently interact with them), and it just seems that the more layers we add – VP, SVP, EVP – the more work is created without true hierarchy and responsibility. We don’t even have a clear IT leader. Is it our VP of IT? Our Chief Innovation Officer, who replaced our Chief Information Officer, but she seems to have limited interest in core IT functions? Our new EVP of “peripheral” services like IT, Finance, Pharmacy, etc.? God only knows. And yet even with an expanded leadership “team,” they all give the impression of having too much on their plate to concentrate at the issue at hand or even, yes, show up for meetings (much less on time!)

There are plenty of books out there about building effective leadership teams. Although they may have good information from an academic standpoint, it’s often hard to put those theories into practice, especially in an environment as chaotic as healthcare.

Most of my early experience in leadership was not on the IT side but rather the operational side of an employed medical group. As I moved through the ranks to CMIO, I was exposed to a lot of different leadership structures within my own health system and was a member of several highly functional teams. Unfortunately, I was also a member of several highly dysfunctional teams. Through interacting with other customers sharing our core vendors I’ve been exposed to even more teams all across the spectrum. Those experiences have given me a lot to consider in answering the question.

Now that I’m in consulting, I’ve had to put together my own methodology for helping people move in the right direction. There’s no one answer for how to get a team to be effective, but there are some key characteristics that have to be present.

First, the group has to communicate effectively to lead effectively. Although some people are naturally strong communicators, most aren’t. In order to drive people in the right direction, I’m a huge fan of applying a great deal of structure regarding communication. All of my clients have to sit through a communication skills for leaders class with me and do a communication matrix exercise where the team decides and documents how they’re going to communicate, at what points in the project/initiative, with what methodology, to what audience, and by whom. Once they put pen to paper, I ride herd on them to make sure they’re sticking with the program. A successful team will realize that they don’t need a consultant to keep them in line and will take on the tasks themselves. I continue to prod them a little to make sure it’s sustainable.

Communication isn’t just how they report things out — it’s how they document things day to day and operate when they’re communicating (for example, in meetings). Do they have written (and time-boxed) agendas before the meeting? Does someone facilitate the meeting, allowing people to participate without worrying about minutes or timekeeping? Does someone take good minutes and get them out the same day? Are meetings halted when key people are missing rather than wasting everyone’s time because topics will have to be revisited with the appropriate people in the room? Are there ground rules for meetings to make sure everyone plays nice with the other kids? Making sure the answer to all those questions is “yes” helps a leadership team become more effective.

Second, effective teams have buy-in to their project. Ideally the team has been together since the project’s inception, participating in charter creation, writing a mission statement, etc. That’s usually not the case for most organizations, where people come and go or restructuring seems like its own constant. Teams that actually understand and agree to try to deliver the mission do much better than those with only a loose understanding. For people who don’t natively buy-in, an organization needs strategies to either coach them to arrive at that point or employ incentives (or penalties) to elicit the desired behavior.

Even people who may not agree with a given mission tend to be motivated by financial or other incentives. Consider Meaningful Use: whether it was the carrot or the stick, it sure got a lot of physicians who didn’t natively give a hoot about EHRs to actually install them in their practices and start using them. In working with end users, recognition and small rewards (giveaways, raffling off gift cards, etc.) can make a huge difference in aligning people’s actions with the end goals. Teams that either have buy-in or are otherwise motivated tend to show up on time and ready to participate.

Third, effective teams have to have clear leadership. I sympathize with your comment that the more leadership layers that are present, the less effective the leadership is. I recently worked with an organization that suffered from what I can only call “title bloat.” Their VP level people were what would have been considered directors at best in my former health system. Did I mention they had assistant VPs, associate VPs, VPs, senior VPs, executive VPs, system VPs, and more? Many of the titles had no discernible meaning, but were used as ways to try to elevate people or reward performance without giving raises. It led to an arms race where they had to keep promoting others to keep parity among the ranks.

Regardless of what people are called, someone has to be in charge. There has to be, in the words of one of my favorite executives of all time, a “single neck to choke.” That person should come into the office every day asking, “What’s at risk today, this week, this month” and address the issues when his or her team answers the questions. In shared initiatives, there have to be clear leaders for operational, technical, and clinical pillars. For those types of shared structures, I like to add additional necks to choke in the form of a steering committee that meets regularly and addresses a standard list of project metrics (budget, timeline, risks and mitigation strategies, etc.) People always ask me who is best to own a project. Operations? IT? Clinical leadership? I’ve seen them all work, provided the structures are in place to ensure accountability. I’d rather have a well-organized leader from an “underdog” part of the organization than a disorganized alpha dog.

The leader has to have skin in the game. They should feel personally responsible if their project is not meeting expectations. The right person will have this quality intrinsically. Others can be motivated (again, think bonus goals or incentives) to put it on the line. The leader also has to have dedicated time and resources to lead the project. In a stakeholder assessment I did recently, the designated IT leader was overseeing hospital revenue cycle and ambulatory EHR implementations, both at the same time. The projects were headquartered on opposite sides of town and both were billed as “highest priority” for the health system. The sheer logistics made it almost impossible for her to be hands-on in the way needed for success because she always seemed to be driving to one location or another for a meeting, while taking another meeting in the car. It was no surprise that both projects were failing.

In my opinion, these three elements are key. When they’re not well defined or executed, things can very quickly fall apart. Of course there are dozens of other “essential” facets of effective teams, but these are the ones I see malfunctioning the most often. Sometimes they’re easy to fix and sometimes you scratch your head figuring out how in the world you’re going to patch things together enough to get the job done. Sometimes it takes an outsider to figure out which person is the square peg in the round hole and how to rearrange them. Sometimes it takes a major project failure to get people to wake up and pay attention. I’d be interested to hear what others think.

Have an opinion on what it takes to build an effective team? Email me.

Email Dr. Jayne.

HIStalk Interviews David Lareau, CEO, Medicomp

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

Tell me about yourself and the company.

I’ve been here since 1995. I discovered Peter Goltra and Medicomp when I was in the billing business and had a customer who wanted electronic health records.

We provide the MEDCIN engine and software. Our sole purpose in life is to present the relevant clinical content to a clinician at the point of care so that they can treat the patient, get their documentation, and have all the billing and Meaningful Use stuff happen in the background so they can focus on the patient, find the information they want quickly, treat the patient, and get on to the next patient. Not slow them down or get in their way.

You have quite a few physicians developing content and helping design the Quippe product and you’ve recently hired Jay Anders as chief medical officer. How do those physicians drive product direction?

We have a knowledge engineering team that, going back to our start in 1978, sits with the physicians and says, you’re treating somebody with asthma — what are you thinking about? What are the symptoms, history, physical exam? What are the tests and therapies? What are the other things that intersect with asthma? What are the co-morbidities? What would differentiate asthma from something else that has a similar presentation? It’s an endless series of peeling away the onion.

The questions that we have for the providers are, what would you want to see given this presentation? Some people think we’re trying to tell the docs, "Here’s what you should do." We’re presenting back through software what the doctors have told us they would want in that case. As you might imagine, it’s an iterative process. It never ends. Things are always changing.

We have anywhere from 15 to 20 physicians active at any point in time. They work with our knowledge engineering team. Jay Anders has joined us recently, because as you add more content to anything, it can tend to complicate life for the user. The more concepts you add to things like SNOMED, to other terminology sets — you’re seeing it with ICD-10 now — more content puts more pressure on the provider of software to make it usable at the point of care.

Jay Anders came on board because he represents the clinical end user for us. OK, Jay, I want your input on everything we do. Are we making it easier or are we making it harder? What should we be showing? What options do we need? How do we let the users control what they’re doing without slowing them down and getting in the way?

Putting more information in front of a user is not always the answer. It’s the right information at the right point in time. Does the engine have the content? Do the UI tools that we’ve built around it to help people deploy it provide for a proper presentation that the docs like, allow them to focus on the patient, and get all that other stuff in the background? There’s a lot more interaction.

One of the things Jay is doing for us is defining ways to do better work flows at the point of care and also recruiting our clinical advisory user  group of physicians, not just a knowledge engineering group. We have two teams that work in parallel.

How many employees does the company have and what do they do?

We have 20 employees now. The last time we talked, we probably had about 10 or 11. We have seven people who are developers. We have three people who do terminology, stuff like mapping to ICD-10, SNOMED, LOINC, Meaningful Use, etc. We have three people who do testing. We have three people in product management. We have three or four people in knowledge management.

Then we have the clinician advisors. We have two-full time physicians on board doing that. Then we have about 10 or 15 who are on staff at major medical centers. They’re not employees, they’re contractors. They do a lot of work with our knowledge engineers on the knowledge base using our knowledge editing tools.

Peter Goltra had a great idea in MEDCIN, but it didn’t feel like a real business early on. What does it take to turn a great idea into a great business?

Focus. Absolute core focus on what you do, what you do well. Any time you’re in the kind of business that we are in — development of intellectual property, development of content, development of techniques to present things — your sole asset is your people. You’ve got to find the best people and you’ve got to keep them.

I consider salaries the only expense I will never cut because those are the people who produce what we have that is of value. Everything else is negotiable. I can move into smaller office space. I can do less travel. I can have non-fancy furnishings, which we do. But we want the best people. We never want to lose anybody, because when you lose somebody, it slows you down. You lose their energy and other people have to make up for it. 

One of the things that happens in other companies is that they don’t focus on one thing. As they get successful, they start doing things they shouldn’t be doing. When bad times hit, they cut their head count. Our head count is our asset. That’s it. I’m not talking about in terms of numbers, I’m just talking about terms of quality. We pay people very well. We treat them very well. We contribute six percent to their 401(k) whether they do or not. We recognize them. We listen to them. We empower them. They love working here. We don’t lose people. That gives us continuity. That allows us to build in successive versions of what we do, on what we had before. 

We do not become unfocused by saying, “They said we should do dental software.” Somebody else says, “Why don’t you guys do a drug database? or somebody else says, “Why don’t you do this?” No. We provide an engine to present relevant information to clinicians at the point of care. That’s what we do. If it doesn’t have to do with that, I don’t want to do it. That’s it. Great software gets produced in small, very collaborative, highly productive teams of experienced people who know what they’re doing and are very committed to it.

I assume Medicomp has been around long enough that you don’t have impatient investors demanding that you do something that sacrifices long-term success for short-term profits. Do you see that happening with other companies?

Absolutely. Anybody that has to answer a quarterly conference call is under that pressure. Any time there’s a blip in earnings or revenue, they really can’t do long-term investment at the expense of short-term results, so they cut people.

We’ve seen some of our own licensees — I won’t mention any names, but the news shows up in HIStalk all the time — they cut and then they hire and then they cut and then they hire and they rearrange and they right size and they downsize and they expand and they cut. It’s a tough way to build a business.

Our advantage is that Peter got into this because he loves what he’s doing. He carried the company through from 1978 to about 1992. We are owned by employees, Peter, and some family members. Everybody here is a stockholder. We’re all invested in the same thing. We all have a long-term vision because we believe that eventually, these systems have to be usable by clinicians at the point of care, and right now, they’re not. That’s why we’re starting to make some inroads.

Are EHR vendors are concerned about usability issues given that most of their development agenda is sucked up by ICD-10, Meaningful Use, and quality measures?

They’re not concerned about it yet. There’s a couple of reasons. The government has just pumped $30 to 40 $billion into HIT. They said that in order to qualify for this money, these are the things you have to do. That’s been a great boon to the sales, revenue, stock price, and valuation of the big vendors because here it is — just do this and you’ll get it.

At the same time, ICD-10 CM is no picnic and neither is Meaningful Use. Those things are so challenging that many physicians have said, well, to heck with this — I’m going to sell out and become an employee. Then they become disempowered by the organization. It’s happened here in northern Virginia. There’s one health system that dominates. They’re buying up practices left and right. They don’t have to listen to the docs right now. They haven’t had to listen to them for a few years because they’re doing great. They’re addicted to this money, which has let them do what they do, not have to adjust, etc. The docs aren’t really empowered, so usability, schmoozeability, we don’t care. It’s not a factor yet.

We think it will be, which is why we have folks like Phoenix Children’s Hospital coming to us and saying, our vendor’s not delivering on usability. Our docs need something they can use. Can we give it a shot with your software and put it in? And they did. Their vendor, Allscripts, tried to talk them out of it, but ultimately cooperated with them. They put it in. Within nine months, their docs love it. They’re seeing 30 percent more patients per day and they’re leaving early. 

I believe that once the tsunami of money coming in dries up, they’re eventually going to have to turn back to, how do we make doctors more productive? Particularly given that with the new health insurance laws, there are more patients to treat and possibly fewer primary care docs to do it. As we go to outcomes-based reimbursement, they’re going to be paid for how well they care for patients. We still think that’s going to happen one patient, one clinician at a time. You need to be able to efficiently provide care, so at some point, you’ve got to make this usable by the providers. 

That’s what we’re hoping. We’re starting to see that. We’re starting to get some traction in that. And as you said, we’re a more patient company than most.

I thought your business was working through EHR vendors who signed up to embed your product into theirs, but Phoenix Children’s went their own direction. Will you offer Quippe or the MEDCIN engine directly to customers without their vendor’s involvement?

Well, possibly. I don’t want to do that. I want to go through the vendors. But Phoenix came to us. They asked their docs, “What do you want for documentation?“ They did about a six-month analysis with the docs. The docs found it. They presented it to Allscripts. Allscripts said we’re not going to do that yet — we might have something in two years. 

Then they came and played our Quipstar game at HIMSS and said, you guys have what we want — can we try it? We said no, we don’t do that. They said, we’re a co-development site for Allscripts. We have access to their code. We’ve convinced them to let us do it. They think we’re going to fail, but they said they’d let us do it.

They had a great team, which is why I don’t want to do it with many other people. They had the best team I’ve ever seen. There’s a reason they got that award a few years ago as the best IT department. David Higginson is a demanding visionary leader, I’d call him. He had one programmer work on this part time for about nine months. They did the full integration with SCM. It went very well, beyond their and our wildest dreams. We had to back up and say, hold on, what are we going to do now?

We’ve done a couple of things. We learned a lot in that process. We’ve made it much easier to integrate Quippe with an existing system. As evidence of that, the next thing we did was when Bangkok Hospital in Thailand came to us. They have an IT subsidiary called Greenline Synergy. We’re getting some really good traction in Asia, in the Asia Pacific region, but we’re not implementation and training people. That’s not what we are and that’s the danger for us. When I talk about focus, I don’t want to do that.

They came to me and said, we want to do a little pilot. We want to see how quickly we can take Quippe and stand it up in one of our ambulatory clinics, and if it goes well, we will consider becoming your implementation, training, support, and distribution partner in Southeast Asia. Because we already have Bumrungrad Hospital live on the nursing stuff and we’re getting a lot of traction in Malaysia, I said, OK, let’s try it. They came here on April 27.  They sent three people — two developers and their clinical lead. They spent two weeks with our team. They went back. They got back to Bangkok on May 15 and they are now live in their ENT clinics with Quippe for physician documentation.

Is the product the same no matter where it’s installed? There’s nothing that needs to be localized?

It needs to be localized. We’ve had to build in some options for people that allow for localization. We did a project about four or five years ago where we said, if they really want to present it in local language, we will never get caught up, because there are 300,000 concepts, positives and negatives for each, and multiple presentations of each. But we did a little study and found that about 10,000 meds and concepts constitute about 95 percent of all documentation activity. Common things are common.

We did that. We did a translation into Thai, Chinese, and Spanish just as a test. When it came back, people said, we don’t really care about that because we operate in English a lot, but we use different forms of things in English. In Australia, they say "nappies" instead of diapers. We had to build in some additional tools to say to people, you can replace things by user, by site, by specialty, by country, etc. It’s sort of a localization pack.

We also have made it much easier for people to change the way that the engine behaves, because infectious disease things in Singapore are taken much more seriously than they are here because of the density of the population — they don’t want hand, foot, and mouth disease getting loose in even one building because it’s so contagious, so they want the software and the engine to work a little bit differently. They want to promote those things and get them right in front of users. It’s similar to what happened here when everybody decided we had to ask a few questions about Ebola. Think about that as a massive localization at every hospital in the United States for a while, although it’s kind of died down now. We’ve had to put in tools that make it much easier to localize our content and localize the operation of the engine.

What will be the biggest factors impacting healthcare IT over the next five to 10 years?

The concrete is poured, in the United States at least, for people who have spent the time and money to put in the systems that they have, which are heavily based on transactions, billing, and organizing admission-discharge-transfer stuff. This is our hope and this is our plan — that attention will turn back to, what are we going to do? How are we going to make all of this big data that everybody’s talking about actionable at the point of care? 

People are going to take a couple of different approaches. People like IBM with Watson, people working on all the natural language processing stuff, big data, all that. They’re going to approach it from the standpoint of, we can analyze all this information on the population and we can detect trends. Now whether they can do just correlations or causation, I don’t know, but at some point, if you’re going to improve outcomes, that stuff has to come back and be usable at the point of care.

We think that’s our opportunity. That’s what we provide. If we’re wrong and nobody cares about that, I probably won’t be around for you to talk to me in 10 years. But we think it’s turning because we’re getting more and more people come to us and say, can we do what Phoenix Children’s did? We spent all this money, our doctors still can’t use this stuff, we’re not getting the data we need, and we’re not pushing it back to the point of care – please help us do that. I think after the dust settles with ICD-10 and Meaningful Use, the industry is going to turn back and say, we’ve poured the concrete, now how do we build a road that these docs and nurses can use?

Morning Headlines 6/22/15

Aerospace Medicine Safety Information System (AMSIS)/ Request for Information

The FAA publishes an RFI for a system that it will use to track medical certifications, coordinate its substance abuse program, and integrate with NHIN and state and regional HIEs to collect medical information on pilots.

Personalized Technology Will Upend the Doctor-Patient Relationship

Harvard Business Review predicts that wearables, implanted devices, and medical apps will eventually deliver a 24/7 picture of individual health, revolutionizing the way chronic diseases are treated and managed and creating a gold-rush style influx of activity from existing businesses and startups. 

8 Indicted in Identity Thefts of Patients at Montefiore Medical Center

Eight Montefiore Medical Center (NY) were indicted Friday on charges of selling 12,000 medical records for $3 each, exposing the names, birthdays, and Social Security numbers of its patients.

Tamper-proof pill bottle could help curb prescription painkiller misuse, abuse

Engineering students at Johns Hopkins University’s Whiting School of Engineering createda 2.7 pound, 9-inch tall, tamper-proof pill bottle that uses fingerprint scanning technology to ensure that narcotics are dispensed only to the prescribed patient. The team cites the growing number of prescription drug-related overdoses as the motivation behind their work.

Monday Morning Update 6/22/15

Top News

The Federal Aviation Administration wants to connect its Amsis pilot medical certification tracking system to government EHRs via NHIN and HIE connectivity, hoping to detect safety-endangering medical conditions such as the depression of the Germanwings pilot who deliberately crashed his plane into the French Alps. The privacy considerations would be extensive.

HIStalk Announcements and Requests

More than half of poll respondents don’t use any smartphone health apps other than fitness trackers, although 17 percent say they use five or more. New poll to your right or here: do Sittig and Wright’s EXTREME criteria (defined here) accurately define EHR openness and interoperability? If you vote no, it’s only fair that you click the poll’s Comments link to describe what they missed.

Welcome to new HIStalk Gold Sponsor Dbtech. The Edison, NJ based document management, electronic forms, and document imaging company offers solutions for document and data archive, paperless registration, patient portal, reporting standardization, and no-silo storage of images. Dbtech’s Ras document management is installed in 350 community hospitals and works with all applications (Cerner, Epic, Meditech, etc.) regardless of hardware, OS, or database and contains workflow automation for SmartLinks, data extraction, AutoPrint, forms, email workflow, and HL7 and other integration standards. Case studies include Saint Michael’s Medical Center, Greenwood Leflore Hospital, Palisades Medical Center, and Mount St. Mary’s & Evangelical. Thanks to Dbtech for supporting HIStalk.

Listening: The Struts, British 1970s-style hard rockers that sound to me like Queen genetically spliced to The Hives and Quiet Riot.

My latest grammar gripes: Yelp restaurant reviewers who talk about their “palette” when referring to their “palate,” almost as annoying as those who didn’t realize the 15-minute shelf life of the trite phrase “to die for” ended years ago. People who needlessly insert “very” in front of words or phrases. Unskilled writers who ask their imaginary readers questions and then answer them instead of just making an authoritative statement in the first place, such as “Do we need ICD-10? Yes.” instead of saying “We need ICD-10.” Starting a sentence with “know,” in a pompous attempt at conveying sincerity, as in “Know that we will support our employees” instead of simply saying, “We will support our employees.” It also bugs me that people still think “the reason why” is somehow better than the correct “the reason.”

Last Week’s Most Interesting News

• England’s NHS announces ambitious health IT plans that include making real-time medical records available to patients by 2018 and issuing wearables for inpatient monitoring. NHS also goes live on its new e-referral service and then shuts it down almost immediately for an undetermined time due to known problems.
• Dean Sittig and Adam Wright propose EXTREME, five criteria that define whether a given EHR is open and interoperable.
• The draft budget submitted by the House Appropriations Committee holds ONC’s funding flat, does not include money for ONC’s proposed Patient Safety Center, and calls for AHRQ to be shut down immediately.
• CVS opens a Boston digital innovation center that will eventually house 100 employees, while the company also announces that it will acquire Target’s pharmacy business for $1.9 billion.
• HHS OIG finds that the federal government is paying many billions of dollars in insurance subsidies based purely on estimates since CMS still hasn’t finished the software modules that are needed to calculate the amounts correctly.
• The VA announces a three-hospital pilot of its open source, open system eHMP integration tool that allows VA clinicians to view context-aware information from non-VA systems such as the DoD’s EHR. Meanwhile, a GAO report that details the delays and cost overruns of high-risk federal government IT projects points out the repeated, expensive failure of the VA and DoD to integrate their EHRs.
• CHIME co-founder Rich Correll announces his retirement.

Webinars

June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.

Acquisitions, Funding, Business, and Stock

Virtual nurse technology vendor Sense.ly raises $2.2 million in a Series A funding round.

Investors who invested $50 million in preferred shares of Merge Healthcare to finance its February 2015 acquisition of DR Systems waive their right to have Merge redeem their shares by August 25, 2015, a vote of confidence that their hastily made investment is still attractive post-acquisition.

Sales

Fairview Health Services (MN) chooses Paragon Development Systems (PDS) for IT end user device asset management.

HealthShare Exchange of Southeastern Pennsylvania chooses Mirth solutions for Direct messaging, integration, MPI, and CDR.

Announcements and Implementations

SSI Group will resell Recondo Technology’s automated claims status solution as part of its revenue cycle solution suite.

Government and Politics

The State of Virginia notifies providers that not only must they be ready for the October 1, 2015 switchover to ICD-10, but also that the state will simultaneously stop using of the similar but separate DSM codes for mental disorders.

CMS awards Data Computer Corporation of America a $24 million contract to support the IT system that supports payout of Meaningful Use money.

A union representing the Pittsburgh VA, trying to gain bargaining power, says implementation of an inventory management system from Shipcom Wireless is stressing out its members. The system, which is being rolled out to all 152 VA hospitals in a contract worth up to $275 million signed in September 2013, is already live in 12 VA hospitals.

Privacy and Security

A clerk at Montefiore Medical Center (NY) is charged with selling 12,000 patient records for $3 each to co-conspirators who used the information printouts to go on luxury shopping sprees. It’s interesting that hospitals always seem to be involved in this kind of breach while retailers aren’t – maybe hospitals are different in their security precautions, hiring practices, breadth of information collected, or employee oversight.

Technology

NTT Data not only sponsors Chip Ganassi’s IndyCar racing team, but provides it with technology ranging from inventory tracking to a wearables device being created by the company’s healthcare division that will monitor the driver’s physiology. I’m suddenly struck by yet another fantastic business idea, of which surely one of mine will pan out one day: sell ad space on the white coats of doctors like NASCAR does its driver fire suits, where every available inch features the emblem of a paying sponsor. Uber could do the same, paying contract drivers to turn their cars into rolling ad space.

Mechanical engineering students at Johns Hopkins University develop a tamper-resistant, biometric-secured, one-at-a-time pill dispenser, which assures that pharmacy-dispensed drugs like oxycodone are used only by the intended patient.

Other

Nebraska Medicine announces its use of Epic’s MyChart on Apple Watch, allow its patients to receive provider messages, appointment reminders, medication information, new results availability, and notification that earlier appointments are available so the patient can accept the proposed time directly from the watch.

I think Vince Ciotti misses writing his HIS-tory series that I ran for a couple of years, as evidenced by this new episode that looks back on the buyer seminars his company has been putting on since the good old days.

A Harvard Business Review article says personalized technology such as wearables and apps that provide continuous monitoring will transform healthcare in the next 10 years, with help from telemedicine, home diagnostics, and retail clinics. The authors say the two business models will be (a) gold miners (insurers, and health systems) that will dig deep in successfully managing patients with expensive chronic conditions via care coordination and monitoring, and (b) bartenders (new healthcare entrants) that will empower consumers with advice and information that bypasses the doctor-patient relationship. Goldminers might approach an atrial fibrillation patient with an app-driven monitoring program administered by a clinical care team, while Bartenders would sell tracking apps that suggest interventions, provide reminders, and let the user retain and interpret their own data.

I’m not sure I see things quite that way since app-empowered healthcare consumers will still make up a tiny percentage as quantified selfers. I expect health systems to use their market share and profits to chase away nimbler competitors and steer consumers away from them in creating fear, uncertainty, and doubt that those upstarts aren’t proven or local like the impressive, comfortingly bureaucratic edifice down the street. Consumers will exercise choice only where they discern little differentiation,using convenient retail clinics and video visits for obvious and self-limiting conditions where all that’s really needed is reassurance and possibly a prescription. Health systems will create narrow networks and manipulate quality and satisfaction metrics so that confused, low-expectation consumers will simply keep going to whatever provider they’re told. Chronic conditions will be much better managed by technology because providers will be paid specifically for outcomes, which is one bright spot, and while companies may well do an end-run around the doctor-patient relationship (which is rapidly eroding anyway), they won’t be able to crack the health system-patient relationship. Any effort to upend the status quo will be squelched via lobbyist influence and deep war chests unless health systems, doctors, drug companies, insurers, and device manufacturers are somehow turned on each other, which is less likely now that employers are bowing out of the healthcare war and leaving their employees to fend for themselves. There’s no equivalent to “changing healthcare” except perhaps “changing government” and the folks running both aren’t going to just step aside.

The San Diego paper profiles 20-employee Humetrix, which along with iBlueButton has developed Tensio, a blood pressure management app that uses information from Apple HealthKit-attached devices.

A New York Times article examines more rapid treatment of heart attacks, with technology earning modest credit: ambulances that can send EKGs to hospital EDs and hospitals using paging systems to assemble response teams quickly. The article seems to confuse heart attack deaths with deaths from heart diseases, however.

The local paper, skeptical of Hartford HealthCare’s (CT) claim of financial distress that requires it to eliminate over 300 positions, notes that the health system paid it top 18 executives $12.8 million in 2013, with bonuses averaging $135K each. The CEO made $2.1 million, while the CIO took home $630K.

Bizarre: Chinese citizens anxious to unload shares as the country’s stock market plunged last week include a woman who crashed her car while executing trades on her smartphone and another who sold her portfolio from her iPad while medicated and laboring in a hospital’s delivery room.

Weird News Andy is happy to hear that AIDS, SARS, MERS, and Ebola have been cured thanks to North Korea’s Great Leader Kim Jong-un, who claims to have created a miracle drug from ginseng and other ingredients he declines to name, to which WNA adds, “It’s a floor wax AND a dessert topping!”

Sponsor Updates

• Experian posts “Using Data to Manage the Cost of Healthcare” and a video titled “Healthcare Data Diagnosis: Using Data to Manage the Cost of Healthcare.”
• Nordic offers a new episode focusing on technical cutover in its “Making the Cut” video series.
• Orion Health publishes an “AHIP 2015 Recap: It’s all about the Consumer, Transparency, Interoperability and Data Exchange.”
• Experian / Passport Health offers “Using Data to Manage the Cost of Healthcare.”
• Patientco explains “Where to Find Patientco at HFMA ANI 2015.”
• PatientPay offers “How Many More Reasons Do You Need?”
• Washington Hospital Services will offer ZeOmega’s Jiva HIE-enabled population health management solution to its members.
• NVoq offers “The EMR Journey to Optimization and Innovation.”
• Phynd will exhibit at the 2015 Annual Physician-Computer Connection Symposium June 23-25 in Ojai, CA.
• PMD offers “Three Lessons Your Baby Will Teach You About Software Implementations.”
• Streamline Health will exhibit at the 2015 AMDIS Physician-Computer Connection Symposium June 24-26 in Ojai, CA.
• Greenway Health highlights its partnership with Talksoft.
• TeleTracking offers “From Patient Flow to Real-Time Operational Management.”
• Verisk Health publishes “Gearing Up for VHC2015.”
• Voalte discusses digital health and wearables in “Let’s pick up the pace.”
• Huron Consulting posts pictures of its work with Sea Island Habitat for Humanity.
• Xerox Healthcare offers “Three Ideas That Will Make Healthcare Work Better.”
• Zynx Health comments on the Medicare Shared Savings Plan ACO final rule.

The following HIStalk sponsors are exhibiting at HFMA ANI June 22-25 in Orlando:

• ADP AdvancedMD
• Allscripts
• Besler Consulting
• Billian’s HealthDATA
• Craneware
• Experian/Passport Health
• GE Healthcare
• Greenway Health
• Health Catalyst
• Ingenious Med
• InstaMed
• Legacy Data Access
• Leidos Health
• MModal
• McKesson
• Medecision
• Medhost
• Navicure
• NextGen
• NTT Data
• Nuance
• Patientco
• Peer60
• Recondo Technology
• Relay Health
• Sagacious Consultants
• SSI Group
• Strata Decision Technology
• TransUnion
• TriZetto
• T-System
• Valence Health
• VitalWare
• Wellcentive
• Xerox
• ZeOmega
• Zynx Health

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/19/15

Health and social care leaders set out next steps to transform NHS services and improve health outcomes using technology and data

In England, the NHS announces that patients will be given real-time access to their entire digital health records by 2018. UK citizens are already able to book appointments, request prescription renewals, and view medical record summaries online.

New NHS e-Referral service ‘unavailable until further notice’

Also in England, the NHS’s new online appointment scheduling system has been taken offline until further notice after going live on Monday. The service, whose predecessor was used by 40,000 patients per day to schedule appointments until last week, launched despite 33 known issues, including missing functionality and slow loading times.

Making appropriations for the Departments of Labor, Health and Human Services, and Education

A draft budget created by the House Appropriations Committee reduces ONC’s requested $75 million budget to $60.4 million, and provides no funding for its proposed ONC Patient Safety Center.

National Medicare Fraud Takedown Results in Charges Against 243 Individuals for Approximately $712 Million in False Billing

The Department of Justice announces that it has arrested 243 individuals, including 46 doctors, in connection with a Medicare fraud scheme that netted $712 million through false billing. The arrests were the largest coordinated takedown in the history of the DOJ’s Strike Force.

News 6/19/15

Top News

England’s NHS makes tech announcements: commits to giving patients real-time access to their entire electronic medical record by 2018, ambulance services will also be connected electronically to hospital EDs. NHS is also looking into the possibility of making all of its facilities free Wi-Fi zones and rolling out wearables to patients for in-hospital monitoring. Other proposed projects include endorsement of third-party health apps, providing technology training to citizens, and adding learning disability and dementia status flags to the Summary Care Record. Patient digital services will be delivered via the NHS Choices website. The announcements were made at the National Information Board meeting, taking place at Kings Fund Digital Health Congress 2015 in London (if you are attending, HIStalk sponsors TeleTracking and  Orion Health are exhibiting).

Reader Comments

From Not in Monterey: “Re: 3M’s coding product. Our hospital system was told they will update their product just weeks before the ICD-10 implementation date. I find this to be insane. I would be interested to hear if users of large EHR systems are receiving endless dribbles of code fixes for ICD-10 even now since we are experience this with Cerner.”

HIStalk Announcements and Requests

It’s that time of year when schools are out and health IT news is slow, so we can all enjoy a slight break until September.

Response has been excellent to “What makes an EHR ‘open’ or interoperable?” as published in JAMIA and summarized by the authors on HIStalk. Dean Sittig and Adam Wright wrote the original article after I challenged someone other than vendors to define what “open” and “interoperable” really mean since vendors have turned those terms into meaningless marketing froth (former Allscripts CEO Glen Tullman was easily the worst offender for repeatedly stating that all of the company’s mixed-ancestry EHRs are open and interoperable by definition since they all run on Microsoft SQL databases). Most notable to me is that nobody has challenged the definition proposed by Sittig and Wright, so they seem to have captured consensus. I have ideas about where it could go from here:

• Assess the three DoD EHR bidders – Epic, Cerner, and Allscripts – on just how open and interoperable their systems are since DoD claims it wants an EHR with those characteristics for our $11 billion taxpayer investment.
• Ask the top EHR vendors, hospital and ambulatory, to provide a live customer example of being able to perform each of the five items in a real-world environment (extract information in an understandable form, send information to another EHR, accept real-time information requests and return structured information, move all of a customer’s patient records to a new EHR along with metadata and a data dictionary, and open up access to its systems using programmatic, secure APIs).
• Athenahealth complains and/or brags the most about openness among EHR vendors. Let’s see the company throw down against its competitors using these measurable criteria. That should raise visibility and give Jonathan Bush something fun to talk about.
• Ask the top EHR vendors to state in writing that they don’t limit openness and interoperability via contract terms that require developer certification, non-disclosure terms, license fees for outside access, custom programing, or documentation fees. As proof, let’s see their most recent signed customer contract.
• Challenge vendors to publish where they stand on each item or their plans to achieve all five.
• Turn the list into a layperson-friendly version that could be used by Congress and other interested political bodies, perhaps inviting the authors to testify at the HELP subcommittee hearings.
• Add the criteria to EHR certification.
• Further expose the criteria and how prospective EHR customers can evaluate vendor performance against them via ONC’s publicity and informational offerings, including ONC-produced contract boilerplate that prospect customers can insist vendors include.

The industry tends to get too deep into semantics when it comes to the technologies that can support openness and interoperability. These criteria leave the technology out of the picture and instead focus on outcomes – systems can either do these things or they can’t no matter what the marketing people say.

I mentioned the other day that Twitter is expanding the character limit on direct messages from 140 to 10,000, which several readers (including Dr. Jayne) misread that to mean that all Twitter messages can now be that length. Direct Messages are the ones where you tweet someone privately using the Direct Message option, which is possible only if they follow you (although I remember joking years ago that if Twitter ran into revenue problems, which seemed inevitable, they could offer a premium membership that expands the tweet box to more characters, knowing that the verbose among us wouldn’t be able to resist). Expanded Direct Messages give Twitter at least a theoretical messaging tool to compete with similar offerings by Facebook and LinkedIn, although the limitation of all three is that unlike email, you can’t message anyone who hasn’t already connected with you, which is often the reason you want to contact them in the first place.

This week on HIStalk Practice: ThoughtWorks partners with Save the Children to develop EHR for infectious-disease outbreaks. ONC releases massive data set on every meaningful user. Quest Diagnostics Care360 EHR ranks high with small physician practices. MyIdealDoctor announces new funding. PAA survey reveals physician frustration with EHR charting and loss of productivity. Young female PCPs show the ACA some love. Federation of State Medical Boards CEO Humayun Chaudhry, DO discusses next steps for the Interstate Medical Licensure Compact.

This week on HIStalk Connect: the FDA partners with online support group vendor PatientsLikeMe to use its database of patient-reported adverse drug events to improve the FDA’s post-market surveillance programs. Telehealth vendor Doctor On Demand raises a $50 million Series B, while Aledade, Farzad Mostashari’s new startup, raises a $30 million Series B. Apple patents a new approach to calculating resting heart rate that should solve many of the problems users are experiencing with the Apple Watch.

Webinars

June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.

Acquisitions, Funding, Business, and Stock

Hospital bed maker Hill-Rom will acquire point-of-care device manufacturer Welch Allyn for $2 billion. Both companies offer technology products, with Hill-Rom selling tools for asset tracking, hand hygiene, staff locating, nurse call, fetal monitoring, and patient safety.

Xconomy profiles Madison, WI-based prescription refill management platform vendor Healthfinch, which has raised $3 million in funding since 2011 and has grown from four employees to 21 in the past 18 months.

Allscripts, which in November 2014 was ordered to pay $9.7 million to Etransmedia for deceptive trade practices after a failed business relationship, petitions North Carolina to deny Etransmedia’s request for further litigation that Allscripts says would cover issues that have already been resolved in arbitration. The November arbitration panel ruled that Allscripts convinced Etransmedia to buy MyWay EHR licenses for resale via a Costco Wholesale program but then “deliberately sabotaged” Etransmedia’s sales by retiring MyWay in October 2012, sticking Etransmedia with millions of dollars in unsold licenses.

In an “only in America” major medical advance, Botox maker Allergan will pay $2.1 billion to buy Kythera Biopharmaceuticals, which just won FDA approval to sell an injection that eliminates double chins, which the company previously estimated as a $500 million per year US business. Allergan offers a number of cosmetic drugs and hopes Kybella will bring women into doctors’ offices for cross-selling opportunities. As a bonus, the money-losing Kythera is also developing a baldness drug. The smart money (like Allergan’s) is that doctors will ignore Kybella’s specific indications and start shooting it indiscriminately into cellulite-laden thighs and butts. KYTH shares are up 91 percent on the year and 209 percent in five years.

Video visit provider Doctors On Demand, which offers $40 medical consultations, closes $50 million in a Series B funding round.

Sales

Recondo Technology announces sales of its patient access and business office solutions to University of Virginia Health System (VA), Northside Hospital (GA), and Hannibal Regional Healthcare System (MO).

Dayton Children’s Hospital (OH) chooses Phynd to manage 7,000 providers across its EHR and other systems.

Legacy Health (OR) selects GetWellNetwork’s interactive patient care system.

People

Health Data Specialists names David Astles, PhD (Encore Health Resources) as VP of revenue cycle.

Regional Medical Center (AL) promotes Pete Furlow to CIO.

Deven Mcraw (Manatt, Phelps & Phillips) joins HHS’s Office for Civil Rights as deputy director for health information privacy.

Healthline hires Paul Clip (RelayHealth) as SVP of engineering for its health IT group.

The HCI Group promotes Cynthia Petrone-Hudock to president of international business. I interviewed her a few months ago.

CHIIME co-founder Rich Correll announces his retirement, with accolades from industry long-timers that include John Glaser, Bill Spooner, Rich Rydell, and Larry Grandia. His LinkedIn profile lists his occupation as “senior old guy.”

Announcements and Implementations

Premier introduces Quality Cycle Management, a SaaS and services offering that helps health systems recognize areas of clinical outcomes that are reducing their CMS payments under value-based purchasing.

Huntzinger Management Group launches a big data consulting service called V6 Data Analytics.

Practice Fusion releases native iOS and Android tablet versions of its free EHR.

Grant-funded and volunteer-led Games for Health will co-locate its annual conference with HIMSS’s mHealth Summit in December. 

Planned Parenthood pilots an app that lets California users order a $149 at-home urine test for chlamydia and gonorrhea, and if the mailed-in urine samples are positive, the user is notified via the app and is issued either an electronic prescription or an appointment prompt, respectively. The organization already offers residents of Minnesota and Washington app-based video consultation by which users can receive birth control and sexually transmitted disease test kits.

@Cascadia notes that Providence Home Health (WA) is offering Seattle-area house calls for $99, scheduled online and prepaid by credit card.

GE Healthcare will move customers of its patient flow solutions to those offered by TeleTracking in a newly signed collaboration agreement that also includes shared analytics.

Government and Politics

A draft budget by the House Appropriations Committee would fund ONC at $60.4 million, the same as it received in FY2014 versus the $75 million requested by the White House. No funding is proposed for ONC’s Patient Safety Center. The draft also calls for AHRQ to be shut down immediately. The Republication-majority committee’s first bullet point in announcing the funding bill is to “stop the implementation of ObamaCare.”

Joe White, the former CFO of Shelby Regional Medical Center (TX), is sentenced to 23 months in federal prison and is ordered to replay $4.5 million to CMS for falsely attesting to Meaningful Use for his for-profit hospital owner employer, whose facilities received $16 million in total MU payments.

The Department of Justice conducts what it says is the largest Medicare fraud take-down in history, with charges of $712 million in false billing filed against 243 people, of which 46 are licensed professionals. Among the charges: paying and receiving kickbacks, coaching patients to appear eligible for services, a physician home visit company that billed $43 million for a single doctor, providing medically unnecessary wheelchairs, billing for services not performed, and mailing $38 million worth of talking glucose monitors to people who didn’t ask for them. The splashy announcement is probably intended to make criminals think twice before committing Medicare fraud, but I can’t imagine a more compelling incentive than the agency happily writing a single doctor $43 million in checks before finally catching on that something wasn’t quite right.

Innovation and Research

CVS, fresh off this week’s announcement that it will buy Target’s pharmacy business, opens a digital innovation office in Boston’s Back Bay to increase access to tech talent and to foster collaboration with local providers and startups. CVS already has 40 people working from the new office and expects to top out at 100 employees. VP of Digital Strategy and Innovation Andrew Macey says the projects will always be prototyped and marketed within one year, adding that CVS is opening up its systems with APIs and is also studying how streams of wearables data can be used to help people get healthier.

Technology

Sprint is forced by new net neutrality laws to stop throttling back customer cellular data bandwidth during busy periods, quickly reacting to the news that FCC will fine AT&T $100 million for misleading customers by selling unlimited data packages but capping their data speeds after 5 gigabytes in a billing period.

Other

In England, hospital executives admit that they should have paid more attention to the concerns of a 19-year-old cancer survivor instead of telling her to stop Googling her symptoms. She died of cancer 10 days after being admitted, with her family complaining that during her stay, she was not given pain relief, referrals were delayed, and doctors were “evasive and aloof” when the family tried to gather information. The hospital has enlisted her mother to help it improve (or at least to improve its image).

Also in England, the NHS’s new e-referral system has been taken offline “until further notice” days after its launch after several of its known problems were deemed to be unfixable on the fly.

The former pharmacy director of Beth Israel Hospital (NY) pleads guilty to stealing 200,000 oxycodone tablets worth $5.6 million on the street by falsifying entries in the hospital’s electronic narcotics inventory system.

What’s ugly about US healthcare in a nutshell: lawmakers argue over the decision by Yale New Haven Health System to close two clinics, with the hospital blaming lower Medicaid payments and higher state taxes, while opponents say the health systems uses anti-competitive practices and opportunistically timed state budget political pressure to support its huge profits and million-dollar executives.  It’s fascinating to me that Connecticut in 2012 starting charging hospitals a new tax worth $350 million, which earned it an extra $200 million from the federal government, and then the state gave the hospitals back their $350 million plus another $50 million in vig, keeping $150 million for itself by beating federal taxpayers in a financial shell game.

Two labor unions sling arrows at each other in trying to gain power over Kaiser Permanente workers, with upstart union NUHW claiming that SEIU-UHW gained Kaiser concessions by blocking whistleblower protections and agreeing to drop ballot measures that would have capped hospital prices and executive paychecks. Consumers lose just about any way you look at it.

Bizarre: hearings continue in the negligence lawsuit brought by a fan of the Kansas City Royals, who claims that in 2009 he was permanently impaired when the baseball team’s former mascot threw a foil-wrapped hot dog while the man was looking at the scoreboard, striking him in the eye and detaching his retina. The lawsuit is in its fourth inning, having already been heard with inconsistent verdicts in three rounds of courts.

Weird News Andy says DNR might stand for “Do No Rong” as nurses in England allow an inpatient to die because someone forgot to remove a previous bed occupant’s “do not resuscitate” sign.

Sponsor Updates

• DocuSign CFO Mike Dinsdale is recognized as the 2015 Bay Area CFO of the Year for Emerging Business.
• Healthgrades releases a white paper on robotic-assisted surgery clinical outcomes in women’s care.
• Extension Healthcare will exhibit at the 15th Annual Healthcare Summit Disruptive Forces in Healthcare June 22-23 in British Columbia.
• FormFast offers “4 ways to improve efficiency in multi-facility hospitals.”
• Galen Healthcare offers “Successfully Attest for Meaningful Use While Simultaneously Converting to a New EHR.”
• GE Healthcare General Manager of Monitoring Solutions Didier Deltort explains how the demand for digital talent will change the healthcare job market.
• Hayes Management Consulting offers “It’s Almost October 1. Do You Know Where Your Documentation Is?”
• HCS will exhibit at the 2015 Long-Term and Post-Acute Care Health IT Summit June 21-23 in Baltimore.
• The HCI Group offers a new white paper, “ICD-10 Health Plans: Essential Elements for Effective Testing Strategies.”
• Healthcare Data Solutions publishes “Health System Pharmacists: 4 Ways to Solve Ethical Dilemmas.”
• HealthMedx will exhibit at the New York State Health Facilities Association Conference June 28-July 1 in Saratoga Springs.
• Iatric Systems will exhibit at the NCHICA AMC Conference on Securely Connecting Communities for Improved Health June 22-24 in Chapel Hill, NC.
• Influence Health offers “Why Mobile Should be the Greatest Priority in Your Online Marketing Strategy.”
• Healthfinch offers “Mission is Great, but Execution Matters.”
• Intellect Resources offers “Resume Writing Secrets from a Recruiter.”
• InterSystems and Intelligent Medical Objects will exhibit at the AMDIS 2015 Physician-Computer Connection Symposium June 24-26 in Ojai, CA.
• Legacy Data Access helps over 175 hospital systems comprising 1,100 facilities retire their healthcare data.
• Healthwise will exhibit at the CMSA 25th Annual Conference & Expo June 23-26 in Orlando.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

EPtalk by Dr. Jayne 6/18/15

Some days I have a love/hate relationship with social media. There are simply too many things to read and not enough time in the day, especially while I’m trying to grow my consulting business and regain my sanity after years in the non-profit health system universe. It was with great dread that I read Mr. H’s comment on Twitter upping its character limit from 140 to 10,000. I have a hard time keeping up with the current twitterverse, where people are forced to parse their thoughts. I can’t imagine what things will become. I know I had to think more along the lines of Haiku than Soliloquy when posting and that was a challenge. We’ll have to see how it flows once the change becomes real.

Crushed by alligator: W58.03XA

One of my clients is arriving at the ICD-10 dance a little late. Although they thought they had been preparing, they lost some key resources and really aren’t sure where they stand. I would bet that they’re fairly representative of small-ish physician owned practices across the country. They aren’t large enough to have dedicated resources, so ICD-10 became “other duties as assigned” for members of the practice. Once those resources moved on, they were in a bind.

I have to give them full credit, though, for realizing that they have an issue and reaching out for help. My first task was to go through the former employees’ computer files (which thankfully the office kept copies of) and identify any ICD-10 preparedness work or documentation that already existed. There was actually a decent amount of material – especially vendor documentation, a couple of partially completed assessment matrixes, and a library of vendor contacts.

I reached out to their EHR vendor and found that they were already offering an ongoing series of webinars. It’s a specialty-specific EHR that I hadn’t worked with previously, so I signed up. At first, I was skeptical because the webinar started late (normally a black mark in my book). However, my opinion started to turn when I realized that they had already placed ICD-10 under the hood of the application almost a year ago. Since it’s a hosted product, the client just has to open a support ticket to get it turned on. Whenever they’re ready, the client can start with dual coding workflows.

The conversion will occur by payer, and based on an effective date of 10/1, so it doesn’t hurt anyone to go ahead and get ICD-10 going. Once the switched is flipped, providers will see an extra column in their diagnosis grid that will hold the ICD-10 codes. Additionally, when selecting an assessment, they’ll be prompted for laterality (right, left, bilateral, unspecified) on applicable diagnoses before they can make their final selections. That all looked pretty good.

I wasn’t impressed, however, by how the providers have to modify their custom lists for past medical history and assessments to associate ICD-10 codes. This provider mapping has to be done through the practice management system. Although they have embedded crosswalks to assist, it doesn’t look like the mapping process shows the native ICD-10 descriptions but rather just the ICD-9 ones. For me as a physician, it would be difficult to trust the mapping without being able to see the native description. Additionally, when walking through the provider mapping process, some diagnoses didn’t appear to have bilateral as a choice even though right, left, and unspecified were present.

They offered interactive question and answer time after the formal presentation. The attendees were pretty quiet, despite there being a number of them dialed in. It was difficult to tell whether they had no questions because they were: a) deer in the headlights; b) confident in the workflow; or c) tuned out and just attending the webinar because someone told them to. The vendor did provide a document with frequently asked questions that was pretty solid, explaining the testing processes they’ve used and their plans for handling billing should something go dramatically wrong on October 1.

I found it interesting that in the FAQ they admitted that they had to use third-party development resources to help meet the timeline. Additionally, they said that their clearinghouse is positioned to provide additional support should there be any issues with claims submission. They also explained in the document that they’ve been using SNOMED coding all along and that is the intermediary by which they are going to transition the ICD codes. The FAQ document also made it clear that they anticipate there may be some downstream issues with payers having “varying levels of preparedness for the deadline.”

Having come from the client-server, self-hosted world, I appreciated the fact that the vendor has done significant claims testing that individual customers do not have to repeat. The vendor uses a single clearinghouse, so I’m sure that made the testing a bit easier than it might have been. I feel pretty confident this client will be OK from a technology standpoint, but am planning some face-to-face provider education as well as structured practice sessions in their test environment. I’m already looking for funny scenarios to break up the monotony of training and found this one today: Z63.1: Problems in relationships with in-laws.

What’s your favorite new ICD-10 code? Email me.

Email Dr. Jayne.

Morning Headlines 6/18/15

Fitbit raises $732M in its IPO, $37M more than expected

Fitbit finalizes its IPO, raising $732 million at a $20 per share price, for a total valuation of $4.1 billion. Shares will begin to trade this Thursday under the symbol FIT.

Congressional GOP plans to continue health law subsidies

As the Supreme Court nears a ruling on a case challenging the legality of ACA subsidies paid on behalf of seven million Healthcare.gov consumers, congressional republicans announce that they will move forward with a plan to extend those subsidies through the end of the year while they draft their own healthcare reform plan.

US Nonprofit Hospital Tax Exemption Almost Doubles Between 2002 And 2011

Health Affairs publishes a study finding that the total value of tax exemptions enjoyed by non-profit hospitals has grown to $24.6 billion, up from $12.6 billion in 2002.

Doctor On Demand Pulls In $50 Million To Continue Expansion Of Its Virtual Doctor Visit Platform

Three-year-old telehealth vendor Doctor on Demand raises a $50 million Series B funding round to accelerate the growth of its platform. The company also announced that it has signed its 200th employer-customer.

Readers Write: How to Sell to MD Anderson

How to Sell to MD Anderson
By Niko Skievaski

Last Wednesday, I had the pleasure of attending MD Anderson’s IS Vendor Summit in Houston. Imagine a room of 200 enterprise sales executives at the edge of their seats listening to how MD Anderson’s transition to Epic may or may not affect their prospects with the world’s largest cancer center. The usual conversations were accented by beads of sweat organizing in military formation on the tips of noses, bayonets at the ready.

CIO Chris Belmont and his team transparently outlined how they plan to transform the patient care experience. Their vision includes the concept of bringing the patient’s overall experience up to par with the world-class care that patients expect. This is along the lines of Branson’s "Virgin Way," in that the service experience begins when a customer starts thinking about your product and not simple when interacting with it.

From the cancer center’s perspective, this experience starts when a patient is diagnosed and gets home to Google for the best place to get treatment. It continues through each encounter at the hospital, including driving directions, parking, way-finding, and waiting rooms. After the treatment (which is the actual product), the experience needs to go home with the patient as they transition to becoming a survivor.

The good news for us: this will take a lot of technology and most of it falls far outside the functionality provided by the EHR. Jeff Frey leads up the Digital Experience and has taken on the role of the true cowboy at the organization. When the room was asked, "Who in here hasn’t worked with Jeff?" we fell silent, either because we all had or we were too ashamed to admit we hadn’t. Needless to say, Jeff and his team need to wrangle what will be hundreds software vendors into a coherent digital strategy to present a seamless experience for patients. (FYI – iPads seem to be the chosen hardware.)

This requires collaboration. That brings me to the key points of selling to MD Anderson, as I understand it. Here it is, summarized, enhanced, and optimized for effectiveness.

How to Sell to MD Anderson

Stop pitching us on how your product will save healthcare. Pitch on how your product will fit into our goals for the digital patient experience. You won’t be able to do it alone. You need to collaborate with other vendors, so talk to each other. You may be competitors on the trade show floor, but in here, you’re part of our vision. Work together and solve these problems. Don’t make us stitch it all together. Don’t give us yet another analytics dashboard — we won’t use it. Give us an API and integration plan. Your chances of landing a meeting dramatically increase with the number of vendor-collaborators you bring with you.

Anyone want to collaborate?

Niko Skievaski is  co-founder of Redox.

HIStalk Interviews Robert Clark, MD, Chief of Pediatric Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC

Robert Clark, MD is chief of pediatric critical care medicine at Children’s Hospital of Pittsburgh of UPMC. He is a co-author of the newly published article in Pediatric Critical Care Medicine titled “Evaluation of Electronic Medical Record Vital Sign Data Versus a Commercially Available Acuity Score in Predicting Need for Critical Intervention at a Tertiary Children’s Hospital.”

Tell me about yourself and the hospital.

I’m the chief of the division of pediatric critical care medicine at Children’s Hospital Pittsburgh. I’ve been in that role since 2009. I’ve actually been at Children’s since 1992 as a fellow. As part of the responsibilities of pediatric critical care medicine, we oversee the rapid response team or the emergency response team for the hospital, in that we essentially respond to patients in cardiac arrest or patients with critical conditions.

What are the most significant information technologies that contribute to pediatric critical care there?

There is a ton of IT in terms of the EMR. The computer has order entry and recordkeeping and things like that.

The reason we gravitated to an electronic surveillance system is based on the fact that we rely heavily on information technology and the IT to keep tabs on what are very complex patients with a lot of data. Essentially, in the pediatric intensive care unit here, we’re taking care of the sickest patients in western Pennsylvania. There’s a lot of information. We can have hundreds of orders on a single patient a day and we can have 100 lab values for patients a day. If you add in vital signs data and things like that, there’s just megabytes of information that need to be filtered and processed. If we tried to do that just with our trainees and nurses and physicians, we would be in a sea of data without directions. We utilize IT quite a bit.

Your recent journal article concluded that PeraHealth’s Rothman Index surveillance system gave fewer false positives that other types of monitoring. Is it a tough balance to get enough data sensitivity to tell you something you didn’t already know versus issuing false alarms?

It is a challenging balance. The key, really, is that we don’t want to take away the human element of things. A lot of the times when a kid is really sick, it doesn’t take the Rothman Index or a fancy artificial intelligence-based system to figure that out. You can take any competent nurse or competent physician or healthcare worker and you can just look at a kid and know that they’re very, very sick.

The issue comes about, from my perspective, when you have children that you can’t look at them and say something’s going on or that something happens unexpectedly. Those are the ones where I think the surveillance technology is really, really important.

We moved from an old hospital to a new hospital in 2009-ish. Now there’s a 200-bed hospital and  the 36-bed intensive care unit. The intensive care unit essentially has a footprint that’s half a city block. It’s really hard to keep track of what’s going on on one side of the block and the patient on the other side of the block simultaneously.

Based on everyone’s level of experience and training, you know which patients you need to keep an eye on, the real sick ones, and they’re right smack dab in the middle of your radar.  But what we’re trying to go after with the surveillance system is keeping track of everyone else while we’re focusing in on some of the kids that are really, really sick. The last thing you want to do with a system like that is to overwhelm people with false alerts. You don’t want to be flying over to Bed 1 from Bed 36 when Bed 1 is actually just fine.

It’s essentially a complementary system that doesn’t take away the human trigger. The human trigger is very, very sensitive in picking up these things. But you can’t be everywhere all at once. The addition of the Rothman Index, the electronic triggered system, really complements it to be able to keep track and keep synthesizing data on everyone in the hospital, in addition to the ones that we’re already focused on.

The kids that have already got our attention, we don’t need a surveillance system for that. We need a surveillance system for the ones that are out on the periphery, not on our radar, not expected to have any sort of event that requires any interventions. That’s where the complementary system is valuable.

There are shortcomings related to the sensitivity of the Rothman Index right now, but I think they are offset considerably by the fact that kids with the lowest Rothman Index you could look at and say, whoa, something’s not right here. The two in combination will work really, really well.

But that said, I know the folks at PeraHealth are in agreement with that. We’d rather boost the sensitivity to increase the performance of the system. That is where we’re still working with the folks at PeraHealth to course correct when we put this in place and find out where’s the real sweet spot in terms of being able to detect instances where we need to perhaps intervene without false alarms. I don’t think we’re there yet, but I think we certainly plan on working on it.

Could similar triggers be used to monitor populations, where data analysis might turn up non-inpatients whose data points indicate a potential need for intervention?

I am personally just focusing mainly on the hospital aspect of things right now, but I’ve had conversations with the folks at PeraHealth. Essentially what we want to do is put child health in a cloud.

Right now, if there’s a child that has an issue on the floor, then my iPhone goes off with a little message that someone needs to take a peek at this child. This is really the first step in the surveillance system, focusing on patients that we knew need some type of intervention.

But you can imagine expanding this out to have child health in a cloud. Someone in a clinic in Johnstown, PA, who had integrated with the EMR through the western Pennsylvania children’s health system have a certain combination of factors in their EMR. Somebody in the system gets a little ping — so and so, check out this medical record or maybe give the folks a call or whatever it is. I think that’s really the future of all this.

It’s kind of a needle in the haystack thing. We wanted to focus in on the patients where we knew there would be a signal, essentially started there with kids that have cardiac arrest or critical intervention. But again, expand that out. You can even imagine this child health in the cloud kind of thing where not only do I get an alert when this happens, but the pediatrician — the primary care provider for the child — also gets an alert. Then in the future, the parents can’t be in the hospital with the child, maybe they get an alert, too.

I think it’s really potentially powerful. Not being really deep in the IT world, maybe this is already going on, I don’t know. But the first step for western Pennsylvania is we start with the sickest kids and the sicker kids in the hospital in the healthcare cloud and then we try to expand that to the whole hospital, which is what we’re doing now, at least with the surveillance. 

We’re planning to finesse this into multiple other areas. Not just for emergency response, but to say when a child’s ready to go home, when a child shouldn’t go home, notifying pediatricians in the community about the status of their children that are admitted here. Eventually you can envision being able to notify families of important things going on.

You co-authored a controversial 2005 journal article that concluded that the implementation of Cerner increased pediatric mortality at the hospital. What has changed in the past 10 years?

I think the biggest lesson that we learned from that is that the IT people need to talk with the folks in the trenches, honestly. There was this real strong desire to roll this out hospital wide, which was OK for 90 percent of the hospital. It would be absolutely fine and wonderful. You can do little course corrections and you can finesse things on the fly. But we saw a certain population where we really thought that they should do a sequential rollout in the less-acute areas before moving into the intensive care unit. 

Had we been in from the beginning, I think we wouldn’t have had these issues. There’s a learning curve with everything and there is a learning curve with implementing computerized physician order entry. We learned a lot about how not to do it. We just thought it was important that we report it because we wouldn’t want other hospitals to go through the same mistakes.

When this new surveillance system came about initially, it was mostly IT and the CMIO working on it. But they contacted potential end users like myself. We said, well, wait a minute, we don’t even know if we will use this. That’s why we wrote the most recent article, honestly. Before we roll this out, before we start buying into it, I want to see how it performs.

After talking with the folks at PeraHealth about the Rothman Index and with our IT people, I sat down with our fellows. We said, let’s do a retrospective study, look at every kid that’s had a cardiac arrest or a critical intervention, and let’s look at the performance of the PRI and see if it’s really something that’s impactful. Lo and behold, it was. It wasn’t perfect. But this was just, how is it performing the last two years of no one paying any attention to it? And it performed pretty well. It performed better than just using the existing set of electronic data that we collect.

It was, again, the launching pad. We’re planning a prospective study where we’ll roll out the system to see if we can get children to the right place to where they need to be in the hospital at the right time. This was the lesson learned in 2005 — get the end users involved, get the people that actually are in the trenches to participate in the development of these sorts of things. This is a good example of why it works really well.

I am skeptical by nature, PRI this or PRI that. So we did the study and it was very objective. There was no bias. We didn’t get a penny from PeraHealth or Children’s Hospital, either. We just took the data, analyzed it, and put our own statisticians independently on it. Like I said, it looks like the performance is decent enough, and the best thing about it is that I think we can make it even better with a few course corrections here and there.

Morning Headlines 6/17/15

CMS Internal Controls Did Not Effectively Ensure The Accuracy Of Aggregate Financial Assistance Payments Made To Qualified Health Plan Insurers Under the Affordable Care Act

An OIG report finds that CMS paid subsidies on behalf of Healthcare.gov and state insurance exchange customers without verifying that payments were made on behalf of confirmed enrollees or verifying that payments were made in the correct amounts.

What makes an EHR “open” or interoperable?

AMIA proposes an objective definition of EHR interoperability that calls on vendors to support data extraction, medical record transmission with structured data elements, exchanging records via record locator service queries, supporting migrations to another vendor by moving existing records to another EHR, and providing APIs that allow third-party apps to access and write to the EHR.

Bethesda health tech company raises $30 million

Bethesda, MD-based digital health startup Aledade raises a $30 million Series B to expand its ACO transition support firm. The company was founded by Farzad Mostashari, MD, former national coordinator for health IT, shortly after he left ONC.

CVS to Buy Target’s Pharmacy Business for $1.9 Billion

CVS acquires Target’s pharmacy business, which includes 1,700 pharmacies within Target stores, for $1.9 billion.

News 6/17/15

Top News

An HHIS OIG report finds that the federal government has paid Healthcare.gov insurance subsidies since January 2014 even though CMS hasn’t finished the software module that verifies the payments owed. Insurers are still submitting estimated claims that the government pays even though it can’t verify their accuracy or whether the enrollees have paid their share of the premiums. CMS sent checks for $2.8 billion in just the first four months of 2014, the period OIG audited.  

Reader Comments

From Levi Kittycat: “Re: University of Virginia. Leaving Sunquest and going with Epic Beaker for lab over the next 2-3 years.” UVA posted a Beaker trainer job a few weeks back, so I assume they are indeed going in that direction. I did a quick search and found Beaker analyst positions recently listed at ThedaCare, Stanford, Duke, University of Colorado, PeaceHealth, Sanford Health, UTMB, Thomas Jefferson, OhioHealth, Wellmont, and others. The best-of-breed LIS vendors had better jump quickly onto genomics and personalized medicine before the customer demand for integrated systems shuts them out despite the complaints of the lab people who like having their own systems.

From Ed Hocken: “Re: MModal. Announced in an internal email that chief scientist and co-founder Juergen Fritsch will leave to pursue ‘personal interests.’” Unverified.

From Willow: “Re: Xerox Midas+. Developers have been ordered to work weekends for no extra pay to try to finish development of the in-house replacement for 3M’s APR-DRG coding, which has been dropped to save $3 million per year and must be finished by August.” Mandatory overtime indicates a management failure in overcommitting and underfunding resources assigned to unprofitable work (if it was profitable, they would happily bring in more help). My short stint with a failing vendor many years ago involved the occasional mandatory work weekends, with our clueless leadership exhibiting complete indifference to the family and religious activities they were disrupting through their ineptitude. However, the free market works – if the employees have better options, they are free to seek them (as did quite a few of the best folks at the vendor I worked for). You would hope that the work flexibility extends in both directions so that employees don’t have to burn PTO for occasionally leaving early or taking a long lunch for an appointment (such as a job interview with a better company). I wouldn’t be thrilled with working every Saturday for a few weeks, but it could be worse – at least it’s for a finite product delivery event rather than just offsetting ongoing inadequate staffing.

From NewHavenNighthawk: “Re: Yale New Haven. Big IT management shakeup – Ed Fisher is out and Jimmy Weeks is in.” Former YNHH VP/CTO Ed lists his current LinkedIn position as of May as being in that “between-jobs limbo” of freelance consultant.

From Ben Dover: “Re: Providence Health & Services IT. The former COO and chief of technology and service operations is leaving and his position eliminated after a number of failed projects and clinical system outages. IT has struggled to execute on the system’s affiliations and acquisitions, leading to rumors that it will revert back to the regional model.”

HIStalk Announcements and Requests

My latest gripe: sites that headline stories with Batman-like verbs (Kapow! Powie!) in describing companies that “snag” funding or hackers that “swipe” data. They probably get their coveted clicks for their low-expectation advertisers, although from readers who quickly abandon the story (and possibly the site) after realizing they’ve been baited one time too many by inexpertly written, non-clickworthy stories that were all sizzle and no steak.

Mr. S sent photos of his South Carolina classroom of profoundly mentally disabled K-5 students, for which we provided (via DonorsChoose and matching funds from Publix) baby wipes, diapers, a blender for preparing food (some of his students can’t eat otherwise), and insect repellent so the kids can participate safely in Special Olympics. 

Webinars

June 30 (Tuesday) 11:00 ET. “Value Based Reimbursement – Leveraging Data to Build a Successful Risk-based Strategy.” Sponsored by McKesson. Presenters: Michael Udwin, MD, executive director of physician engagement, McKesson; Jeb Dunkelberger, executive director of corporate partnerships, McKesson. Healthcare organizations are using empowered physician leadership and credible performance analysis to identify populations, stratify risk, drive physician engagement, and expose opportunities for optimized care. Attendees will learn best practices in laying a foundation for developing a successful risk-based strategy.

Acquisitions, Funding, Business, and Stock

CVS buys Target’s money-losing pharmacy business – which includes 1,660 drugstores and 80 in-store clinics – for $1.9 billion. CVS will rebrand the departments as CVS/pharmacy and MinuteClinic. CVS and Walgreens are pulling away from the drugstore chain pack in footprint, technology, and revenue as they diversify traditional drugstore offerings into providing extensive health services in convenient locations. I would expect grocery stores that operate in-store pharmacies (Kroger, Safeway, Publix, and possibly even Sam’s Club and Costco) to pay attention since running increasingly complicated pharmacy businesses isn’t their core competency. 

Forward Health Group moves to a new headquarters location in Madison, WI.

Big insurance companies take acquisition aim at their smaller competitors that are still worth dozens of billions of dollars, with UnitedHealth hoping to acquire Aetna, Aetna eyeing Humana, and Anthem and Cigna performing a mating ritual. Reasons: (a) declining employer-provided insurance in favor of exchange and government plans; (b) the need to improve bargaining position with big and expensive market-dominating health systems; and (c) the rise in value-based care.

Former National Coordinator Farzhad Mostshari, MD’s ACO startup Aledade raises $30 million in a Series B round. It will be interesting to watch as heavier investments and the mandatory outsider board seats they require set up a potential clash between idealism and capitalism and the ongoing need for the founder to keep investors and the board happy. The industry rags are covering the story like it’s breaking health IT news, but other than Farzhad’s former job and Aledade’s somewhat related need to assemble information from its physician EHRs, it’s not all that relevant to healthcare IT in general.

CTG will take a $0.09 Q2 earnings charge after failing to convince payers to buy its end-stage renal disease management system that cost over $1 million to develop. CTG will also lay off the non-billable employees working on the product and has revised its Q2 and full-year earnings guidance down sharply. CTG is also considering selling its Buffalo, NY headquarters building. CTG shares are down 48 percent in the past year, valuing the company at $147 million.

Sales

Millinocket Regional Hospital chooses Medhost’s emergency department information system.

Florida Hospital Physician Group (FL) chooses Smartlink Mobile for its Medicare Chronic Care Management services, billing for which at $40 per patient per month requires clinical information exchange, management of care transitions, creation of a patient-centered care plan, and patient access to electronic communication.

Westchester Medical Center Health Network (NY) signs a $500 million deal with Philips for consulting services and medical technologies that “gives us access to the latest in connected digital health technologies, it will be allow us to collaborate on proactive health management and co-create new patient-centered models of care for the Hudson Valley area.” It would be fascinating to see how the actual agreement matches up to the lofty statements in the announcement, and even more fascinating to look back in five years to see how much of the deal was hype.

Weill Cornell Medical College and New York-Presbyterian Hospital sign up for electronic informed consent from Mytrus for clinical trial enrollment in their oncology clinics.

People

Spok promotes COO Hemant Goel to president. He replaces Colin Balmforth, who will “pursue other opportunities.”

Boston Children’s Hospital (MA) promotes John Brownstein, PhD of the Children Hospital Informatics Program to the newly created role of chief innovation officer.

CTG names Alfred Hamilton, PhD (George Washington University) as VP/GM of CTG Healthcare and Life Sciences. He is retired lieutenant colonel in the US Army Medical Department, where he served as a military CMIO and CIO and was deployed to Iraq to support the IT needs of two mobile trauma units.

Don Kemper, who founded Healthwise in 1975 and still serves as its CEO 40 years later, will retire in 2016.

Announcements and Implementations

Imprivata joins App Configuration for Enterprise, which is developing open standards for managing and securing enterprise mobile apps.

Patientco announces the launch of a redesigned PatientWallet, which allows patients to pay bills from any device. The announcement says, without apparent irony, that the product uses “new-and-improved technology.”

Cerner and the Commission on Accreditation of Healthcare Management education announce an awards program and scholarships that will recognize graduate programs that focus on the use of information for healthcare performance improvement.

Incident training in Elgin, IL includes the use of a cellphone app by Augusta, GA-based Global Emergency Resources that allows first responders and hospital personnel to log patient information, including photos and driver license images, so that hospital employees and other emergency teams can monitor progress.

Government and Politics

HHS seeks software developers to become Entrepreneurs in Residence for two development projects: an FDA cancer and hematology data aggregation analysis platform and a CMS system that connects providers to their Medicare interactions.

In England, NHS alerts users that its newly live e-referral service, which replaces the problematic Choose and Book system, has 33 known problems, including system delays, search problems, and reporting capabilities.

The government’s top seven contractors are, in order, Lockheed Martin, Boeing, General Dynamics, Raytheon, Northrop Grumman, and McKesson, which slipped into the defense-heavy list with its $6 billion in drug contracts.

The Senate’s HELP committee convened its second hearing Tuesday, this time on EHR user experience. Vindell Washington, MD, CMIO of Franciscan Missionaries of Our Lady Health System (LA) testified that EHR workflow and documentation requirements are based on outdated paper models and providers should instead be rewarded for patient outcomes. Tim Pletcher, executive director of the Michigan Health Information Network Shared Services, said that health plans and payers have been conspicuously absent from Meaningful Use and patients are still forced to use their portals as are providers who are asked to submit additional documentation, suggesting that health plans be encouraged by HHS to use direct secure messaging. Meryl Moss, COO of the Coastal Medical ACO, urged the government to harmonize quality measures and add data analytics criteria to EHR certification. 

Privacy and Security

The FBI is investigating reports that the St. Louis Cardinals hacked into the player performance and scouting databases of the Houston Astros, which had hired the head of its “Moneyball”-type operation who apparently reused his Cardinals password on the network of the Astros, thereby inadvertently enabling the alleged unauthorized access.

Technology

A JAMIA article by Dean Sittig and Adam Wright proposes use cases of exactly what determines whether a given EHR is “open” or “interoperable,” which hopefully will squelch the bleating of robotic vendor CEOs who insist on abusing the term to mean “whatever we’re selling at the moment.” The authors also question whether a system is open if its vendor requires those who need access to its system to be certified, to sign a non-disclosure agreement, to pay a license fee, to pay the vendor for custom programming, or to buy documentation. The EXTREME (Extract, Transmit, Exchange, Move, Embed) use cases require the EHR to:

1. Export patient records in a format that can be discretely imported into another system that includes enough metadata to make the information usable, with a published dictionary describing how the information is stored and what it means.
2. Support the ability for users to send some or all of a patient’s information to another EHR or PHR system via a standard format, allowing the user to choose which information to send and maintaining a usable data structure.
3. Respond to data queries 24×7, use a record locator service, send information in a structured format, and send its data dictionary to the receiving EHR.
4. Allow a customer to move all of their patient information to a new EHR, preserving metadata and maintaining the existing transaction history.
5. Provide read and write API access to clinical and administrative information, such as by using SMART or FHIR services, and store new values provided by the external application.

For more information, see the summary Dean and Adam wrote as a HIStalk Readers Write article.

Here’s a challenge to EHR vendors: is your system open and interoperable based on the definition above?

An interesting article in Wired debates whether “apps” as we know them are obsolete, with both Google and Apple developing technologies that allow apps to be accessed more like services, so that users don’t even need to open one of many apps that reside in their “bag of hammers.” A developer says companies might be forced to sell “powers” rather than “things,” explaining, “There’s a lot of startups that are features masquerading as companies, and they’ll find a better home in this world. For some transactions, it’s ideal. If you can write a perfect API, there’s no longer a need to wrap it up in an app or UI.” The downside is that big companies like Google and Apple will control the entire user experience and compete to lure users into their competitive ecosystems. The author concludes that users may not care since they want results, not services.

Other

A Cerner spokesperson tells me that the Leidos tweet and infographic claiming that “40%+ of healthcare facilities worldwide use Cerner’s EHR system” was, as HIStalk readers pointed out, incorrect (which was pretty clear given that 40 percent of the world’s healthcare facilities don’t have an EHR at all, much less Cerner’s specifically). Cerner says someone probably misinterpreted an analyst’s “global” report title as indicating that it covers the entire world. They’ve asked Leidos to correct the statement. Cerner responded quickly and apologized for the misstatement, which was nice considering they didn’t make the claim in the first place.

Hartford Hospital (CT) says proposed state budget cuts will force it to cut jobs and eliminate programs, with the health system’s CEO calling on residents to demand that Medicaid funding be restored. The most recent tax return I found for the hospital (2012) showed that it earned a $110 million profit, paid the quoted CEO $2.1 million, and had at the top of its one-year compensation list a VP who took home nearly $4 million.

It’s all about perspective: a research article addresses how states are “protecting consumers from unexpected charges,” specifically when they are billed the balance not covered by insurance, such as when they are referred to an out-of-network specialist. That’s something the federal government could address – requiring providers who aren’t covered by a patient’s insurance to state that fact and to provide an estimate of their charges. It’s infuriating to be treated in an ED, where you have no choice in the hospital’s choice of contracted service providers, and to receive out-of-network bills weeks or months later that charge non-negotiated list prices from the ED doctor or even the lab. That’s much more egregious than predatory lending practices if you ask me, especially since the providers dump the responsibility on patients who are usually, by definition, not prepared to sort it all out on the spot.

Dilbert takes on wearables.

Weird News Andy says you have to pay extra for this service at some places. A 21-year-old home health nurse in Florida is arrested after she “decided to take off her clothes and not act normally” in stripping off her uniform and attacking the elderly patient under her care. The local TV station predictably made the non-news item its breathless lead, sending a reporter to report live from the jail’s driveway. Providing competitive snark to WNA this week is @JennHIStalk, who provided the heads-up that a neurosurgeon in Italy plans to lead a team of 100 technicians in transplanting a human head in 2017, with the ailing Russian patient saying, “I hope it will be OK.”

Sponsor Updates

• Culbert Healthcare Solutions becomes a CHIME Foundation Affiliate.
• Frost & Sullivan names Validic a “Healthcare Disruptor.”
• Ricky Caplin, CEO of The HCI Group, is named EY Entrepreneur of the Year in the Florida Health Care & Life Sciences category.
• ADP AdvancedMD offers “ICD-10 billing & coding help – just in the nick of time.”
• AirStrip will exhibit at Connected Healthcare 2015 June 18-19 in San Diego.
• AirWatch by VMware is recognized as a leader in the 2015 Gartner Magic Quadrant for Enterprise Mobility Management for the fifth consecutive year.
• Practice Unite offers “Is your mHealth app HIPAA compliant?”
• Besler Consulting offers an “Update regarding HIPAA Eligibility Transaction System (HETS).”
• Bottomline Technologies will exhibit at ACE June 17-19 in Austin, TX.
• XG Health outlines “XGlearn – Care Management Training.”
• Craneware kicks off a new “value cycle” initiative at HFMA ANI 2015 next week.
• Caradigm offers “The Cultural Shift to Population Health.”
• Commvault offers “Backup-as-a-Service (BaaS) Just Became Easier with Cisco and Commvault.”
• TechOhio discusses startup success with CoverMyMeds VP of Engineering Alan Gilbert.
• Divurgent team members race to support the Children’s Hospital of the King’s Daughters.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Readers Write: Defining Our Terms: Does Anyone Know What an "Open EHR" Really Is?

Defining Our Terms: Does Anyone Know What an "Open EHR" Really Is?
By Dean F. Sittig, PhD and Adam Wright, PhD

Adapted from “What makes an EHR “open” or interoperable?” J Amer Med Inform Assoc 2015. Available at: http://jamia.oxfordjournals.org/content/early/2015/06/13/jamia.ocv060.

There’s been a lot of talk lately about “open” EHRs, ranging from Congressional hearings to industry buzz. Last summer, Mr. H challenged his readers with, “What core set of published standards or capabilities must a given EHR support to be considered open?” We thought this was a great question, so we decided to give it a try.

First, “open” does not mean “open source.” Although open source software is of great value, an EHR can certainly be open without being open source.

We’ve also noticed that some commentators equate open with the platform software is built on, and specifically, that systems which use relational databases and support SQL (structured query language) are inherently more open than those that use hierarchical databases (e.g., Cache). We think this is a distraction, too – you can make closed systems on SQL or open systems on Cache.

Regardless of the database technology (relational, hierarchical, object-oriented), data exchange with another application requires significant effort to transform the data into an agreed-upon format with agreed-upon meaning. This transformation must take into account the data’s syntax (the format), semantics (the meaning), and pragmatics (the way the data are used in context to create a meaningful clinical application). The internal representation of the data, in either the sending or receiving EHR, is largely immaterial.

We decided to organize our definition of open around five use cases, which we refer to as the EXTREME criteria (short for EXtract, TRansmit, Exchange, Move, Embed):

EXTREME Use Cases

An organization can securely extract patient records while maintaining granularity of structured data.

• Secure login and role-based access controls.
• Structured data importable programmatically into another database (unstructured formats such as PDF, do not suffice).
• Audits of extracted records.
• Sufficient metadata included in the extract to ensure interpretability, e.g., units and normal ranges for lab results.
• Freely-available data dictionary indicates where data are stored and what they mean.

An authorized user can transmit all or a portion of a patient record to another clinician who uses a different EHR or to a personal health record of the patient’s choosing without losing the existing structured data.

• Data selection methods that allow users to identify which data to include or exclude.
• Standard method to structure data (e.g., C-CDA) or portions thereof (e.g., DICOM, e-prescribing).
• Standard methods used to describe the meaning of the data (i.e., controlled clinical vocabulary used) Note: conversion of structured data to an unstructured format such as PDF would not meet these requirements.

An organization in a distributed/decentralized health information exchange (HIE) can accept programmatic requests for copies of a patient record from an external EHR and return records in a standard format.

• EHR infrastructure capable of responding to queries 24 hr/day, 7 days/week.
• Record-locator service functionality available and in use.
• Standard method used to structure data (e.g., C-CDA).
• Sending EHR’s data dictionary available to receiving EHR.
• “Internet robustness principle” respected (be liberal in what you accept and conservative in what you send).

An organization can move all its patient records to a new EHR.

• Standard method in which to structure key clinical data (e.g., laboratory results, medications, problems, admission history) provided (e.g. HL7 v2.x or v3).
• Data dictionary used to define clinical and administrative data.
• Existing metadata (e.g., timestamps, source, and authors) exported to the new system.
• Transaction history of data items (e.g., renewals and dose changes for a medication) preserved.

An organization can embed encapsulated functionality within their EHR using an application programming interface (API). Goals: access specific data items, manipulate them, and then store a new value.

• External applications have “read” and “write” access to clinical and administrative data, including metadata from the EHR (e.g., using the SMART app platform or HL7’s Fast Healthcare Interoperability Resources (FHIR) services.
• Programmatic method to embed external applications (either code or presentation, i.e., an embedded web application, e.g., Cerner’s mPages) with which the user can interact via the EHR’s user interface without re-compiling the existing EHR’s codebase.
• Appropriate support and maintenance to ensure that encapsulated functionality will continue to work and meet user needs following system configuration changes or upgrades.
• HIPAA-compliant protection of newly created data item(s) (e.g., only accessible to authorized users and backed-up with all other patient data) like all other patient-related data.

These use cases were designed to address the needs of patients, so they can access their personal health information no matter where they receive their healthcare; clinicians, so they can provide safe and effective healthcare; researchers, so they can advance our understanding of disease and healthcare processes; administrators, so they can reduce their reliance on a single-source EHR developer; and software developers, so they can develop innovative solutions to address limitations of current EHR user interfaces and create new applications to improve the practice of medicine.

In addition to the specific features and functions required to implement these use cases, we also note that many developers limit access to their systems by requiring: special training and certification by the developer before users can extract data from the system or integrate an application; users to sign a non-disclosure agreement; users to pay an additional license fee to access data or integrate an application; customized programming that only the developer can do; or access to documentation that requires special permission or additional fees. While we understand that developers need to maintain a degree of control over access to their software for financial, security, intellectual property, and reliability reasons, we question whether a system subject to such constraints can be considered truly open.

In addition to these use cases, open EHRs should be subjected to stringent conformance testing to ensure that receiving systems are able to import and parse the structured data and store it in the appropriate location within the receiving EHR, while maintaining the metadata and transaction history from the sending system.

Widespread access to open EHRs that implement at least the five EXTREME use cases we propose is necessary if we are to realize the enormous potential of an EHR-enabled healthcare system. Healthcare delivery organizations must require these capabilities in their EHRs. EHR developers must commit to providing them. Healthcare organizations must commit to implementing and using them.

In addition to having all EHRs meet these technical requirements, we must also begin addressing the myriad socio-legal barriers (e.g., lack of a unique patient identifier, information blocking, high margin, fee-for-service clinical testing) to widespread health information exchange required to transform the modern EHR-enabled healthcare delivery system.

Dean Sittig, PhD is professor of biomedical informatics at the University of Texas Health Science Center at Houston. Adam Wright, PhD is senior scientist in the Division of General Medicine of Brigham and Women’s Hospital, a senior medical informatician with Partners HealthCare, and assistant professor of medicine at Harvard Medical School.

Morning Headlines 6/16/15

Anthem Talks to Cigna on Possible Takeover

Anthem pursues rival insurer Cigna in an acquisition deal that values Cigna at $45 billion.

FDA to Work With Online Patient Forum to Mine Safety Data

Online support group vendor PatientsLikeMe signs a research partnership with the FDA to supplement its post-market drug surveillance program with patient-generated adverse events reports.

Inside Obama’s Stealth Startup

Fast Company profiles Obama’s growing US Digital Services team, which was established in the days after Healthcare.gov’s failed launch. Todd Park, who is responsible for recruiting Silicon Valley’s best and brightest for the team, describes it as “DARPA meets the Peace Corps meets SEAL Team Six,” and tells stories of Obama’s hands on involvement in recruitment efforts.

White House Weighs Sanctions After Second Breach of a Computer System

The Office of Personnel Management reports that mental health data may have been compromised in its second confirmed security breach in the last two weeks.

Curbside Consult with Dr. Jayne 6/15/15

As a free-range CMIO, organizations often hire me to do work that they should be able to do themselves. Sometimes there are valid reasons why they can’t, such as the unexpected departure of a key employee. More often, though, it’s due to lack of organizational structure or even outright chaos.

I was working with a group in the latter position this week, putting together a plan to try to get them back on their feet. It’s a mid-sized group of employed physicians associated with a mid-sized hospital. They were initially referred to me by one of their physicians after we met at a conference.

I knew I would be in for an interesting time after the first discovery call. I usually set up a meeting or two to figure out who the key players are and why they think they need assistance. The calls usually reveal that why they think they need my help is not actually why they need my help. More often than not, they think there’s a problem with their software, or that they have problems with individual physicians refusing to get with the EHR program. When we start to talk about the specific concerns, it tends to show that they have problems with communication, resource allocation and prioritization, or perhaps strategic planning. If I’m lucky, it might be a project management issue.

This time it was all of the above. The first time we tried to do a discovery call, only one of five client attendees bothered to show up. The second time, we had several “leaders” (and I use that term loosely) attend, but two of them had no idea why they were on the call or why the organization was seeking outside help. We spent the first half of the call with one of their internal IT resources trying to explain to them who I was and why they had contacted me. Ideally that would be done before we all get on a call together, but then again if they had their act together, they wouldn’t need my help.

We talked about their key concern of “we’re not going to get Meaningful Use” money and did a quick exercise to determine root cause. I love techniques like the Five Whys for their simplicity. The premise is that you can get to the heart of an issue by asking why something occurred, then following each answer with another “why” question. Usually after three to five repetitions, it becomes clear what the real problem is. People are often astonished when you start identifying the real reasons behind their situation. Of course, there are a lot of other formal methodologies you can use to do a true root cause analysis, but when there are “soft” issues at play, the Five Whys is usually enough.

We quickly identified some major issues contributing to their lack of MU confidence. Their EHR is poorly configured and overly customized. When physicians complain about the workflow, there’s no routine analysis. Instead, the IT team just adds fields and checkboxes to the EHR because they perceive they’ve been given a mandate to “make them happy.”

The operations team, on the other hand, feels that IT coddles the physicians and that the customization interferes with their ability to control the providers. The finance team thinks the whole thing is too expensive and the consultants they’re using to customize the system are laughing all the way to the bank.

I’ve been working with them for a couple of months to put together a proposal and actually get them to approve it. Through that process, I was able to identify that they have some pathological corporate policies that certainly aren’t helping things. One major issue is their email retention policy – all emails delete after 45 days unless they’re manually archived. I don’t know about you, but I certainly don’t have time to go through my emails on a regular basis and manually archive things on that kind of cycle. My former employer had a six-month retention policy, which was reasonable – after six months, you know whether something is archive-worthy (and they actually had a class in how to best manage folders and filtering to make the retention policy easier). These folks just leave their employees hanging.

Inability to manage and retain emails led to a lot of requests to resend documents and repeat conversation threads that we thought were already resolved. It also was instructive in warning me that I needed to dramatically increase the block of time that I was planning to allocate to this client.

Once they accepted the proposal, I was able to do a fair amount of remote work with them while we waited for calendars to open up for our first onsite visit. I had requested documents related to their organizational structure, roles and responsibilities, contracts between the client and their EHR vendor, and service level agreements between IT and their internal customers. Although it took weeks to get some of the documentation, eventually most of it turned up.

What surprised me (but probably shouldn’t have) was the lack of awareness of some parties regarding their own documentation. Interestingly, no one could actually produce the policy about the 45-day email retention standard. Needless to say, unless they can validate why they want to allow that to contribute to their dysfunction, I’m going to push to lengthen it.

This week was my first time at their offices. I had scheduled a number of one-on-one interviews with identified members of their leadership. Usually I walk through an interviewee’s understanding of the EHR initiative and its purpose, what they think is in it for them, what they hope it will accomplish, etc. For the first few interviews, I felt like I should be charging behavioral health CPT codes because the leadership interviews turned into therapy sessions. I felt like I was in junior high school again, but instead of dealing with cliques and mean girls, I was dealing with organizational silos and power-hungry players with grossly inflated titles.

Of course, most of them want me to just jump right in and “fix the EHR.” Having been in this game for a fair length of time, I know that without putting the right leadership structures in place and making sure we have functional processes to sustain any changes to EHR content and workflow, we might just worsen the chaos and make the physicians even less happy. Once we identify who the decision-makers will be and what the strategic goals are (besides just “get that MU money”), we’ll be able to really figure out how to solve the problem.

I wasn’t able to finish all the interviews last week (of course, many “emergencies” prevented people from attending, but they wouldn’t tell me what those urgent problems were) so I do have some phone interviews to finish this week. At least I won’t have to hand out tissues since we won’t be in the same room. I also don’t have to worry as much about maintaining my poker face when the stories of one department slighting another get petty or silly. Once the interviews are complete, I’ll deliver a formal assessment and recommendation and we’ll see how it is received.

Having done this more than once, I know they’ll go through some of the stages of grief (particularly denial, anger, and bargaining) before we can arrive at a real plan to move forward. They have some strong physicians who seem to be buying what I’m trying to sell. They’re not ‘titled’ leaders, but rather informal ones, so I’m hoping they’ll be able to help drum up some grassroots support. The titled leaders will be a bit of a challenge, but I’m hopeful that the burning platform of MU will help move them in the right direction.

What is your current stage of grief? Email me.

Email Dr. Jayne.

HIStalk Interviews Jay Deady, CEO, Recondo Technology

Jay Deady is CEO of Recondo Technology of Greenwood Village, CO.

Tell me about yourself and the company.

Recondo has been in existence for about seven years. We have a SaaS-based single platform focused on revenue cycle and have built a series of modules or applications off that single platform. We commercialized the first product, Sure Pay Health — which does patient estimation — about five years ago. We’ve continued to add more functional modules since then.

I joined the organization as CEO in mid-November of this past year after originally being contacted around the HIMSS conference the prior year about becoming a board member. During the course of those discussions, it switched to both being on the board and an opportunity to run the company as well.

How would you differentiate Recondo’s offerings from those of its competitors?

When you say the words “revenue cycle” in the industry, it’s almost like saying “analytics” or “work flow” these days. It means a lot of different things to a lot of different people.

We take revenue cycle in three phases. The first is around patient access. The second is what I’ll describe as the mushy middle, where I’ve spent a lot of my prior experience and career in health IT — the ordering, the delivery of care, the documentation of that care, and the coding against that care. Then you have the back-office claims processing and the adjudication thereof. We have solutions in patient access and in the business office – we stay out of the middle for right now. 

We have a suite of products from patient access. We have a couple of competitors that have a suite. There’s a lot of niche players that might just do eligibility, payment estimation, or registration QA. We’re taking a broader suite approach versus a number of those more singular niche players in the market.

Do you see integration occurring between financial and clinical work flows that is tied together under the revenue cycle umbrella?

I do. In some of our more recent contracting efforts, it’s quite varied. Meaning, we have a really sophisticated back-end cloud engine where we have patented bot technology. We can go out to payer websites around what historically might have EDI transaction sets for eligibility and payment estimation, and then certainly on updating claim status. We can grab more information, create a superset between the EDI transactions and the additional information that we can grab with the bot technology, and run that through a rules engine and make it actionable. We can serve that information up in our own applications in work flow. That’s the way the majority of clients have contracted and deployed with Recondo.

But we also have multiple Epic clients. It has a fully-integrated patient payment estimator solution with their Cadence registration and scheduling products. We’re serving up the information I just described by enabling that product as a Web service.

In the past, there was certainly a lot of bi-directional HL7 integration. What we’re starting to see, in some cases, is API Web service enablement integration. For some of these applications, we might not be the front end, but we’re doing a great job with our back-end capability of enabling other solution front ends with more intelligent data.

Is revenue cycle management still a core competency for health systems?

The answer to that question varies by segments of the acute care market in the US, so I’ll answer it that way. I think we’ve seen in the past few years an increase in outsourcing in mid-sized singular institutions. They’ve increased their outsourcing. One, because of the competitive nature of getting resources. Two, are they really experts in that or should they focus on being experts in care delivery, and as it relates to coding and other aspects of revenue cycle such as claims and collections, can they outsource that to somebody who’s an expert at just doing that? We’ve seen an increase in that market segment.

Inversely, in the IDN and investor-owned market, we have a large relationship with Community Health Systems, CHS. They have consolidated 215 business offices out of their hospitals to six or seven regional centralized business offices. They have actually decreased outsourcing during that process. They are using some of our technology to help support more efficient automated processing versus what used to be more of a manual effort as it relates to claim status, processing, and adjudication.

I think outsourcing is alive and well in certain market segments, but as IDNs merge and try to consolidate their business offices, we’re seeing a trend to take some of that back.

Healthcare administrative overhead is high and yet revenue cycle is one of the hottest areas since hospitals have to jump through hoops to get paid. Will that become more streamlined with value-based care?

I think it will become more streamlined for two reasons. Historically, revenue cycle has been patient billing and HIS systems with some bolt-ons. But then a lot of personnel are required from the health system on the front end and the back end of the business office on what has historically been a lot of manual effort around some of that automation. As more tools from Recondo and some of our competitors continue to come to market, you’re seeing more aspects of the revenue cycle and work flow becoming less manual, more automated, with a higher percentage of claims going all the way through in a touchless fashion. That is contributing to a reduction in overhead.

Whether it’s under an ACO heading or some form of capitated at-risk bundle that takes many different forms, since they know how they’re going to get paid based on that value-based, at-risk package, it’s more about how they efficiently track, project, and manage costs against it versus the overhead of how do I get paid for the care I’m delivering. They understand what the denominator’s going to be. Now their question is, how are they going to maximize their efficiency in the health system against that denominator?

Are consumer expectations changing for the revenue side of healthcare and are ideas being brought in from other sectors that have more experience with deploying consumer-focused technology?

Absolutely. What has accelerated that more recently has been the Affordable Care Act, the exchanges, high-deductible plans, even private plans that are going to high-deductible plans. We have a high-deductible plan here at Recondo. The company contributes two-thirds of that based on people seeing primary care docs. It affects what our contribution is.

That type of plans, whether it’s through the exchange or through an employer insurance product, is causing people to not just take their healthcare coverage for granted. It is turning them into consumers, particularly in patient access. There’s a really interesting dynamic of understanding not so much the net price that will be paid for whatever the procedure might be, but the out-of-pocket price associated with it. It’s definitely now being viewed by the consumer differently.

There is a crossroads at the same time for availability or access. If I can save $50 to $200 by going to an imaging center versus having that scan done at an academic medical center, depending on whether I have a minor meniscus tear versus a blown-out ACL, how fast I can get in probably determines whether that $50 to $200 out-of-pocket savings matters to me.

There is an empowered consumerism that is accelerating. That’s going to change that whole upfront patient access, whether it’s through portals, but the convergence of scheduling availability with what it’s going to cost the consumer against those plans. It’s really driving some change in the industry.

Are health systems struggling with trying to get more intimately involved with their patients while at the same time pressing them harder for payment?

I think they are struggling a bit. Historically, they haven’t participated directly so much in it. Two, there’s been a number of companies in the industry and other players in the industry that have tried to disintermediate the actual providers. What I mean by that is there are pricing estimate tools, some of which have gone public with a lot of notoriety, and they have been targeting the major employers and in some cases the payers.

The larger IDNs, some of our clients that we do pricing estimations for now, are frustrated that the quality of the care they deliver as well as the pricing is being represented to the marketplace without their input. They’re taking action themselves so that they can start to present both a combination of quality and pricing on a direct basis versus allowing third parties in the health ecosystem to represent that information to the market under an apparent market fairness play, when in fact the pricing for a particular patient on a particular plan, looking at something that’s generically available from an employer or insurer website, could be off as much as 30  to 40 percent. That’s pretty frustrating to some of our largest clients, so we’re working with them so they can represent that on a consumer basis themselves.

For patients who have a provider choice, do they have enough information to make a decision based on value since there’s no published price that is the same for everyone?

The information is getting better. I believe you’re going to see providers provide a lot more of that information themselves. I’ve seen some third-party studies and we’re contracting some primary research ourselves. Depending on the economic situation of an individual, there appears to be somewhere between $300 and $500 from an out-of-pocket perspective that does start to impact location and care decision based on price. That seems to be the number where someone in Boston who typically go to Partners might go to CareGroup, for example.

I think it is based on the quality of the information. It’s based on a perceived confidence in a price that’s quoted upfront. It’s a lot easier, as we know, for a radiological imaging procedure than a major surgical situation, because once they’re in, what happens on the surgical table can vary quite a bit from what was originally scheduled. 

I think you’ll see a stepped in, service-by-service situation where the confidence of both the health system providing the price estimate and the confidence of the consumer receiving it passes what I call the Twizzlers test. If you go into the 7-Eleven to buy a package of Twizzlers and it’s $1.89, you don’t want to go to the register and then get hit with a 40 percent price change. There are certain service lines where the confidence can be high enough to pass that test. In others, for a while, it’s going to have a lot of variability to it.

I don’t think it’s going to all or nothing. I believe people from a service line perspective will step into this, both on the consumer and a provider side.

Hospitals have never been good at cost accounting and determining whether a given patient is profitable –they just know that if their market share and payer mix don’t change, that $5 aspirin will probably keep them in a financial surplus. How can hospitals quote a patient a competitive price for a given service when they don’t really know what it costs them?

I had with my team a lot of experience with that a number of years ago at Eclipsys when we bought EPSi. We did have clients who fully deployed that capability, and for certain service lines, got to a true cost accounting model.

As an industry, what accelerated that more recently with that tool and others and new ones that have come out –and some of those are going through IPO processes – is the whole bundling process. Whether it’s an ACO or other forms of capitation, in the beginning, they were probably bidding somewhat blind. If I don’t bid, I’m going to lose share, but I’m not quite sure if I’m going to make or lose money based on my bid. That’s accelerated a lot of analytics and cost accounting plays in the industry.

Compared to others, because of the longer-term historic nature of not deploying that, the industry is still a little bit behind. But in the last five years, based both on tools that are available as well as the changing market conditions, folks are making some pretty fast strides to close on that.

How will healthcare look different in five years?

Everything will continue to push as close to the patient’s home as possible. The furthest right on a graph of lowest patient satisfaction versus highest cost is an ICU bed. Advances that allow doing cardiac care and others laparoscopically and driving it into a clinic and ambulatory setting has been accelerating and I think that’s going to continue quite a bit. The trend of the percentage of physicians that are employed versus independent is going to push forward.

Consumerism, cost, and quality are becoming bigger decision makers that will force health systems and physician groups to market themselves and be accountable against. I see that rapidly accelerating, primarily because of the economic pressure from high-deductible plans as well as capitation bundles. That’s going to accelerate over the next three to five years as well.

Lastly, based on some of that, we’ve seen the historic ramp-up in annual cost to somewhat curtail. In general efficiency in healthcare, how the revenue cycle and care delivery gets more streamlined, I see that continuing to accelerate as well.

Do you have any final thoughts?

Recondo’s solutions are touching the consumer with our provider clients more directly. A fun aspect of my 26-year career is starting to work with clients on that consumer enablement, where historically I’ve been a bit more removed working with clients more internally focused from an EMR and revenue cycle perspective. Together with our clients, where they in the past may have been disintermediated by employers and insurers, putting some of these tools out faster, putting some of this information out. It’s going to be exciting in the next couple of years of helping our largest clients catch up and take control of that conversation with their patients and consumers.

Morning Headlines 6/15/15

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A GAO report on government IT projects finds that projects often result in “multimillion dollar cost overruns and years-long schedule delays,” with billions wasted on failed project cited. The government spends $80 billion on IT projects annually.