Morning Headlines 6/4/15

ICD-10 Medicare FFS End-to-End Testing: April 27 through May 1, 2015

CMS reports the results of its latest end-to-end ICD-10 testing period: 88 percent of the test claims were accepted, up from the 81 percent in February. Two percent were rejected due to invalid ICD-10 codes, while the remaining rejections were due to errors unrelated to ICD-10.

Why CMS should stop Stage 3 of meaningful use

AMA joins the growing list of industry organizations calling on ONC to delay MU3. AMA proposes a one-year pause in the program in 2017, giving providers and vendors a much needed break, before moving forward with MU3 in 2018.

We the people want easy, electronic access to our health information

Farzad Mostashari, MD and former National Coordinator for Health IT, unveils a new petition called Get My Health Data that is soliciting signatures from people that are passionate about patient’s access to medical data. He also encourages patients to test the current environment by requesting their medical records from local health facilities and then reporting issues they run into under the Twitter hashtag #tracer.

HIStalk Interviews Asif Ahmad, CEO, Anthelio Healthcare Solutions

Asif Ahmad is CEO of Anthelio Healthcare Solutions of Dallas, TX.

 

Tell me about yourself and the company. 

I was in academic medicine for 18 years. I was a CIO and head of globalization at Duke University Health System and prior to that at Ohio State. About five years ago, I moved onto the corporate side. I had done a lot of startup companies out of academics. I was at McKesson for three years. Now I’m CEO of Anthelio. I come from 23 years in healthcare, specifically in technology, with a big focus on clinical optimization and driving efficient and effective utilization of health IT.

Anthelio is the only independent, vendor-agnostic, full-breadth IT services and technology company. I thought it would be a great marriage of my background and a company with the footprint to start defining some interesting new models of service delivery and service management with what is happening since Meaningful Use.

We are privately held and the largest technology company in the pure healthcare space. We have about 2,000 employees and close to $250 million in revenue, which makes us a pretty big, mid-cap privately held company.

We provide three product lines. One is pure IT services all the way from full IT outsourcing to prioritized IT services, including EHR implementation and optimization. Then we have a second line, which is revenue cycle and health information management, from coding to revenue optimization to clinical documentation improvement. Then we have our products portfolio, which is a vendor-agnostic patient engagement product, data solution products like data warehousing and operational data store, and our analytics products. That’s what defines the company — a IT solutions group, an HIM revenue cycle solutions group, and vendor-agnostic across the board products.

Your background as an academic medical center CIO and a biomedical engineer makes you unusual among large-company CEOs. What was the transition like and how would you advise CIOs with similar interests?

The transition for me was really easy, because even in the academic medical center, I was really the one who was going against the norm. Things can be done faster, quicker, more efficient. Cost should be an issue, revenue, opportunity losses should be an issue, and also making a bigger footprint for your academics. When I was at Duke, for example, the three hospitals weren’t integrated a lot at all, so I was brought in to bring that together. Nobody was even thinking about outpatient care — this was pre-population health — and I, working with the chancellor, put that big footprint together. In two to three years, we had full adoption of CPOE. This was all pre-Meaningful Use. We had integrated physician-hospital billing as a single CBO. We spun a lot of companies out of there like Sentillion, a company that Microsoft bought, which was out of my department at Duke. I was always working to optimize whatever the opportunity was for the parent organization.

What I would advise for a CIO is to get yourself organized to learn the operations of healthcare. I think there’s a big movement there. The CIOs don’t really get involved in learning and being held accountable for driving the operations of healthcare. At both Duke and Ohio State, I had P&L responsibility. I was running almost a billion-dollar business for Duke. I had volunteered to run the lab and radiology business, which is a very technology-based business, and my biomedical background was in imaging. I’ve always utilized my technology background to drive operations.

You are right, you don’t see too many people like me in business. There should be more of my kind because part of the problem is that CIOs are always on one end of the board room and the CEO is on the other end calling up Deloitte or Accenture or somebody else to advise them how to use technology. There’s not really that much of a connection between the two groups. 

I have always prided myself in being that bridge, somebody who understands technology, but who wants to grow, drive, and be held accountable for managing the operations of healthcare. I always have had physicians reporting to me from a P&L perspective. At Ohio State, I was building the heart hospital with the doctors there. I was doing a lot of things that were eventually very strongly technology enabled, but we started first with, what’s wrong with the process? What’s wrong with the current way of delivering care? Then technology got introduced. But I was the one who drove both the clinical side and the technology side.

What is the trend for health systems to outsource infrastructure, security, or application management?

I think it’s going to start moving. There’s going to be a huge tailwind towards that. Everyone has invested a lot of money in big systems. A lot of people have bought the Epics and the Cerners and now they’re sitting with huge amounts of cost which is depreciating.

Previously most hospital CIOs were a little afraid of outsourcing because the whole idea was that you have to manage, maintain, and contain it. With cloud services and the advent of cybersecurity issues, you cannot have enough competency within your own portfolio to do it. You have to take chance of things where you think scale matters. When I look back on my days at Duke, I would never manage IT security on my own with what I know now being on the commercial side. Similarly, I built a $30 million data center. Why should you be building data centers in academic medical centers or hospitals when that’s just a huge cost sink? You should be working with somebody else to outsource.

Similarly, application management and application hosting. Why would you want to put an Epic and a Cerner or whatever else out there with the SaaS model? Take it out of your portfolio. I have to manage everything close to my chest because the whole technology evolution has told us that that’s not the way to manage in the most cost-effective or effective way because you’ll have a lot more downtime. You put all your eggs in one basket in one building and one server.

Everybody invested a lot of money, and yet the cost of IT has not borne the benefits that one was to see in how the impact of these EMRs were to be had from an outcomes perspective or what needed to happen from patient safety or better financial outcomes. People are not seeing it used for that. You’re seeing post some of these big implementations hospitals taking a hit on their credit ratings. So I think you’re going to see a lot of trends towards outsourcing. I’m able to relate to it because I was also on the other side and we work with our clients now.

But the plan is not to fully outsource everything you have. Take the pain points, take where the scale matters, and let’s take that. That’s where the idea of productized  services solutions comes in. It used to be that everything needed to be outsourced, that you would give me everything because I can’t do just parts of this business. Now we’re in an ecosystem that CIOs of the health systems can work with companies like Anthelio and we can take the headaches off you because we have the scale. Then you should focus on clinical optimization, driving changes with your physician behaviors and the patient engagement. We talk about population health, but yet a patient portfolio itself doesn’t give you that. You have to have the patients engaged in some kind of mobility solution. So focus your interests there and then companies like ours handle the back-end infrastructure. Historically, everything had to be very close to you, but now because of the cost structure and evolution of technology, people are easing up on that. I think it’s the right thing to do.

Is offshoring increasing or decreasing?

I’m glad you asked. Almost 30 percent of our workforce at Anthelio is based out of India. The whole trend for offshoring is different. Ours is growing because we don’t think of it as an offshore. I always tell my team that Mumbai is no different than Michigan. By the way, we have a huge delivery center in Michigan, so that’s why I use that analogy. If you align operations tightly, you don’t think of India or Philippines or wherever else you’re offshoring as some destination or location where there is a buffer and a black box. If you tie every community working from home and diffuse services, big vendors have already shown that it can be done. You don’t have to be in one location. The fact that you could have a remote workforce really changed offshoring. That’s one thing that is helping offshoring at the moment. If you align your accountability, it doesn’t matter where the employee is with the right confines in place.

The number two thing that helped us is that it’s not just a cost arbitrage to us. You look at where the best talent is, where the best access to talent is to scale, and how to drive growth from there. People used to send just the back-office jobs to India or somewhere else like that. I’m going to send my billing clerks to India, for example, with ICD-10 coming. I think that has changed. India has some really good talent. I have turned India into an innovation hub for us. We do combined product development. We do combined software delivery as well as service delivery there, not just cost arbitrage.

Offshoring done right should have never been an issue, but the problem is that it wasn’t done right. People took chunks of cost — the quarter end is coming, so let’s just thrown this out to India or wherever else and let’s drive the cost. But it’s not a cost equation. It should be a value equation. Where do you drive the most value? The way we have done offshoring is to balance that out. You can have access to some lower-cost talent in India, but what should that be, and how do you mix that talent then with the talent pool in US so it’s one combined talent pool and not just this bifurcated or trifurcated talent pool who never see each other? 

In our case, the people at all levels between our teams in India — in two locations in Mumbai and Hyderabad — and our locations here Dallas, Tennessee, Michigan, Chicago — they keep going back and forth. There’s a true sense of one combined team. Offshoring is going to continue, but in the context of where the value is driven. It’s not just a cost arbitrage, which is  bound to fail. It needs to be seen as value arbitrage.

What will the most important healthcare IT implications be over the next five years?

There’s been this big push to buy new integrated EMRs, and yet you don’t see an impact of it to the outcomes. I think there’s going to be a litmus test. Patients are going to push to ask for more access to their information. The traditional EMR systems can’t provide it, so I think there’s going to be a disruption.

I see in the next five years there should be a disruption in how we manage health technology in the US, which is done in vacuums and silos still. It’s gotten somewhat better, but you’re not going to get your value-based reimbursement. There’s going to be more consolidation, but at the same time, I think the patients themselves are going to push for a much more holistic kind of view. More mobility solutions are going to come forward, not just the enterprise systems that are out there.

In five years you should see a lot of non-profit and for-profit collaborations in a very meaningful way, and hopefully more transition of roles going back and forth. There’s a big vacuum in what the actual understanding of healthcare delivery is versus what the vendors perceive, both on the service and the product side. Hence, many products don’t work. The ones that do work are the ones who understand.

EHR Design Talk with Dr. Rick 6/3/15

The Story of My Leukemia

Dear Friends and Readers,

I can’t begin to tell you how happy I am to resume writing about EHR user interface design and to share my ideas with the HIStalk community. I am grateful for this opportunity. By all odds, in the long view of human history, I should not be alive.

In the fall of 2013, while jogging I noticed that my exercise tolerance had decreased – I couldn’t run up a hill which a few months earlier had presented only a slight challenge. At the time, I attributed the change to just getting older. A little later, however, after climbing a single flight of stairs at work, I found that couldn’t utter a sentence without first stopping to catch my breath. Although I was still in denial, I reluctantly took time off from work to see a colleague of my PCP who was available that afternoon.

Although I had minimal findings on physical exam and my ECG was negative, by this time it was clear even to me that something was wrong. My labs were drawn and sent off. A little later that evening I got a call from my primary care doctor and friend. She advised me to go to the hospital to be admitted via the emergency department, as my hematocrit was 18 and I had other hematologic abnormalities as well.

When I asked if I could delay admission until the next morning, the answer was a tactful but emphatic ‘no.’ So with my wife Karen’s help, I packed a toothbrush and a few other things, drove to Mount Auburn Hospital (where I had done my internship 30 years before), and was admitted.

A bone marrow biopsy performed the next day revealed acute myelogenous leukemia (AML). That evening I was transferred by ambulance (although I insisted on walking and carrying my own bag) to Feldberg 7, the inpatient Bone Marrow Transplant (BMT) Unit of Beth Israel Deaconess Medical Center (BIDMC), where I received extraordinary, life-saving care over the next three months.

Quite frankly, when I was told I had AML, I thought it was more or less a death sentence. My last training in AML had been more than 30 years ago when I was a medical student. At that time, the likelihood of successful treatment was very low. My mind went to practical issues such as whether I would have enough time to organize important family documents. It was easier to focus on these kinds of things than wonder how I would say goodbye to my family and friends.

The attending physician on call that week for Feldberg 7, who has since become my trusted primary oncologist, came in from home to see me. By then it was nearly midnight. We had a long talk. Although she did not minimize any of the very real risks of the disease, the induction chemotherapy, or the eventual stem cell transplant if I should get to that point, I regained hope. I learned that my chances not just for life-prolonging treatment but for a cure were approximately 50 percent.

After two courses of induction chemotherapy complicated by several medical issues, I received a stem cell transplant on December 9, 2013. I am now a year and a half out from my transplant. Although my recovery has been complicated by mild chronic Graft versus Host Disease, I am doing very well. My most recent bone marrow biopsy showed no evidence of relapse, and at this point, there is a good chance that I am cured.

I have been transformed by my journey through illness and back to health. I am grateful beyond words to my doctors, including the fellows and house officers who took care of me; to my nurses, who in addition to providing extraordinary care, were also the main emotional support for me and my family; and to all the other members of my BIDMC health care team whose contributions often go unacknowledged.

My experience has also made me keenly aware that, day after day, at hospitals and clinics across the country (and the world), healthcare teams like mine put in the same kind of long, hard hours and devote the same kind of demanding cognitive effort in order to take care of their patients.

Even before my illness I had a strong interest in applying what we know about human perception and cognition in order to create simple, powerful, elegant EHR user interface designs – designs that make it easier for doctors and nurses to care for their patients. Now that I have experienced a life-threatening illness first hand, this interest has taken on an added personal dimension.

As a patient, I could not of course (and was far too sick to) sit next to my doctors and nurses and observe them as they entered, reviewed, and interpreted my data in BIDMC’s EHR (WebOMR), but I was certainly aware of the long hours they put in at the computer. From what I have subsequently seen of WebOMR, despite being homegrown, it is an excellent system that rivals those of the major EHR vendors.

By the same token, it shares many of the same EHR usability issues that are becoming increasingly recognized as a major barrier to achieving the Triple Aim of enhancing patient experience, improving population health, and reducing costs. I believe that John Halamka, BIDMC’s CIO, would agree – in a recent interview, he described today’s EHRs as “a horribly flawed construct.”

One ‘benefit’ of my long illness is that I have accumulated my own rather extensive electronic medical record data set (although I wouldn’t recommend obtaining one in this way). In the posts that follow, I look forward to using my data set as the basis for sharing ideas about how to display EHR information so that we can perceive it using our lightning-fast, high-bandwidth visual processing system, sparing our more limited cognitive resources for patient care issues.

Specifically, I look forward to presenting a design where we can use our visual system to grasp both the subject matter and the temporal sequence of EHR documents. The design is not intended to be a finished product, but rather a starting point, a springboard for discussion and deliberation. I welcome input from healthcare IT professionals, interaction designers, vendors, and clinicians. I would love nothing more than to see some of the design concepts incorporated into innovative open source applications that could serve as new front ends for existing EHR systems, and eventually, for personal health records as well.

Next Post: My Data Set

Rick Weinhaus, MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

Morning Headlines 6/3/15

Partners’ $1.2b patient data system seen as key to future

Partners Healthcare goes live on Epic across nearly all locations except for its Massachusetts General Hospital facility. The total cost of the implementation grew to $1.2 billion, double the $600 million initially budgeted, making it the largest investment the health system has ever made.

Revisit Rates and Associated Costs After an Emergency Department Encounter: A Multistate Analysis

A study published in the Annals of Internal Medicine finds that 8.2 percent of ED patients will readmit within three-days, often going to a different hospital for the second visit. Skin infections generated the highest rate of revisits at 23 percent, and the second visit was typically far more expensive than the initial encounter.

Comvest Partners Acquires McKesson Care Management Business

McKesson sells its care management system, marketed to payors and risk-bearing health systems, to investors for an undisclosed sum.

Governor: Update fixes health exchange delays

Vermont updates its health insurance exchange to fix problems that were causing delays of up to two-hours for users trying to update their coverage mid-year due to life changes such as marriage or the birth of a new child. The HIE is still unable to enroll businesses, a requirement of ACA, and the governor has reported that he will push to have the requirement dropped before attempting to add the functionality to the site.

News 6/3/15

Top News

Partners HealthCare (MA) goes live on Epic at a cost of $1.2 billion, double its original $600 million estimate, making the project the single largest investment the health system has ever made. The Boston Globe article quotes a Tufts professor and Health Policy Commission member as saying, “We will ultimately all pay for it. Will we get dividends back in terms of better care and greater efficiencies? We don’t know yet.”

Reader Comments

From Around St. Louis: “Re: SLU Hospital. The university is buying their hospital back and conjoining with SSM to run it. SLU Hospital was the only Tenet hospital with Epic – all others are on Cerner.” The 356-bed hospital wasn’t happy that buyer Tenet, which paid $300 million for the hospital, failed to establish a regional network. The city will lose $6 million in annual tax revenue that for-profit Tenet was paying that SSM won’t, although the mayor’s office say it’s happy with the hospital providing “quality healthcare, jobs, and expansion,” thus neatly illustrating that it’s tough to control healthcare costs when everybody likes the huge employment it creates at public expense.

HIStalk Announcements and Requests

Mr. K sent a photo of students with the Bluetooth speaker we provided to his Wisconsin PE class via DonorsChoose, which apparently was a great student motivator for our $178 donation. Mrs. F’s Ohio first graders are using their STEM kits in summer school sessions where they learn “while they think they are playing,” she reports. Meanwhile, companies donating $1,000 or more to our DonorsChoose project get mentioned and double their impact via matching funds provided by an anonymous HIT vendor executive – contact me.

I was thinking about complaints that providers don’t make EHR data available to patients vs. the tiny percentage of patients who actually request it. Someone should perform a study to determine the level of demand and the reasons people aren’t requesting their information. I haven’t seen anything to suggest that providers are denying those requests, so targeting them as the villain doesn’t make sense. Proponents should be taking their case to the public, not to providers and EHR vendors. I’ve never requested my own information or changed providers just because I couldn’t get it easily – have you?

I was also thinking that among all the unrealistic expectations placed on health IT to improve health, a big one is caused by consumers who think a huge problem is misdiagnosis. That’s a minor issue compared to lack of consistent, evidence-based treatment of easily diagnosed conditions in which the patient accepts full responsibility for their outcome. Improving outcomes and cost for obvious conditions such as COPD, diabetes, and heart disease unfortunately isn’t as sexy as uncovering a gene for an obscure disease or using Watson to suggest treatments. The transition to a public health mindset is slow and patients don’t like hearing that the answer to their problems is willpower, moderation, and acceptance rather than a decisive, inconvenience-free prescription or procedure.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Acquisitions, Funding, Business, and Stock

Post-hospital care coordination systems vendor Careport Health closes $3.8 million in financing.

McKesson sells its Care Management business, which offers case and disease management services to payers, to investors who will rename it AxisPoint Health.

Premier acquires CommunityFocus, a community health needs assessment management solution jointly developed by UNC-Charlotte and Premier that will be incorporated into PremierConnect.

Sales

Kingsbrook Jewish Medical Center (NY) will use CipherHealth’s Echo to provide secure, online audio recordings of verbal discharge instructions to visually impaired patients.

Kentucky Medical Services Foundation chooses MedAptus Enroll for managing provider credentialing.

People

Payor platform vendor Healthx names Sean Downs (Enclarity) as CEO.

Government and Politics

Vermont Governor Peter Shumlin says a successful software upgrade to the state’s troubled health insurance exchange system this week will reduce the time required for “change in circumstance” updates, but adds that consumers will still need personal staff help until more changes are made in the fall and that warns that it will take time to catch up on the 10,000 changes that have been backlogged. Optum met the May 31 deadline for applying the update but must clear the backlog by October 1 to keep the state from considering shutting down the exchange and moving to Healthcare.gov.

Privacy and Security

Cottage Healthcare System’s (CA) cybersecurity insurer demands that the hospital repay $4.1 million it provided in settlement costs following a 32,500-patient data breach in 2013, saying the health system lied on its application in saying that it was applying patches, performing annual audits, and verifying the security capabilities of its outsourcers. The hospital failed to update the default FTP settings of servers, allowing patient information to display on Google searches.

Other

County-operated 439-bed Riverside County Regional Medical Center (CA) requests $53 million to convert to Loma Linda University Health’s Epic system, which I believe would replace Siemens Soarian for inpatient and NextGen for ambulatory.

A Northwestern University study finds that 84 percent of teens have looked up health information online (mostly by Googling a topic and clicking on the first link presented) and 21 percent have download health-related mobile apps, although two-thirds of them say they didn’t change their behaviors based on health information or tools. Three-fourths of teens were at least moderately satisfied with the information they found, but a significant percentage also ran across negative information such as how to manufacture drugs, play drinking games, or create eating disorders. Only seven percent had ever used a fitness tracker. 

A New York Times analysis finds that hospitals are jacking up their list prices (paid only by uninsured and out-of-network patients) at double the rate of inflation, while their Medicare payments remain flat.

A study finds that 8.2 percent of ED patients returned within three days, with a third of them choosing a different ED and the second visit often costing a lot more than the first. The highest revisit rate involved skin infections that probably shouldn’t have required an ED visit in the first place, but of course most doctors in private practice work banker’s hours in rarely being available without an appointment and nearly never between 5 p.m. and 8 a.m., leaving the ED as the only medical “open now” sign on for well more than half the day unless you count urgent care clinics that actually expect patients to pay upfront instead of if and when they get around to it.

Your cutting edge, contemporary, and fresh HIMSS16 presentation proposal is due June 15, a mere 8.5 months before you’ll actually present it.

AOL founder Steve Case, now an investor, says healthcare is one of the big economic sectors that will be disrupted by startups, for which he advises perseverance, partnerships, and policy. On the other hand, Steve’s one hit was dumping AOL on the clueless and Internet-terrified Time Warner in a disastrous and scandal-driven 2001 dot-bomb merger, with his follow-up Revolution Health sinking without a trace and his current healthcare IT investments being companies I’ve never heard of. He spoke at HIMSS08 back when it still looked like he might disrupt healthcare.

Weird News Andy flipped over this story that he titles “spatuvula.” A woman tries to clear her allergy-swollen throat using a foot-long kitchen spatula handle, removal of which (and part of her esophagus)required emergency surgery. WNA loves the bonus story at the end that describes a doctor removing a fish from a boy’s throat on camera, leading WNA to question whether he was paid scale.

Sponsor Updates

• Valence Health is named as one of Chicago’s fastest-growing companies with its 50 percent annual growth rate and 800 employees.
• Cumberland Consulting Group’s Annamarie Lee will present “Navigate Complexities of Contracting and Government Compliance” at CBI’s Medicaid and Government Pricing Congress this week in Orlando.
• Health Catalyst is named as one of the best places for millennials to work.
• Forward Health Group CEO Michael Barbouche is interviewed by a Madison newspaper.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
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Curbside Consult with Dr. Jayne 6/1/15

I had lunch this week with some former colleagues. One of the topics of discussion was the 21st Century Cures initiative that was approved by the House Energy and Commerce Committee in May. Supporters such as Representative Frank Pallone state that it “will ensure that innovative treatments are getting to those who need them most, giving real hope to patients and their families.”

For those of you who may not have seen the non-IT details, the bill has significant goals:

• Reauthorize National Institutes of Health (NIH) funding through FY2018
• Establish an innovation fund at NIH
• Require strategic planning and greater accountability at NIH
• Increase funding for pediatric research
• Require sharing of data generated through NIH-funded research
• Standardize patient information across trials housed in ClinicalTrials.gov
• Establish a public-private Council for 21st Century Cures to “accelerate the discovery, development, and delivery of innovative cures, treatments, and preventive measures”
• Increase patient-focused drug development
• Require the FDA to issue guidance on precision medicine
• Streamline policy to facilitate development of new antibacterial and antifungal agents
• Formalize vaccine recommendation processes
• Modify FDA review requirements for certain categories of drugs and devices

Most of us have heard about the language on ensuring interoperability and “holding individuals responsible for blocking or otherwise inhibiting the flow of patient information throughout our healthcare system.” There is also a section on expanding telehealth under Medicare.

As a primary care physician, I also liked the section addressing issues where Medicare beneficiaries can’t get certain services covered because care is delivered in the home setting. My favorite part, though, is Medicare site-of-service price transparency. I hope all the health systems doing so-called “provider-based billing” take note of this. It’s going to be harder to trick patients into paying exorbitant facility fees if this makes it through. Rebranding free-standing physician offices as hospital departments as a thinly-veiled cash grab is one of the more despicable practices I see among hospitals and health systems.

The Senate is working on its own version of the bill, so it remains to be seen whether all of this passes, and if it does, how much the individual sections are modified. Funding research and cutting edge therapies is important, as is dealing with various Medicare oddities that complicate care delivery. In talking with my colleagues, however, we all balk a little at the call-out for precision medicine. Although it’s an interesting concept, is it really going to be pivotal for the majority of patients?

I’m a huge fan of public health. Basic sanitation and preventive measures have made a tremendous difference in quality of life for people around the world. However, I’d like to see more discussion (and also funding) of the basic health services that many people either cannot access or lack understanding of their value. It is still difficult to get insurance companies to pay for nutrition counseling or sessions with a registered dietician except for certain disease states. We can try to get patients to self-pay for these services, but it’s a difficult proposition when some are already paying large premiums for minimal coverage.

I’d like to have the time and resources to try to convince patients of the return on investment for these interventions (both in quality of life and lower health costs), but it’s hard to make headway during a 10-minute office visit. Watching Congress debate legislation that impacts rare diseases and drug development is difficult when one realizes how much work is still yet to be done on diseases that have 19th and 20th century cures already. A good number of the diseases on which we spend the most can be markedly improved (if not cured) through behavioral and lifestyle interventions, but these are the most difficult to implement. It’s much easier to take a pill for many Americans.

I’m not sure what primary care will look like in the next century. I can’t wait for the next generation to be able to scan patients with a Tricorder and synthesize antidotes and treatments Star Trek style. That seems such a long way away, though, when we’ve yet to figure out how to implement some of the basics such as universal vaccination, healthy eating habits, and regular exercise.

Looking back through the Bill’s history, I did see a small step that actually will make an immediate difference. At the same time the House of Representatives Energy and Commerce Health Subcommittee was hearing about 21st Century Cures, they were also considering HR 1321, the Microbead-Free Waters Act of 2015. It caught my eye because I’ve been aware of the microbead problem for a while, especially the fact that the US lags other countries in banning them. I must say, this Act is probably the shortest piece of legislation I’ve seen in a long time – a grand total of two pages and 14 numbered lines. If only Meaningful Use was that simple.

What’s your favorite Act of Congress? Email me.

Email Dr. Jayne.

Startup CEOs and Investors: Bruce Brandes

All I Needed to Know to Disrupt Healthcare I Learned from “Seinfeld”: Part VI – A Festivus for the Rest of Us
By Bruce Brandes

Is necessity still the mother of invention? Edison with the light bulb. Bell with the telephone. Ford with the automobile. Costanza with the Mansiere (or was it Kramer with the Bro)?

Given the clear market need for all of these innovations, was there ever any question that these entrepreneurs would become wildly successful? Or were men content with candlelight, telegraphs, and horse-drawn carriages, which caused their man-boobs to jiggle as they rode along?

Today, conversely, as suggested by Jared Diamond, invention may be the mother of necessity. Did we know we needed an iPhone until Steve Jobs showed us the compelling device? Unfortunately in healthcare, too often it seems entrepreneurs and investors are introducing products believing they have invented the next iPhone-like phenomenon, to eventually realize that not only does the market not have a need, in many cases does not even have a want.

When looking to invest in an early stage venture which seeks to address a well-understood but yet-unsolved problem, how does an investor know with which one of the multitude of aspiring inventors to bet?

An important consideration is understanding the motivation and passion of the founder to launch the undertaking in the first place. An example lies in the prolific innovator, Frank Costanza, and the remarkable global embrace of the sensation that is his Festivus, whose origin is summarized in the exchange below.

FRANK: Many Christmases ago, I went to buy a doll for my son. I reached for the last one they had, but so did another man. As I rained blows upon him, I realized there had to be another way!

KRAMER: What happened to the doll?

FRANK: It was destroyed. But out of that, a new holiday was born. “A Festivus for the rest of us!”

In Venture, we often meet bright entrepreneurs seeking funding motivated to build a company that will make them rich and famous. Each time we make this assessment, I am reminded of Philip Rosedale, founder of SecondLife, who once said, “If you have an idea and you know you won’t earn a dime from it but you have to pursue it anyway and solve the issue, then you’re a true entrepreneur.”

While in hindsight most investors would prefer to have backed Mark Zuckerberg ahead of Philip Rosedale, I suggest that if becoming rich and famous is your primary goal, you are very likely going to fail. Financial rewards may be the result of a more noble primary goal being achieved, but should not be your first focus.

I believe this is particularly true in healthcare. Two excellent examples (from reality rather than Seinfeld) of promising healthcare technology-enabled solutions that were founded by purpose-driven entrepreneurs and briefly their inspirations.

Wiser Together – Shub Degupta

In the fall of 2007, my wife and I went through a difficult pregnancy. In particular, the decision about whether to undergo invasive and expensive genetic tests daunted us. There were plenty of sources of information: friends, family, the Internet, helplines, genetic counselors, even academic literature.

In fact, in some ways there was too much information, often out of context. Our friends were helpful, but the information was anecdotal. Health websites had good information, but it was overwhelming, not actionable, and not personalized for our situation. It was nearly impossible to get to a decision that gave us peace of mind.

What we really wanted was the right information for us: What did other couples like us do? What tests did they have? What treatments did they seek? And, always lurking in the background, what was covered in our insurance plan?

We had to make some of the toughest decisions of our lives with insufficient information. Our experience was very stressful—and yet extremely common.

I realized this didn’t have to be the case. With new technology, extensive data, and a thorough understanding of how people make health decisions, WiserTogether was founded in early 2008, a few weeks after our eldest daughter was born. Today, WiserTogether helps millions make health decisions efficiently and intelligently, achieving better outcomes at a lower cost .. and with peace of mind.

Rallyhood – Patti Rogers

I created Rallyhood after witnessing the power of community and kindness during my long battle with breast cancer. The love and support from family, friends, and neighbors truly changed my life and made a significant impact on my ability to heal. The truth is I could not have done it alone. I needed my doctors and medicine to kill my cancer, but I needed my people to bring me back to life.

While the people were amazing, my family and I experienced the frustration of trying to organize the support effort with fragmented, difficult-to-use tools. It added unnecessary stress and burden for all of us. After getting well, I was inspired to build a platform for purpose-driven communities that made it easy to rally around a person, event or any common cause. Blending the best of social and and the best of productivity in one place.

Today, Rallyhood has helped more than 20,000 communities organize emotional, practical, and financial support in one place. By engaging the person’s trusted community, providers can now extend the continuum of care in a more holistic way—improving outcomes, enriching the patient (human) experience, and expanding their brand into the daily mobile lives of the people they serve. Everyone wins.

Ultimately, growing a viable new company and achieving valuable business outcomes takes more than just an inspired founder. There will be conflicts where your team must air grievances if there is any hope for a Festivus miracle. We all know that any success story, over time, will reflect fondly on the feats of strength required to achieve greatness.

What is the mother of your invention?

Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.

Morning Headlines 6/2/15

New Medicare data available to increase transparency on hospital and physician utilization

CMS releases its latest Medicare payment dataset, covering all inpatient and outpatient hospital billing and reimbursement figures for 2013. The latest data breaks down what hospitals charged, and what Medicare reimbursed, for the 100 most common inpatient DRGs and outpatient procedures.

AMA Weighs Ethical Telehealth, Doctor Care Via iPhone

At the 2015 AMA Annual Meeting this week, the AMA’s Council on Ethical and Judicial Affairs will debate and vote on a new telehealth policy that will advise doctors on everything from patient privacy, diagnostic procedures, and follow up care.

Providers want CMS to slow down EHR superhighway

Several provider organizations weigh in with their concerns over the proposed MU3 rules, with Catholic Health Initiatives saying “We are concerned that CMS is trying to force providers to move toward meaningful use of EHRs at a pace that is too fast and impossible to meet,” and the AHA saying “We do not yet have sufficient experience at Stage 2 to be confident that the proposals for Stage 3 are feasible and appropriate.”

Morning Headlines 6/1/15

Federal Court rules in favor of Teladoc, blocking Texas Medical Board rule and preserving telehealth in Texas

Dallas-based Teladoc wins an early victory in its anti-trust lawsuit against the Texas Medical Board, which passed a rule earlier this month requiring a face-to-face consultation before any telehealth services could be provided in the state. A US District Court has blocked the rule from going into effect until after the trial.

Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs

The American Medical Informatics Association publishes the recommendations of its EHR 2020 Task Force in a report on the status and future direction of EHRs.

Erlanger spending $91 million on major IT overhaul

Erlanger Health System approves a $91 million contract to implement Epic across its system, with an additional $97 million budgeted to maintain the system over the next 10 years. The hospital’s selection committee, made up of clinical and operational leaders, voted in favor of Epic 28 to two over Cerner.

Big Data Beats Cancer

IEEE Spectrum profiles John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, who helped pioneer several big data initiatives in healthcare and in 2011 turned to big data to help create a personalized treatment plan for his wife when she was diagnosed with stage III breast cancer.

Monday Morning Update 6/1/15

Top News

A judge approves an injunction requested by Dallas-based telemedicine provider Teladoc against the Texas Medical Board for its new rule that requires doctors to conduct a face-to-face patient visit before issuing a prescription.

Reader Comments

From Talking About BS: “Re: Athenahealth. Has spent almost $1 million on lobbying so far in 2014-15 and VP Dan Haley is listed in OpenSecrets.org as a ‘revolving door’ lobbyist, described as federal employees turned lobbyists and vice versa. Athena’s cloud vapor simply isn’t selling to real customers and instead is being sold to Wall Street and Congress. Einhorn has this company pegged.”

From Travlinman: “Re: Epic. Guarantees ongoing interoperability with TeleTracking. Are they going to start playing nice with other vendors?”

HIStalk Announcements and Requests

More than half of poll respondents think Cerner is the HIT stock to buy. New poll to your right or here: who is most to blame for lack of patient data sharing among providers? Vote and then click the poll’s comments link to make your case.

I have no idea what a Rekenrek is, but Ms. S says her Indiana first graders are using the ones we bought via our DonorsChoose project daily for Math Warm-Up, adding that, “We had been using Rekenreks that we made on our own that are falling apart, so to see professionally made ones is wonderful!”

I seem to be especially cranky about grammar these days, so add these to my already long list: (a) starting sentences with the word “So” like a drunken bar patron launching into a long, dull anecdote; (b) sloppy use of geographic terms such as “a German doctor” that could mean a doctor from Germany, a doctor in Germany, or both; (c) using “less” rather than “fewer” in describing a collection of individual items, as in erroneously stating, “The event had less people than before”; (d) confusing “I” with “me” as in incorrectly proclaiming, “My brother came to visit Mary and I.” There, now I feel better.

I’m also annoyed by the expression “EHR mandates.” Nobody requires doctors to use EHRs except perhaps their employers – they just pay them extra if they do.

Last Week’s Most Interesting News

• HHS names Susannah Fox as its new CTO.
• Two entrepreneurs who sold DiagnosisOne to Alere in 2012 buy back the business – now known as Alere Analyics – to form Persivia. 
• Athenahealth VP of Government and Regulatory Affairs Dan Haley said in a New York Times article titled “Tech Rivalries Impede Digital Medical Record Sharing” that customers typically pay EHR vendors $1 million upfront, $500,000 per year, and $2 per patient record to exchange information with other systems.
• Forbes names Epic CEO Judy Faulkner as the wealthiest women in all of technology with an estimated $2.6 billion net worth.
• Cerner told shareholders that it recorded $4.25 billion in sales for 2014.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

People

Tim Theriault, global CIO of Walgreens Boots Alliance (the former Walgreen), resigns for personal reasons. He will be replaced by Anthony Roberts, SVP/international CIO. Roberts came on board with the December 2014 Boots acquisition.

Former Meriter CIO Peter Strombom died May 18 at his home in Costa Rica. He was 75.

Jeremy Delinsky, chief product officer at Athenahealth, resigns after five months in the position to take a CTO position with an online furniture company. ATHN shares dropped more than 5 percent Friday following the announcement.  His interim replacement will be VP Kyle Armbrester. ATHN shares are down 20 percent so far in 2015.

Announcements and Implementations

Athenahealth offers athenaCommunicator Enterprise to new customers who participate in an ACO for a flat 10 percent of their MSSP shared savings payouts.

Government and Politics

Florida Governor Rick Scott, former CEO of for-profit and fraud-admitting Columbia/HCA, wants to hold the state’s non-profit hospitals more accountable for their huge profits, topped by Lee Memorial Health System’s $230 million.

Technology

Ashish Jha of Harvard tweeted out rave comments about Doc Stats, an app that shows the approximate number of procedures a doctor performs as derived from CMS data.

A Bay Area recycling firm is looking for a woman who dropped off garage junk following her husband’s death that included an Apple I computer, one of only 200 that were hand built by Steve Jobs and Steve Wozniak in 1976. The company wants to give the woman $100,000, her half of the amount a private collector paid to buy it from them.

Other

AMIA’s EHR 2020 task force publishes its recommendations. Many of them are observations of the current state or non-specific ideas about long-term changes that I didn’t find especially compelling or novel, but a few actionable items are:

• Use natural language processing to convert free text notes to discrete data and reduce reliance on documentation templates.
• Spend government money to study data entry methods and encourage the use of those that improve provider efficiency.
• Slow down or freeze the Meaningful Use and certification requirements.
• Eliminate requirements for providers to enter EHR information that isn’t used for direct patient benefit.
• Eliminate E&M codes and checkbox-driven data entry that fails to capture the patient’s voice.
• Allow vendors to meet MU certification with less-prescriptive methods and require them to post video recordings of their system so that EHR purchasers can see how they work.
• Create the national Health IT Safety Center.
• Require vendors to offer APIs to earn certification.

The board of Erlanger Health System (TN) approves its $91 million Epic contract, which will also require $97 million in maintenance costs over the next 10 years. The CFO says Epic beat Cerner on price and the selection committee preferred Epic 28 votes to two.

The Indianapolis business paper profiles ICUcare, which puzzling offers both a smartcard-based PHR (the company owner says he spent $25 million to develop it) and a telemedicine platform. The owner says the company has 12 employees and $3.5 million in revenue, some of which should probably be directed to updating the website, whish announces plans to release new technology in June 2010 and that lists Windows Vista as the required operating system (those are just the tip of the “ice-burg,” it says).

A Florida hospital tests the Internet lag time in performing telesurgery using the da Vinci surgical robot, finding that surgeons can’t tell the difference whether they are a few feet or a few states away from the patient.

Influential healthcare IT expert Jess Jacobs of Aetna’s Innovation Labs recounts her recent and current experiences (with photos) as an inpatient of a hospital that can’t do anything right – a bathroom sink clogged for three days with her roommate’s bloody vomit, having to use her own cellphone to coordinate the work of several attending doctors who hadn’t talked to each other, mixing up mouthwash with handwash, a nurse call system that didn’t work, the nursing staff’s disregard of her roommates sickle cell crisis pain, and the barring of her patient advocate (who is a medical student at the same organization) from participating in her care. She complained to hospital administration after an earlier visit and received a halfhearted apology blaming her being housed in a treatment room as due to unplanned admissions, an acknowledgment that it was “unfortunate” that the hospital didn’t allow her friend to serve as her patient advocate (without offering an explanation as to why), and defense of her roommate’s pain management as being appropriate based on medical evidence. She’s back in as an inpatient for intractable vomiting and says nothing has improved – the hospital missed her abnormal lab results, security guards confiscated her prescribed drugs and supplies and threatened to arrest her for objecting, and the hospital assigned a “sitter” who sleeps, talks loudly in the hall, and eats bacon in her room. The scary thing about her story is that it’s not unusual from my experience – everybody who lives through an inpatient stay can relate equally horrifying stories about the incompetence and indifference they encountered.

A good article in IEEE Spectrum describes how BIDMC CIO (and gentleman farmer) John Halamka, MD helped develop early big data platforms I2B2 and SHRINE that later may have saved his wife’s life as he researched the best treatment options for her newly diagnosed cancer based on historical outcomes. He adds in describing future innovation, “All these big companies are fine, but do we really think the next cool innovation is going to come out of an 8,000-person company? No. It’s probably a two-person garage operation.”

Another interesting IEEE Spectrum article addresses the healthcare uses of IBM’s Watson, which it concludes isn’t ready for prime time and may not be for some time because: (a) it not only has to find existing answers in existing content but also has be trained to think like a doctor; (b) journal articles Watson uses as source material aren’t always current or based on actual medical practice; (c) EHR databases are full of errors and focus more on billing rather than clinical usefulness. The article mentions other companies working on medical artificial intelligence such as QPID, DXplain, and CancerLinQ.

A small study of Facebook users finds that those with low self-esteem post often about their romantic partners, while those who brag about diet, exercise, and achievements are often narcissists who crave “likes” and positive comments from annoyed “friends” just trying to be nice.

Sponsor Updates

• Medicity posts “ICD-10: Are We There Yet?”
• MedData will exhibit at the Coastal Emergency Medicine Conference June 5-6 in South Carolina.
• First Databank customer Joshua Schmees, PharmD of Hospital Sisters Health System describes the organization’s success in reducing alert fatigue by using FDB’s AlertSpace.
• Quest Diagnostics employees raise over $11,000 in the American Cancer Society’s Relay for Life.
• WeiserMazars posts pictures from its nationwide community service day.
• NTT Data offers “Predictive Intelligence Brings Increased Value to Data.”
• Versus Technology will exhibit at AAMI 2015 June 5-8 in Denver.
• Truven Health Analytics posts “Understanding Your Exchange Population: Are You Asking the Right Questions?”
• Microsoft summarizes the origins of Oneview Healthcare as part of its Customer Stories series.
• Orion Health and Passport Health will exhibit at AHIP Institute 2015 June 3-5 in Nashville.
• Patientco offers “Out-of-Pocket Costs are Increasing Faster Than Expected.”
• PatientPay Founder and CEO Tom Furr asks “What Would Steve Jobs Say?”
• ZirMed posts “Leveraging Data Analytics, Keeping Up with Value-Based Care, and Rev Cycle Success at Stanford Children’s Health.”
• PMD offers “Reusing Code to Improve Care Coordination.”
• Wide River will host an educational event, Health IT: Compliance & Innovation, June 4 in Lincoln, NE.
• Sagacious Consultants posts “What You Don’t Know Can Hurt You: the Importance of Measuring Productivity.”
• Huron Consulting will sponsor the 2015 Aria Health Golf Classic June 1 in support of Philadelphia-based Aria Health’s ICU renovations.
• The Nashville Business Journal features Shareable Ink CEO Hal Andrews in its “The Boss” video series.
• Streamline Health will exhibit at the 2015 CHIA Convention & Exhibit June 8-10 in Palm Springs, CA.
• T-System will exhibit at NYHIMA’s 2015 Annual Conference June 7-10 in Syracuse, NY.
• TeleTracking offers “Making Interoperability a Commonplace.”
• Valence Health Project Manager Jacob Krive will present a session on big data and population health at the University of Illinois College of Medicine Chicago June 3.
• Verisk Health, West Corp., and ZeOmega will exhibit at the AHIP 2015 Institute June 3-5 in Nashville.
• Voalte offers a new blog showcasing the successful deployment of its smartphone solution at Massachusetts General Hospital.
• Winthrop Resources will exhibit at the NY Tech Summit June 4-5 in Verona.
• Xerox offers “The Best Kept Secret in Healthcare.”

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 5/29/15

I’m the New CTO of HHS

Patient advocate and former associate director at the Pew Research Center Susannah Fox is named the next CTO of HHS. Fox will be the third person to hold the position, following Bryan Sivak and Todd Park, and will be the first female CTO.

The Wealthiest Female Techies In America

Judy Faulkner is named the richest woman in technology, with a net worth of $2.6 billion.

Allscripts to build 12-story tower at North Hills

Allscripts will move its 1,000 Raleigh, NC-based employees into a new 12-story, 250,000 square foot office tower, scheduled to open in early 2017.

Cambia Health Solutions Leads New Round of Investment in lifeIMAGE

LifeImage, a medical image exchange platform vendor, closes a $17.5 million funding round led by investor Cambria Health Solutions. The company will use the new funding to grow its support staff and further develop its functional capabilities.

News 5/29/15

Top News

Patient advocate Susannah Fox (Pew Research Center) is named CTO of HHS. She replaces Bryan Sivak, who stepped down last month.

Reader Comments

From Publius: “Re: DoD EHR bid. Consulting firms are already contacting Epic consultants in regards to the IBM/Epic DHMSM bid. The communication is that the decision is anticipated to be made August 1, 2015, and consulting firms want to have a list of consultant resources ready to present as soon as the decision is made.” Unverified, but logical. The DoD project could be the equivalent of HITECH in spurring consultant demand, at least for those chosen to work on the project.

From Frank Poggio: “Re: Mr. H’s observation that patients aren’t Meaningful Users. That’s an idea for a new CMS program since it looks like ONC is struggling to find its next life! Everyone says that patient participation is a key to controlling healthcare costs, so ONC should develop a book of Meaningful Use criteria that is tied to a patient’s insurance premiums. If they don’t hit all criteria each year, their premiums double (or triple?), but if they hit them all, their premiums are cut in half. Since ONC would have to deal with some 100 million participants, they should easily be able to justify massive department budget increases.” I like it. When it comes to health, the customer definitely isn’t always right.

From Freddie Paris: “Re: New York Times article on interoperability. Wonder if Dan Haley would respond to a truth challenge to come up with any references to his assertion?” Athenahealth VP of Government and Regulatory Affairs Dan Haley was quoted in “Tech Rivalries Impede Digital Medical Record Sharing” as saying that IT vendors have business models that impede data sharing, a typical arrangement that he says costs customers $1 million to connect to another system, $500,000 per year to maintain the connection, and $2 each to send records to another system. Dan sent this response to my inquiry, which still doesn’t provide the $1 million vendor and client details the reader seeks:

The information I shared with Mr. Pear came from conversations with our clients and prospects who’ve told us firsthand and on countless occasions over the years about the exorbitant costs imposed by market-dominant vendors for out-of-platform information sharing. These costs are imposed in a number of ways: via one-time interface fees that can total more than a million of dollars for even a medium-sized health system; via annual interface maintenance charges that extend and compound that initial cost; and via per-transaction fees of the kind that one major vendor recently resolved to stop charging under pressure from Congress and others. The specific amounts vary, but are all large. The point is that any significant imposed cost for out-of-platform communication effectively discourages true interoperation and impedes progress toward the bipartisan societal goal of information fluidity in healthcare. As many in the industry know, vendor contracts are usually protected like the crown jewels, but they are sometimes obtainable via Freedom of Information Act requests directed at institutions that benefit from significant federal contracts. Enterprising reporters interested in this issue to should check for themselves. Clearly ONC gathered ample evidence of these business practices when preparing their recent information-blocking report. We are glad that both ONC and Congress are taking action.

From Carrollton Outsider: “Re: Lightbeam Health Solutions. Acquired by Greenway to be their population health solution.” Not true, said CEO Pat Cline when I asked him about the rumor, and he’s not talking to any entity about selling the company, either. Lightbeam announced a non-exclusive partnership with Greenway last year, one of several such agreements it has with EHR vendors to provide a PHM platform, but that’s it. I interviewed Pat a year ago if you want to know more about the company.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Boston Software Systems. The company revolutionizes how healthcare works by providing error-free automation for any application or purpose – EHR migration, streamlined business processes, and improved productivity. Its automation products are the most sophisticated available, giving customers the peace of mind that their critical data is 100 percent error free as it bridges the gap between their technologies. BSS’s reputation for ease of use and customer support is stellar. Check out the interviews with customers CVSHealth (onboarding new MinuteClinics), Unity Health System (improving discharge workflow), Methodist Houston (validating Medicare accounts), Fauquier Hospital (mass Meditech updates following a hospital acquisition), and CIO Kent Henriksen describing how his health system used BSS to migrate millions of clinical records to Epic. Thanks to Boston Software Systems for supporting HIStalk.

My latest grammar pet peeve is when people say something like, “If you have questions, please don’t hesitate to call,” the latter part of which can be equally clearly stated by just saying “call.” How many people would ever use the word “hesitate” except in this awkward form, and why can’t I hesitate if I want to? Peeve #2: a phrase such as “20 different physicians,” where nobody really needs the “different” part to understand that it’s not 20 of the same physician.

I was having odd, persistent “waiting on …” browser site loading messages that I fixed by reinstalling a solution I’ve used previously: OpenDNS. It’s a free, 30-second network connection change that bypasses slow, unreliable DNS lookups in replacing them with its own. It improved site load times quite a bit.

This week on HIStalk Practice: HHS awards $112 million to help primary care practices optimize EHR utilization to improve cardiac health outcomes. Morrow Family Medicine launches NeighborAide app for elderly patients and caregivers. Minnesota will no longer force solo docs to implement EHRs. The Illinois Gastroenterology Group rolls out new technology for Crohn’s patients. Physician practices show cloud-based EHRs some love, but still have reservations about data security. American Well CEO Roy Schoenberg, MD explains why the future of telemedicine is already in physician pockets.

DonorsChoose Project Updates

Ms. N from California shared photos of her disabled high school seniors using the Chromebook we provided as a DonorsChoose grant to type their essays, complete college applications, and apply for jobs. The second graders in Ms. A’s class in Texas are using the math games we bought to learn to count money, write fractions, measure objects, and tell time, and she adds that they are so popular that the kids make a beeline for them during indoor recess.

The $10,000 Challenge

 

A vendor executive who shall remain nameless was so moved by the participation and classroom reports that I’ve mentioned here that he/she is putting up $10,000 to match new DonorsChoose donations. If your company donates $1,000 or more (I’ll set up a credit card payment), I’ll feature it here and also apply matching funds from our anonymous benefactor, which will provide double bang for the buck (actually quadruple bang for the buck potentially, since I often find requests that will be matched by charitable groups such as the Bill & Melinda Gates Foundation). DonorsChoose is a stellar charity that spends 94 percent of its income on projects rather than overhead, paying its CEO and genius founder only $240K (and that’s New York city money, a rounding error in the salaries of health system CEOs there). Centura SVP/CIO Dana Moore, who conceived this HIStalk project in the first place and donated his time at HIMSS to encourage donations, has ideas to keep it going as well.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.

Acquisitions, Funding, Business, and Stock

Cloud computing services vendor ClearData closes a $25 million Series C funding round.

Medical image exchange platform provider LifeImage closes a $17.5 million investment round led by non-profit insurance and health solutions company Cambia Health Solutions, which owns several healthcare technology vendors.

A construction company confirms that Allscripts will move its 1,000 Raleigh, NC employees into a new 12-story office tower that will open in the spring of 2017.

Forbes names Epic CEO Judy Faullkner as the wealthiest female in all of technology. The assets of the top 11 women combined ($10.6 billion) is 3 percent of the wealth of the top 11 men.

Sales

Community Hospital of the Monterey Peninsula (CA) and University of New Mexico Health Sciences Center choose revenue cycle management products from Experian Health/Passport.

Lakeland Health (MI) chooses ProVation Order Sets for clinical content management.

Announcements and Implementations

Nuance announces PowerScribe 360 Reporting v3.0, which allows radiologists to create higher quality reports using real-time, evidenced-based guidance developed by the American College of Radiology.

ToSense’s CoVa body-worn sensor (thoracic impedance, heart rate, heart rate variability, respiration rate, skin temperature, and posture) earns FDA 510(k) clearance. Elderly patients wear the necklace-type device in their homes for a few minutes each day to allow remote monitoring for heart failure.

CompuGroup Medical US and rehab services company Weston Group will partner to develop rehab modules for CGM’s webEHR.

Privacy and Security

Ohio’s medical board reprimands a radiologist for violating HIPAA by looking up the electronic medical records of a colleague for unstated reasons.

Other

Weird News Andy would enjoy captioning this photo of a virtual butt being used for medical student prostate exam training. In slightly related news, a Florida college will stop requiring female sonography students to perform vaginal probes on each other for ultrasound training and will instead move to simulators.

Bizarre: a father and son in their 70s are married after 52 years together, with the “bizarre” part being that in order to game the system in a state that doesn’t recognize domestic partnerships, one had adopted the other in 2000, a parental status the court agreed to vacate prior to their nuptials.

Sponsor Updates

• First Databank President Chuck Tuchinda, MD provides advice for career success in a San Francisco TV interview.
• Nordic posts a video of its Community Giveback Day activities on May 22. Check out the 1:00 mark when the guy recording Nordic employees working on a Habitat for Humanity house asks one of them, “What do you think your KLAS rankings for hammering upside down would be?”
• VMware posts “New Research Highlights Clinical Benefits of Virtual Desktops.”
• Healthfinch asks “How does a 21.7 hour work day sound to you?”
• Impact Advisors posts “The Good, the Bad and the Ugly of Meaningful Use Stage 3: Objective 2 – ePrescribing.”
• E-MDs will exhibit at the Texas Medical Society event June 1 in Austin.
• Extension Healthcare and Iatric Systems will exhibit at the AAMI 2015 Annual Conference June 5-8 in Denver.
• Healthgrades recaps its experience at the Colorado Digital Health Summit.
• Galen Healthcare posts “Point-to-Point vs Interface Engine: Does your interface setup suit your needs?”
• InterSystems and Intelligent Medical Objects will exhibit at the e-Health Conference May 31-June 3 in Toronto.
• Glytec presents several research studies at the AACE 24th Annual Scientific and Clinical Congress.
• HCS will exhibit at the LeadingAge CA Region Meeting June 3 in LA.
• The HCI Group posts “PeopleSoft ALM is as Important to Patient Safety as it is to Cost Control.”
• HDS asks “Are Text-Only Emails Obsolete?”
• Healthwise will exhibit at the AHIP Institute 2015 June 3-5 in Nashville.
• InstaMed will present a session at the AHIP Institute 2015 on June 4 entitled, “Positive Member Payment Experience is Critical – See How Health Plans are Delivering.”

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 5/28/15

Even though I’m not ready to jump into another CMIO position at the moment, I still keep up with job postings and am watching a couple of positions to see how long they take to fill. I know the health systems involved more deeply than I’d like to admit. It will be interesting to see who is brave enough (or naïve enough or desperate enough) to sign up for those kinds of adventures. I’ve subscribed to a couple of job sites and today’s email brought some laughs under the banner of “great new jobs found for you this week.”

They included: utility location technician, Uber driver, business analyst at Emdeon, inside sales rep at Thermo Fisher Scientific, data entry clerk, patient experience officer, chief technology officer, and my favorite – Deerpark Barn Supervisor at The Biltmore. When I hit that last one, I noticed that all the jobs were in Asheville, NC. Although it’s a beautiful city and I’ve had some fun times with good friends there, I’m wondering if my profile has been hacked.

Speaking of job hunting, I’ve received several recruiter mailings this year and find it curious that they have all mentioned what EHR system is used at the site. Having used many systems, I’m not sure having one vendor over another would really make or break an opportunity for me. I’d rather have a well-implemented version of a low-key system than a poorly managed version of one of the industry darlings. Even in the cloud or on standardized MU-ready versions, clients still seem to have enough configuration and workflow options to get themselves into trouble.

I started a consulting project this week training ICD-10 for a local group of independent providers. It’s been a lot of fun working with end users who aren’t used to having a clinical informaticist around. With their focus on clinical care, they haven’t been PowerPointed to death and actually seem excited about learning something from my traveling road show. I’m just doing introductory content now then will circle back in a month or so with actual workflow training on their EHR system.

We’ll see how enthusiastic they remain after we get into the gorier parts of the workflow. I knew it really clicked with at least one student, who sent a piece from MSN entitled “The Strangest Ways Americans Die in all 50 States.” She asked whether the “cause of death” information would be more specific once ICD-10 is live. I hope so, because some states have amazingly general categories listed such as “water, air and space, and other and unspecified transport accidents” in Alaska and “legal intervention” in Nevada.

I received a handful of “thanks for stopping by our booth at HIMSS” messages this week, mostly from booths I don’t remember visiting. I’m pretty meticulous about taking notes while I’m crawling the exhibit hall and none of them were on my list, either. I’m attributing it to a HIMSS technology glitch rather than faulty memory. Nonetheless, if I want to buy mounts for my flat screen displays, I know where to go.

The National Healthcare Innovation Summit takes place next month in Chicago. An advertisement for it asks. “How will you innovate healthcare this year?” Most of my CMIO friends aren’t going to be doing any innovation. It looks like 2015 is about catch-up and ICD-10 preparation. Especially with Meaningful Use Stage 3 howling at our door, I don’t foresee vendors doing a lot of innovation, either.

I hadn’t realized that Minnesota passed legislation in 2007 that required all healthcare providers to implement a certified EHR by January 1, 2015 and to connect to a state-approved HIE. I came across a blurb this week that the legislature has approved an omnibus bill containing an exemption for cash practices and solo practitioners. I’d be interested to hear from Minnesota readers who have an opinion on the situation.

One of my favorite shoe enthusiasts brought these to my attention. Controlled by a smart phone app, they change colors and patterns to match the wearer’s needs or possibly just her mood.

In a related link, we’re introduced to motion-capture ballet slippers constructed from Arduino components and conductive thread. I forwarded it to my nephews in the hopes that they might need a project to keep them busy this summer. Maybe we can combine the two technologies to put together a graphical representation of what really happens on the HIStalkapalooza dance floor.

Email Dr. Jayne.

Readers Write: The Internet of Things Can Revolutionize Healthcare, But Security is Key

The Internet of Things Can Revolutionize Healthcare, But Security is Key
By David Ting

The Internet of Things (IoT) holds tremendous promise in healthcare, potentially enabling a digital health revolution and support the future of care delivery.

Gartner estimates that approximately 3.9 billion connected things were in use in 2014. This number is expected to increase to 25 billion by 2020, a growth trajectory that will surely impact the healthcare industry, which is already being flooded with devices for generating valuable patient data.

However, the transformative potential of the IoT won’t be realized for healthcare unless data integrity and security are built into the foundations of the IoT movement.

The IoT’s network of IP-connected computers, sensors, and devices allows care providers and patients to share information to a transformative degree by:

• Giving care providers access to a greater number of devices for accessing protected health information (PHI).
• Allowing patients to generate real-time biometric data with low-cost devices and applications.
• Changing the nature of encounters with care givers from episodic to real time.

For clinical staff, the ability to interact with EMRs or other applications containing PHI from any device is invaluable, especially in creating a push vs. pull dynamic for access to patient information and health records. Today’s care providers are highly mobile and the IoT can provide the ability to seamlessly use connected devices within a single session.

For patients, the IoT offers the ability to participate in their own care. Specific patient opportunities include:

• Generating valuable health information from wearables and home health devices.
• Allowing real-time voice, video, and data streaming for telemedicine.
• Enabling more active patient engagement. Instead of requiring patients to take initiative to look up records or set appointments, messages can be proactively sent to patients informing them about updates or other relevant information

Some of these changes are already taking place on a small scale. But for the IoT to reach its full potential in healthcare, identity and data integrity will become critical as PHI moves from the hospital to the edge of patient care delivery, especially to assuage consumer concerns about privacy and security.

The data generated by a series of connected devices can only be captured, aggregated, analyzed, and put to meaningful use on a broad scale if the identities of providers and patients are verified. The data being generated, collected, and shared through networked devices must be protected with strong, usable authentication methods.

For providers, authentication is required to meet compliance and privacy regulations. If security considerations are baked into the IoT infrastructure, wearables or others devices can be assigned to particular users and leveraged to verify their identity. Similarly, proximity awareness technologies can simplify the user authentication process to access various devices and applications.

Patient authentication is also essential in the IoT paradigm because it ensures the correct information is being generated by and shared with the correct patient. Creating a one-to-one link between patients and their medical records can establish a foundation for additional forms of patient identification. As with providers, devices will become part of the digital credential set for patients, necessitating a secure enrollment process to bind one or more devices to unique patient identities.

Constructing the necessary infrastructure to properly manage and optimize the proliferation of connected devices in healthcare starts with security. A strong security strategy includes authentication technologies and processes to verify patient and provider identities to ensure that devices can only be used by authorized users. The communications channels between the devices within the IoT must also be secure to ensure the integrity of the information passing through them.

Putting these security building blocks in place will help create a closed-loop system in which patients and providers can securely interact in a more engaging, meaningful way. 

David Ting is chief technology officer for Imprivata.

Readers Write: Trusted Data Is the Foundation for Advanced Analytics

Trusted Data Is the Foundation for Advanced Analytics
By Vicky Mahn-DiNicola RN

Much has been said about using advanced predictive analytics to improve the quality of healthcare. But one thing not receiving the attention it deserves is the pre-requisite of trusted data being sewn into the fabric of the healthcare organization. Every organization has data at its fingertips, but full value of that data can only be actualized if it is properly understood and trusted.

Take a relatively straightforward data element like a patient’s weight. While it is a simple, basic element, it can create havoc for analytics teams who discover there are upwards of 17 different places in their HIT systems where weight is captured. Weight is recorded in the emergency department flow sheets, nursing assessment intake forms, pharmacy profiles, ambulatory clinic records, and daily critical care flow sheets, just to name a few. Determining which weight field is the most reliable and appropriate to use is a difficult, lengthy process and one that is multiplied by hundreds of data variables required in advanced analytics projects.

Healthcare organizations are excited by the brilliant technology coming our way in the form of genomics, mobile health, and telemedicine. But too often, the cart is put before the horse. Just as bad ingredients guarantee a bad meal for even the best of chefs,  unreliable data in healthcare will inform inaccurate, even dangerous decisions.

Effective use of analytics is not something you can buy off the shelf from a vendor. Rather it is an organizational strategy, structure, and culture that have to be developed over time. While the technical and tactical execution is delegated to others, the chief executive in a healthcare organization is responsible for determining and overseeing this direction and progress.

The executive also needs to align the organization with data cooperatives and national groups that promote data standardization. National standards have historically been ambiguous, so it is important for providers to ensure they are not working in a vacuum, but have a common understanding of national guidance.

Diversity of systems and processes breeds confusion. Because there are many ways to express any given concept, there is a need for robust crosswalk, data mapping, and standardization to ensure data integrity within, between, and across organizations. This body of work is the responsibility of a designated data governance body within an organization.

Data governance implies far more than the maintenance of documents that describe measurement plans and reporting outputs.  It is a comprehensive process of data stewardship that is adopted by all data stakeholders across the organization, from the board room to the bedside.   Data governance is critical in order to standardize data entry procedures, reporting outputs, clinical alerts, or virtually any information that is used in clinical and business decision-making.  In the era of pay-for-performance and risk-based care, data standardization is mission critical for a true, accurate comparison to take place when evaluating an organization’s performance against external benchmarks and determining reimbursement based on value.

Another final step toward creating robust data governance structures is to create a data validation process. Data cleansing and maintenance should be automated, centralized, and transparent across the organization and should be designed to accommodate the needs of both clinical and business stakeholders.

A “data librarian” should be appointed to catalogue and oversee data elements across the healthcare system. The most mature organizations will implement a master data hub that is fully integrated into their application system environments so that changes are made simultaneously to all systems that need the same data. By doing so, a simple element like a patient’s weight will always be consistent in HIT systems.

Organizations need to recognize that the advanced analytics of tomorrow will only be achieved if the data we have today can be trusted. Those who succeed in establishing proper data governance will unlock the full value data can provide in our industry, beyond regulatory reporting and retrospective benchmarking initiatives to the more exciting prospects of predictive and prescriptive analytics.

Vicky Mahn-DiNicola RN, MS, CPHQ is VP of research and market insights with Midas+ Solutions, A Xerox Company.

CIO Unplugged 5/28/15

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

Time for Me to Fly

Speculation swirls as to the reasons for my departure from my Texas employer on April 20, 2015. It is really simple and drama free. The organization I served was awesome. The most amazing place I have ever worked. Loved it. What I can share with you is my resignation speech below.

I called you all here this morning to share something important with you in person. Most of you know what happened to me in January on my ascent of Aconcagua. I had every intent of summiting that beautiful and rugged peak, but it was not to be. I had to abandon my climb, although my team would successfully summit 10 days later.

In the same way, I won’t make our summit climb with you. But I know you will be fine without me. You are trained, you are equipped, and you know the path. The climb was never about me. It was about all of us fulfilling our calling here. You will climb to the top without me and continue to save lives.

It was exactly seven years, six months, and one day ago. I drove with my family down from Cleveland through Kentucky and Louisiana. And there it was — the vast flatlands known as east Texas. As we crossed the state line, a Ford 350 pulling a flatbed trailer carrying 20 head of cattle pulled in front of us in our yuppie Lexus.

My daughter was spinning the radio dial looking for travel music, but every station was playing Nascar or college football. Suddenly we were hit by a dust storm. No wait, that wasn’t a dust storm! We were being pelted by cow dung that exploded on the asphalt highway into shit shrapnel penetrating the wax of our freshly washed veneer. Welcome to Texas!

I showed up here not sure what I was getting myself into. Tumbleweeds? F150s? Country music? Cowshit? WTH!

I knew it would not be forever and I am thankful for the precious time I had to serve with you. My last day will be April 20. Seven years, six months and 20 days. Five years and 20 days longer than some of you thought I would last, or at least hoped for.

I am not leaving for another opportunity too good to be true. I am not unhappy here — quite the contrary. I am not looking for more time with my family. I am not trying to fulfill a promise made.

A leader knows when it is time to move on. Give others a chance to fulfill their leadership calling.

I am giving myself some time for reflection.

We have an amazing leadership team and you are part of it. I am so proud of all of you. I brag about you all the time. You are the envy of many.

My only frustration in leaving now is you don’t know how good you are. How good you have become. Those of you who have been to the CHIME CIO Boot Camp know what I am talking about.

What have we done together? What storms have we weathered? What challenges did we overcome? What have we innovated? How much did we grow? How much impact did we have? It is overwhelming to think about.

Trust me, I have focused on this the past 30 days. Sigh. When I think about us, I think about all our “one anothers.” You know, as in, “We served one another,” or, “We upheld the promise with one another.”

• We labored with one another.
• We danced with one another.
• We did obstacle courses with one another.
• We hopped on 3 a.m. severity one calls with one another.
• We drank with one another.
• We stayed up 24+ hours with one another.
• We cheered and experienced joy with one another.
• We engaged with one another.
• We elevated with one another.
• We excelled with one another.
• We passed out with one another.
• We cared for one another.
• We rounded at every hospital with one another.
• We got tattoos with one another.
• We played soccer with one another.
• We played volleyball with one another.
• We played softball with one another.
• We took grief from clinicians with one another.
• We sang carols with one another.
• We debated with one another.
• We challenged one another.
• We loved one another.
• We broke bread with one another.
• We listened to Ralph’s SEAL Team stories with one another.
• We made meals for one another.
• We took care of each other’s families with one another.
• We read books with one another.
• We supported go-lives with one another.
• We did karaoke with one another.
• We did way more than IT for our customers with one another.
• We survived audits with one another.
• We bared emotions with one another.
• We rebounded with one another.
• We were mesmerized by Ferdie’s chants with one another
• We broke silly rules with one another.
• We cried with one another.
• We survived (name removed) with one another.
• We endured Dale Carnegie with one another.
• We discovered and learned with one another.
• We worked from home with one another.
• We climbed mountains with one another.
• We preserved through RIFs with one another.
• We celebrated weddings with one another.
• We had all our expense reports rejected with one another.
• We climbed ropes with one another.
• We played jokes on one another.
• We achieved the highest levels of physician satisfaction with one another.
• We prayed with one another.
• We laughed with one another.
• We enabled the dignity of death with one another.
• We won Davies with one another.
• We visited many bedsides with one another.
• We worked out with one another.
• We held hands with one another.
• We consistently achieved world-class customer satisfaction with one another.
• We attended Leadercast with one another.
• We lovingly tolerated security with one another.
• We bar crawled with one another.
• We improved business outcomes with one another.
• We were with the family of Stacy with one another.
• We were with the family of Dale with one another.
• We were with the family of Fred with one another.
• We were with the family of Renee with one another.
• We were with the family of Carole with one another.
• We spent time in my home with one another.
• We received way too many texts from Jim with one another.
• We yammered with one another.
• We created TEDx with one another.
• We suffered through ITSM classes with one another.
• We improved clinical quality with one another.
• We improve patient safety with one another.
• But most of all, but most of all, we saved lives with one another!

@#%$@ I watched so many of you blossom into amazing leaders that enabled these one anothers!

The future is awesome. The summit is in your sights. You have what it takes. You are leaders, you got this! You will become stronger without me But be assured. I will be watching you. You better not @$#%!@ up!

Jeremiah 29:11 says, “I know what I am doing. I have it all planned out. Plans to take care of you, not abandon you, plans to give you the future you hope for.”

I have tried to live my life embracing the following verses. I fall short, but share it with you nevertheless. It is aspirational. I pray this for you.

I Corinthians 9:24-27: “You have all been to the stadium and seen the athletes race. Everyone runs; one wins. Run to win. All good athletes train hard. They do it for a gold medal that tarnishes and fades. You are after one that is gold eternally.

I don’t know about you, but I am running hard for the finish line. I am giving it every thing that I got. No sloppy living for me. I am staying alert and in top condition. I am not going to get caught napping, telling everyone else all about it, and then missing out myself.

I will miss you. #@!&&^% I will always love you. You have no idea the depth of the pride and love I have for each of you.

We will always be about…one another…and saving lives. That’s our legacy.

I then went one by one to every VP, director, and manager and laid hands on them and spoke to their soul. I knew my people. I asked God to give me the words to encourage each one. I gave each one a specific word.

And when the last person left the room. I wept.

Today I have the privilege to serve the people of the world’s greatest city working in public health. Through an arrangement with The Advisory Board Group/Clinovations, I am part of the NYC Health and Hospitals Corporation IT leadership team. I could not be happier. Perhaps a future post I will get into more details.

And yes, I still have my eye on my Texas colleagues.

Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.

Morning Headlines 5/28/15

Medicaid rule could extend health IT support to behavioral health, long-term care

A newly proposed CMS rule governing Medicaid managed-care plans has implications on health IT. The rule authorizes state Medicaid programs to offer incentive payments for organizations that do not qualify to participate in the Meaningful Use program, like behavioral health providers and long-term care providers, to purchase and implement EHRs. The new rule also authorizes states to mandate participation in health information exchanges as part of their contracts with Medicaid managed care organizations.

Telemedicine exams result in antibiotics as often as regular exams, study finds

A new RAND corporation study published in JAMA Internal Medicine finds that antibiotic prescribing rates are comparable between office-based visits and telehealth visits, but notes that virtually-treated patients were more likely to be prescribed a broad-spectrum antibiotic, which is concerning because use of these drugs drives up costs and contributes to antibiotic resistance.

Antitrust Lawsuits Target Blue Cross and Blue Shield

Two antitrust lawsuits filed independently by health care providers and employers is advancing in federal court in Alabama. The suits charge Blue Cross and Blue Shield with acting as a single, illegal cartel, rather than as 37 independently owned companies to minimize competition. BCBS currently covers one-third of all Americans.

Early Marketplace Enrollees Were Older And Used More Medication Than Later Enrollees; Marketplaces Pooled Risk

Researchers assessed the medication needs of the 7.3 million Americans that signed up for health insurance through the 2014 Affordable Care Act marketplaces and found that marketplace enrollees had a lower average drug spending and were less likely to use most medication classes than an employer-sponsored comparison group.