Morning Headlines 8/26/14

Assessing The Financial Impact Of 4.5 Million Stolen Health Records

Forbes looks back on prior data breaches to calculate the likely true cost that Community Health System will incur as a result of its recent 4.5 million-record data breach, pegging the total cost at between $75 million and $150 million.

No proof deaths caused by delay in care, VA says

After completing its assessment of scheduling improprieties at the Phoenix VA Health System, a VA inspector general’s report concludes that there is no evidence that the unethical delays in care directly contributed to preventable veterans deaths.

EMR Market Share by the Numbers: The Cerner/Siemens Acquisition, Part I

In the first of a two-part piece, KLAS covers the Cerner/Siemens acquisition and what it might mean for Cerner’s market share in the years ahead.

Curbside Consult with Dr. Jayne 8/25/14

I usually start my day with a bagel and the local news, courtesy of a newspaper website. Once I catch up on homefront happenings (the comments are usually more entertaining than the articles they accompany) I hit a couple of national websites.

In the course of my usual surfing, I came across a link to “The End of Absence: Reclaiming What We’ve Lost in a World of Constant Connection.” I was able to find a couple of reviews and it looks like it will probably be one of my next reads.

Author Michael Harris looks at people born before 1985, namely because they “know what life is like both with the Internet and without.” For non-IT professionals and the general consumer base, I’d broaden that to include those that experienced life BC and AC: before computers and after.

I enjoy history, but never thought of myself as having lived through a major transformation. Don’t get me wrong — there have been many sociopolitical changes in the last few decades, but I missed out on the moon landing and other key “tech” touchstones.

I remember thinking some years ago about my great grandfather (who was born in the late 1800s and died in his 90s) and all he had seen in his life: from the Wright Brothers to the Concorde, and from Sputnik to space stations. He also saw the progression from the crank-powered phone to the cell phone and many other advances. At the time I thought of how cool that would be – to see that kind of change – and I also remember thinking that technology had come so far that I couldn’t fathom something that revolutionary.

Back then, broadband Internet was available, but it wasn’t a fixture in peoples’ daily lives like it is now. There was no Facebook, no Twitter, no cell phones in every person’s pocket. The iPod had barely been invented and it was for music only. We didn’t know we were on the cusp of an information revolution.

I was talking about this idea with a friend of mine over lunch yesterday. She has kids in middle and high school and was joking about the classic “back in my day, we rode dinosaurs to school uphill both ways” sayings she finds herself throwing at them. We talked about when we were exposed to our first computers (Commodore 64, anyone? TI-99? Apple II?) and what kids of today would think if they saw them in action compared to the smartphone firepower in everyone’s pockets. It used to be a major undertaking to put a computer lab in a school and now it’s expected.

Still, there are completely different sets of issues that today’s kids are dealing with involving technology and its appropriate use or lack thereof. At my friend’s local school, some teachers demand that students use technology in the classrooms and others ban it. I can only assume that the pre/post Internet generation gap might have something to do with it.

In thinking about my physicians who complain about the EHR, I don’t see a clear line age-wise. At least in our group, some of the older physicians tend to be more forgiving of the software’s shortcomings, perhaps because they expect less than the more tech-savvy physicians who tend to be younger. It would be interesting to do some actual research on their attitudes and opinions regarding technology in general as well as the EHR, but I’m not likely to find the time (or funding) to do something like that anytime soon.

One of the other concepts the book addresses is how people now use technology to quantify their self worth. I know the HIStalk team enjoys seeing how many Facebook friends, LinkedIn connections, and Twitter followers we have, but we don’t let it drive who we are.

I’ve seen multiple discussions on physician forums looking at teenagers who have significant psychological issues that stem from interactions with social media. One might infer that those of us in the “before” column had established our own sense of self independently of that kind of input, where those in the “after” column “lose the ability to decide for ourselves what we think about who we are,” according to the review’s interview with Harris.

I mentioned my own run-in with the “quantified self” after my running GPS was waterlogged. Being able to translate subjective experiences such as daily activities into actionable numbers is a powerful thing. It’s made a tremendous difference in my health and well-being, but I can see how data points might be overwhelming or discouraging to some. I can’t run a half marathon as fast as I could three years ago, but I can chalk that up to a bad knee and an uncooperative training schedule rather than letting it get me down.

Harris ends up taking a month off from the Internet while writing the book. Most of us could never do that for occupational reasons, but I like the idea of the challenge. As a physician, I frequently ask patients to limit “screen time” for their children. For many adults, it might be time to do the same. A quick search of ICD-10 codes fails to reveal much Internet-specific pathology, but we’ll have to see what ICD-11 brings.

Who’s with me for some time off the ‘net? Email me.

Email Dr. Jayne.

Morning Headlines 8/25/14

U.S. CTO stepping down

Todd Park steps down as US CTO after two-and-a-half years in the position and will transfer to a new White House staff position where he will lead a team responsible for recruiting technology leaders from Silicon Valley to work on government projects.

Usability and Impact of a Computerized Clinical Decision Support Intervention

Researchers at the University of Pennsylvania Health System test CDS alerts designed to boost timely urinary catheter removals and found that customized CDS alerts are far more effective, and result in more significant improvements to patient outcomes, than basic CDS alerts provided by EHR vendors.

Oregon: State Sues Over Health Website

Oregon files its anticipated lawsuit against Oracle over the state’s failed health insurance exchange website, which Oracle was contracted to develop and deploy.

Patient Portals. Patient Engagement: The Holy Grail of Meaningful Use

Peer60 publishes a report that trends patient portal engagement rates by hospital size, patient portal vendor, and local population sizes.

Monday Morning Update 8/25/14

Top News

Todd Park will reportedly step down as US CTO but will remain a White House employee, moving back to the Silicon Valley to work on brokering relationships between technology companies and the federal government.

Reader Comments

From HIEway Robbery: “Re: HIEs holding registries hostage per Carl Dvorak’s testimony to ONC. Several CIOs have told me that HIEs have been allowed to use state-based immunization and public health registries to as a leverage point under Meaningful Use, forcing their health systems to join the HIE for up to several hundred thousand dollars.” Hospital IT people, please let me know if you’ve had such pressure applied. I promise to keep your details confidential, but I’d like to know the registry, state, and price quoted for HIE access. ONC needs to know that the generally noble idea of connecting to public health agencies as part of MU2 is being milked as a profit center by revenue-desperate HIEs if that’s the case. I’ve heard that one health system had to pay $700K to an HIE just to access the state’s immunization registry.

From Surveyor: “Re: Modern Healthcare’s top employers and Inc. 5000. These lists are a joke and your running the results is questionable.” I only mentioned in the Sponsor Updates which sponsors won. I don’t think the lists are a joke, but publications give awards to sell magazines and generate ad revenue, no different than those full-page airline magazine ads for “best steakhouses” or “best plastic surgeons.” Which means: don’t take them too seriously either as a reader or a winner. Let’s take a look at those two awards based on what I could find online. Readers with more information are welcome to chime in.

Modern Healthcare’s Best Places to Work

• Participation is free, but companies are offered a detailed employee feedback report that isn’t (the price, however, is modest).
• Information is self reported and not verified by the magazine.
• The survey asks for the voluntary employee turnover percentage, but it’s not clear how that number fits into the rankings even though it’s arguably the best way to assess employee satisfaction.
• A random number of company employees are surveyed directly using an adequate sample size from the entire employee database. The survey company was created specifically to conduct “Best Places to Work” programs across all industries and is a division of a publishing company.
• My grade of the methodology: B+. The employee survey portion seems sound and is of sufficient depth, but online survey of company programs and benefits is self reported and apparently unaudited (but the company HR people who respond aren’t likely to game the system to win). I’d like to see the voluntary turnover number reported in the profile of the winners. I think the winners are probably doing a good job in how they manage their employees, but it’s easy to forget that most companies don’t participate. It’s not quite perfect, but as good as can be expected from a voluntary survey type program designed to simultaneously stroke the egos of winners and the magazine.

Inc. 500/5000 list of fastest-growing private companies

• Information is self reported and not verified by the magazine.
• Companies send in 2013 gross revenue vs. 2010 gross revenue and basic demographic information only.
• Applicants have their short entry form signed by any CPA, financial analyst, or attorney. No proof of the claimed revenue numbers is required.
• Companies could be losing a ton of money and still make the list as long as their gross revenue increased in the previous three years. Privately held companies aren’t going to disclose profits, so the magazine has to go with revenue alone.
• Companies have to pay $150 to submit their information. The magazine pitches the exposure they’ll get as a result. They don’t indicate the number of applications received, but the 5,000 winners alone would generate 5,000 x $150 = $750,000 for very little work on Inc.’s part since they don’t verify the submitted information – they basically plug it into an Excel worksheet, sort by revenue growth percentage, filter by industry and a few other factors, and call it done.
• My grade of the methodology: F. The entire premise of the award – that revenue growth is the single best measure of company success – is suspect enough, but choosing winners from fee-based unaudited company submissions is lazy. Winners aren’t necessarily even the fastest growing companies – only the fastest growing of those that dash off the quick information form and mail in their $150. I wouldn’t dock a company points for trying to generate some easy PR in return for an investment of $150 and the five minutes it takes to complete the application form, but I also wouldn’t necessarily think more highly of the winners, especially noticing that some of the highly-ranked companies have only an employee or two. I like seeing fast-growing companies, but I wouldn’t buy shares of a publicly traded company’s stock based on a one-time snapshot of unaudited revenue growth. 

From The PACS Designer: “Re: iPad vs. Android L. The iPad monopoly may start to start to shrink with the Android L, scheduled for release in late October with a true 64-bit system.” I would argue that the iPad doesn’t have a monopoly even now, representing less than a third of tablets sold in Q1 2014. Samsung is gaining ground quickly and Lenovo is coming on strong in the past year, although tablet sales seem to be hitting the wall anyway since there’s not much incentive for people to trade up.

HIStalk Announcements and Requests

Nearly two-thirds of poll respondents thing Cerner is getting a good deal in buying the Siemens healthcare IT business for $1.3 billion. New poll to your right or here, for health system IT employees: is your organization taking new security steps in reaction to the Community Health Systems breach? I would be interested in hearing more … click the Comments link after voting.

Listening: new from SOJA (Soldiers of Jah Army), an eight-piece DC-based reggae band.  It’s not my favorite genre, but I like this since it sounds more like decent pop music instead of formulaic noodling by ganja-stupefied Rastafarians.

Last Week’s Most Interesting News

• Chinese hackers steal the data of 4.5 million Community Health Systems patients, most likely enabled by outdated network software as vendors responded slowly to address the Heartbleed exploit after it was announced in late spring.
• Oracle’s lawsuit against the state of Oregon says state officials should have hired a systems integrator to oversee the creation of its failed health insurance exchange, comparing Oregon’s project to an inexperienced company deciding to build a skyscraper without hiring an architect. The failed rollout of Healthcare.gov has been similarly attributed to CMS’s attempt to serve as its own project overseer.
• CMS statistics show that few providers (and thus few vendors) are clearing the Meaningful Use Stage 2 hurdle, with the early trend suggesting that practice-based users appear to be moving from smaller vendors to Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
• A New York Times article says CMS’s Medicare fraud prevention efforts are expensive and ineffective due to its poor management of private recovery audit contractors and the bogged down provider appeals process.
• The private equity owners of revenue cycle vendor TriZetto are rumored to be shopping the company at a price of $3 billion.

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.  

September 11 (Thursday) 1:00 p.m.ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding  (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors.  Registrants get a free electronic or paper copy of the book.

Announcements and Implementations

The Albuquerque business paper profiles Seamless Medical Systems, which will release SNAP Express RX on Monday. It’s an iPad-based patient self-history system for pharmacies (vaccines, immunizations, and medications). The company also says its SNAP Practice check-in system will be piloted at Houston Methodist Hospital starting in October.

Government and Politics

The state of Oregon finally files the lawsuit it has been threatening against Oracle, saying it paid Oracle $240 million to build the dysfunctional Cover Oregon health insurance exchange site. The Associated Press named the spectacular failure of Cover Oregon, which will be shut down, as the state’s top news story in 2013:

Once considered a national healthcare leader, Oregon produced the worst rollout in the nation of the new national health insurance program. While the crippled federal website eventually got up and walked, Oregon’s remained comatose, unable to enroll a single person online. The state had to resort to hiring 400 people to process paper applications. Officials lay much of the blame on the primary information technology contractor, Oracle Corp., and withheld some $20 million in payments. But state officials’ own actions played a role, too. In the face of disaster, they insisted on doing things The Oregon Way, clinging to a grandiose vision of creating a grand health IT system that would not only enroll new people in the national health insurance program, but also provide other vital services.

The personal information of 25,000 Homeland Security employees is compromised when hackers penetrate the systems of a federal contractor that performs security clearance. The contractor, USIS, says the cyberattack appears to be the work of an unnamed country’s government.

For-profit hospital operator Steward Health Care System (owned by a private equity firm) and The Boston Globe engage in legal wrangling over the hospital’s use of a patient’s medical records. The newspaper is running an in-depth feature about the man’s experience with the mental health system that Steward expects to be uncomplimentary to its hospitals, so it filed a lawsuit asking to be able to publicize the man’s records to tell its side of the story. The court said no. All of this happened before the article ran in Sunday morning’s paper and it appears that Steward’s heavy-handed actions were premature – the article touches little on the patient’s experiences at the chain’s Quincy Medical Center and Norwood Hospital and focuses more on the challenge of fitting mentally ill people into society so they can’t harm themselves and others.

Innovation and Research

Wired profiles Enlitic, a just-announced startup that will use deep learning algorithms to diagnose medical conditions. Data scientist founder Jeremy Howard says the company’s approach is different from that of IBM, which tries to teach Watson by feeding it textbooks that contain information that doctors already know vs. giving the computer raw data and letting it figure out the patterns that represent new knowledge. I’m not sure doctors need as much help diagnosing patients as computer people tend to think, but at least a small percentage of patient conditions are baffling.

Other

Cedars-Sinai Medical Center (CA) reports exposure of the information of at least 500 patients following the theft of a laptop from an employee’s home. The hospital says the device was not encrypted per hospital policy because of an installation mistake. The description of the employee’s job suggests that he or she has IT responsibilities since it includes “troubleshooting software used for clinical laboratory reporting” and requiring off-hours availability.

A peer60 report on patient portals finds that the most implemented are from Cerner and Epic, while those most often being considered by the 10 percent of providers who don’t have one are Cerner, Medfusion, Meditech, Epic, eClinicalWorks, and Medhost. Generally deficient functionality includes meeting the needs of specialists, EHR integration, appointment scheduling, streamlined enrollment, bill pay, and  managing the information of patients under 18. It concludes that health systems can hit the 10 percent engagement threshold required by Meaningful Use Stage 2.

Jonathan Bush’s 1990s business idea as described in his book finally happens: EMTs are providing primary care services in the home instead of just giving 911 callers expensive rides to the ED for non-emergent issues. It’s a smart idea: the supply of relatively easily trained EMTs and paramedics exceeds the available jobs (often in fire departments) and most people would prefer being evaluated and treated at home, especially if the EMR/paramedic was in touch with a doctor via telemedicine as needed.

A University of Pennsylvania Health System study finds that urinary catheters were removed more promptly (presumably reducing the chance of urinary tract infections) when EHR provider reminders were replaced with an integrated homegrown alert that required fewer clicks to generate the DC order.

Interesting: improved guidelines and more widespread use of less invasive surgical procedures have reduced blood transfusions by a third and blood profits by 70 percent in the last five years. The Red Cross takes in nearly $2 billion of its $3 billion annual budget from selling blood and employs 17,000 of its 26,500 employees in its blood program, requiring layoffs and expense cutting. People don’t realize that their thoughtful blood donations are sold to hospitals for hundreds of dollars per unit, sometimes by for-profit blood centers that don’t exactly broadcast that fact, one more aspect of healthcare that doesn’t seem like it should be a business but very much is one.

An investigation of the corporate support services department of Health and Hospitals Corporation of New York finds that officials contracted with friends and neighbors for no-work temporary jobs and hired unqualified but connected employees. In one case, a supervisor who was also a minister performed a wedding in his office during work hours.

The individual is no longer an employee of Memorial Hermann. We cannot disclose any further information.

— Memorial Hermann (@memorialhermann) August 20, 2014

Memorial Hermann Southeast (TX) fires an employee after someone complains to it about a racist comment she posted on her personal Facebook, on which she doesn’t identify herself as a hospital employee. The hospital announced the employee’s firing on Twitter, ironically. According to a legal analyst, “People have the right of free speech, but employers can fire you for whatever they want in the state of Texas.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 8/22/14

FBI warns healthcare firms they are targeted by hackers

The FBI issues an alert to the healthcare industry that hackers are targeting them following their breach of Community Health Systems.

Oracle Calls State’s Health Exchange Planning Akin To Building ‘A Skyscraper With No Architect’

Oracle blames Oregon officials for not hiring a systems integrator for developing its health insurance exchange.

AliveCor Receives First FDA Clearance to Detect a Serious Heart Condition in an ECG on a Mobile Device

The free app, which requires a $199 sensor, monitors ECG activity to detect atrial fibrillation.

HealthQuest Capital raises $110M for healthcare investments

The investment group plans to invest in medical devices, diagnostics, and healthcare IT.

News 8/22/14

Top News

The China-based hackers who stole the information of 4.5 million patients of Community Health Systems used the Heartbleed exploit for access, the first major cyberattack to do so since Heartbleed received major world attention in April 2014.  Community Health Systems provides employee VPN access using networking equipment from Juniper Networks, which along with other networking vendors was slow to update its products in response to Heartbleed. The hackers were able to log in as employees in the weeks after Heartbleed was announced and before vendors updated their software. There’s a lesson to be learned: watch for unusual behavior from user accounts and certainly for huge data files being sent outbound. Meanwhile, the FBI issues a flash alert to healthcare firms, warning that that they’re being targeted by hackers.

Reader Comments

From Former SMSer: “Re: former Shared Medical Systems employees. A members-only Facebook group was started on August 15 and has 1,200 members. It is special to have so many warm personal connections 14 years after the Siemens acquisition.”

From Eek How? “Re: Ekahau. Let its president go and the VP of marketing walked out. The company has gone from 119 employees to fewer than 45 in the past year. WiFi-based RTLS still disappoints hospitals.” Unverified, but former CEO Mark Norris has updated his LinkedIn profile to indicate his immediate availability.

HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi digs deep into data on the EHR replacement market. Industry representatives weigh in on Walmart’s foray into primary care. Newt Gingrich makes the case for integrating mobile health tools into care for veterans. Greenway Health and Apple are granted patents, though for decidedly different innovations. A physician in Alaska gets creative when attempting to opt out of Meaningful Use. Azalea Health CEO Baha Zeiden dishes on the simplifyMD acquisition and the role of telemedicine in rural communities like his. Thanks for reading.

I talked today with the brilliant and articulate Dim-Sum,  who knows everything about the Department of Defense and its impending choice of EHR vendors for its $11 billion EHR project. He graciously agreed (probably while grimacing at the arm-twisting Lorre and I were applying) to host one or more webinars on the topic. Mark your calendar for September 18 at mid-day for the first one, in which Dim-Sum will describe the DoD’s healthcare reach, current systems, relationships with contractors and other government agencies, and selection process. The webinars will be fun, slightly cynical, and highly educational to those of us who don’t really understand military health, as well as crucial to those with a vested interest in what will be one of the largest and most expensive government IT projects in the world.

Also in September: the virtual launch of Ed Marx’s upcoming book, “Extraordinary Tales of a Rather Ordinary Life.”

I’m always interested in hearing from providers who would like to be interviewed, write guest articles, or otherwise participate in HIStalk. Let me know if you are willing. I get plenty of volunteerism from vendor people, but not much from those working on the provider side. 

Upcoming Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.  

Acquisitions, Funding, Business, and Stock

HealthPrize Technologies, which offers a medication adherence app, raises $3 million in its first institutional financing. Co-founder Tom Kottler’s first startup was MedAptus.  

HealthQuest Capital raises a $110 million fund to invest in medical devices, diagnostics, and healthcare IT.

Aging services technology vendor Healthsense, which offers a remote monitoring system for chronic diseases, adds a $10 million funding round.

Vocera shares touched a 52-week low this week, closing Thursday at $8.48 and valuing the company at $216 million. Above is the one-year price of VCRA shares (blue) and the Dow (blue).

Sales

Saint Agnes Hospital (MD) chooses clinical alerting and secure texting solutions from Spok, also upgrading its hospital call center suite.

Baylor Scott & White Health chooses the Allscripts dbMotion HIE platform.

Baystate Health (MA) selects Premier’s PremierConnect Enterprise to support development of solutions within its Health Informatics & Technology Innovation Center, a co-working space and late-stage accelerator.

The Froedtert & Medical College of Wisconsin network chooses the analytics platform of Explorys.

Atlanta Gastroenterology Associates chooses Greenway PrimeSUITE EHR/PM.

People

Surescripts names Tom Skelton (Foundation Radiology Group) CEO.

Announcements and Implementations

PerfectServe opens an Atlanta office.

Forbes names Cerner to its list of the world’s most innovative large, publicly traded companies. Salesforce.com came in #1, and other familiar companies joining Cerner in the top 30 are Amazon, VMware, Red Hat, Stericycle, and Express Scripts. The ranking is derived from the somewhat questionable metric “Innovation Premium,” representing the degree that share price exceeds current business value.

SAS and 39-hospital Dignity Health (CA) will create a big data platform to reduce readmissions, create best practices for CHF and sepsis, and manage drug costs.

Greenway Health receives a patent for the function of automatically aligning billing codes with payer- and location-specific fee schedules.

AliveCor receives FDA clearance for its atrial fibrillation detection app that monitors ECG in real time and allows the user to email, print, and analyze their single-channel ECG records. The app is free, but the monitoring hardware costs $199.

UltraLinq’s cloud-based image management solutions will be available through athenahealth’s No More Disruption Please program.

Government and Politics

Oracle, in its lawsuit against the state of Oregon for not paying the company for its work on the state’s failed healthcare insurance exchange, says the state should have hired a systems integrator instead of trying to run the project itself. CMS made the mistake in trying to run the Healthcare.gov project without outside help.

CMS Administrator Marilyn Tavenner didn’t just accidentally delete Healthcare.gov-related internal emails as she claimed, although this request pertains to a largely dull conversation about training telephone reps handling manual insurance sign-ups after Healthcare.gov failed. 

The FDA releases an API to allow programmers to access its MAUDE medical device problem database.

Other

Cerner CEO Neal Patterson not only dumps ice water over his head, he issues an Ice Bucket Challenge of his own to John Glaser, CEO of the Siemens health IT business that Cerner is acquiring. Glaser accepted the challenge.

As simultaneously cute and annoying as the virally spread ice bucket challenge videos are, this one is worth watching if you really want to understand the non-entertaining aspects of the disease as one of its sufferers takes the challenge and then explains how ALS affects him.

Jamie Stockton of Wells Fargo Securities provides updated slicing and dicing of CMS hospital attestation data through June 30. The significant Stage 1 vendors are (in order) Meditech, Epic, Cerner, CPSI, McKesson, and Medhost. Of the 10 hospitals that have attested for Stage 2, Cerner has four, Meditech and CPSI have two each, and Medhost and Allscripts have one each. Top vendors of the EHRs used by the 977 physicians who have attested for Stage 2 are, in order, athenahealth, Epic, and Practice Fusion, who have 97 percent of the Stage 2 attestations among them.

Economist Uwe Reinhardt writes a brilliant and remarkably compact criticism of the bizarre payment system of US healthcare. A tiny sample:

For starters, we allow our providers of health care – doctors, hospitals, pharmaceutical companies and other providers—to use classic price discrimination in the markets for their products and services. That tactic helps sellers to extract from buyers with different abilities or willingness to pay as much total revenue as can possibly be extracted from the buyers collectively … Altogether, the highly complicated cash flow resulting from this strange system of financing, flowing through so a myriad of capillaries, makes it almost impossible to hold any providers formally accountable for all of the moneys they receive. Somehow this rickety Rube Goldberg contraption of financing health care has worked in some fashion in this country, for over half a century. Many hospitals have thrived financially under it, while hospitals located in mainly low-income areas have struggled or gone under. And as a series of journalists—most recently Steve Brill in “The Bitter Pill”—have reported, this system also has put brutal financial stress on the budgets of many American households.

Aaron Carroll, MD, MS, a medical school professor and contributor to “The Incidental Economist,” explains why doctors have plenty of data problems without having to deal with patients sending them their fitness tracker information.

The Columbus business paper profiles CoverMyMeds, which is doubling in size every year while remaining profitable as a bootstrapped company.

Honored to meet doctors & Veterans with @RepAnnaEshoo at @VAPaloAlto, now using iPads to help treat Vets & families. pic.twitter.com/lOZwDT8KZu

— Tim Cook (@tim_cook) August 21, 2014

Apple CEO Tim Cook visited the VA hospital in Palo Alto, CA, tweeting a photo from the facility that is using iPads.

Massachusetts eHealth Collaborative President and CEO Micky Tripathi examines the EHR replacement market in an HIStalk Practice post:

• The number of EHRs used to attest has dropped considerably from MU Stage 1 to Stage 2.
• Customers are switching from smaller vendors to the benefit of Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
• Athenahealth and eClinicalWorks are losing customers to Epic.
• Allscripts lost more customers than anyone, most likely because of its retirement of MyWay, which boosted Aprima’s customer base.
• Epic, Greenway, and athenahealth are the EHR vendors most acceptable both to larger practices as well as hospitals given their maturity,support, and product stability.

Burke Mamlin, MD of Regenstrief Institute pens a letter in response to the Indianapolis newspaper’s article on medical scribes, recommending caution since physicians don’t always review scribe EHR entries until after the fact, they don’t see clinical decision support recommendations, and they become dependent on the scribe. The letter describes Regenstrief’s vision:

Rather than using a scribe to reduce the computer’s role in the exam room, we envision the medical scribe’s role to increase the computer’s role. By using the scribe as a “Wizard of Oz” replacement for the keyboard and mouse, the computer can become an intelligent, anticipatory and active participant in the conversation between patient and physician. Physicians can become super-users as they learn from watching the scribe, there is less chance for errors when the physician is actively monitoring input, and benefits of real-time decision support will not be lost.

Weird News Andy finds this article interesting in that not only have an estimated 90 percent of hospitals and clinics lost patient data, the black market pays $50 per stolen medical record vs. just $1 for credit card information.

Sponsor Updates

• Craneware will hold its first Revenue Integrity Summit October 14-16 in Las Vegas.
• HCS participates in LeadingAge Center for Aging Services Technologies (CAST) EHR 2014 Selection Portfolio.
• Ingenious Med employees complete their third annual 100-day team-centric Thrive Challenge.
• Andrew Borland, Wellcentive’s director of architecture and research, is interviewed on Atlanta Business Radio.
• The SSI Group adds contract management to its RCM offerings.
• Aspen Advisors, Clinovations, CoverMyMeds, CTG Health Solutions, Cumberland Consulting Group, Encore Health Resources, Hayes Management Consulting, Health Catalyst, Iatric Systems, Impact Advisors, Imprivata, Intelligent InSites, Nordic, Santa Rosa Consulting, and The Advisory Board Company are named on Modern Healthcare’s 2014 Best Places to Work in Healthcare list.
• Besler Consulting, Clinovations, CompuGroup Technologies, Cornerstone Advisors, CoverMyMeds, CSI, Cumberland Consulting Group, Divurgent, eClinicalWorks, ESD, Etransmedia Technology, Forward Health Group, GetWellNetwork, Health Catalyst, Health Care Software, Healthcare Data Solutions, Impact Advisors, Imprivata, Informatica, Ingenious Med, Patientco, pMD, Santa Rosa Consulting, SRSsoft, Strata Decision Technology, HCI Group, and Wellcentive are named on the Inc. 5000 Fast Growing-Growing Companies 2014 list.

EPtalk by Dr. Jayne

One of my CMIO duties is to periodically review the patient care protocols in our EHR and recommend updates and additions. Evidence-based guidelines have been a part of our organization for almost two decades, but they’re constantly evolving. I like to do a comprehensive review every year, but there are always guidelines that change on the fly.

Occasionally, it seems like every day brings a new recommendation for screening or treatment. Some of the updates are relatively straightforward, but others can be quite controversial.

This year my review process took a twist. Our organization wants to start building financial information into our care protocols, including the cost and accessibility of various services according to the patient’s insurance coverage. Most payers are fairly transparent about what they do or don’t cover. Sometimes, however, the nuances between different plans offered by a given payer tends to make me a little crazy.

In addition, our state legislature has mandated coverage for certain services, but most of the laws were written to apply when patients enroll in a plan after the law goes into effect. For patients who are on older or existing plans, they may not be covered for the services until they change jobs or their employer changes plans or payers. We have some large regional employers who self-insure and somehow they seem to skirt some of the payment requirements as well.

Medicare has always been the steady player as far as knowing what will be covered and how. The payment guidelines are transparent and usually follow along with other federal guidelines. This year we have a bit of a wrinkle since the Medicare Evidence Development and Coverage Advisory Committee has decided not to cover CT screening for lung cancer, which is a “B” grade recommendation by the US Preventive Services Task Force. I read the commentary from their meeting and they cite the American Academy of Family Physicians, which feels the evidence is insufficient to recommend for or against the test.

This is where it gets really fun. In accordance with the Patient Protection and Affordable Care Act, marketplace insurance plans and many private plans are required to cover the screening with no out-of-pocket costs to the member. However, the law does not specifically state that Medicare is required to pay the full cost to Medicare beneficiaries. Instead of being able to do some relatively clean development around the USTSPF “A and B Recommendations” list,  we have to continue with the patchwork approach.

Quite a few guidelines have been revised for 2014 and more are under revision, so this project is definitely the gift that keeps on giving. I’ll be taking my recommendations to our clinical quality committee in the next week or so and then the development team can get to work. I’ll also be giving a report of my findings to our managed care negotiation team so we can try to leverage better coverage for the services we find most clinically appropriate.

Got guidelines? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 8/21/14

US hospital hack ‘exploited Heartbleed flaw’

A cybersecurity firm claims that the theft of information on 4.5 million patients of Community Health Systems was performed using the Heartbleed exploit. The firm says CHS used network equipment from Juniper, which was slow to correct software vulnerabilities.

Cerner lands on Forbes’ most innovative companies list

Forbes names Cerner #22 on its list of large, publicly traded companies that invest in innovation.

SAS to build cloud-based big data analytics platform for Dignity Health

Analytics software vendor SAS will create a big data platform for Dignity Health to support care planning, value-based reimbursement, and outcomes and value performance analysis.

Wearable Intelligence is raising $8.4M for Google Glass for doctors

San Francisco-based Wearable Intelligence has raised $7.9 million of its goal of $8.4 million from investors that include Google Ventures and Andreessen Horowitz. Its Google Glass technology displays information from EHRs,clinical alerts, and real-time information from patient monitors.

HIStalk Interviews Chris Longhurst, MD, MS, CMIO, Stanford Children’s Health

Christopher Longhurst, MD is CMIO of Stanford Children’s Health, founding program director of the clinical informatics fellowship of Stanford University School of Medicine, and clinical associate professor of pediatrics and biomedical informatics at Stanford University School of Medicine of Palo Alto, CA.

Tell me about yourself and your job.

I’m the chief medical information officer at Stanford Children’s Health. I have a faculty appointment in pediatrics and a courtesy appointment in biomedical informatics at the Stanford School of Medicine. I help to lead our clinical information technology and strategy for the health system as well as the academic fellows training program.

The new clinical informatics board certification allows physicians working in an informatics role to be grandfathered in for the first few years. Can you describe how you see that morphing into the requirement that applicants complete a clinical informatics fellowship and explain how your program is structured?

This started in 2011 when the American Board of Medical Specialties approved informatics as a board-eligible subspecialty. It’s a particularly unusual subspecialty because you can board in a subspecialty after training in any of the 24 primary specialties. Until 2017, people can grandfather in through extensive work experience and education, after which time the only way to be board eligible will be to have completed an accredited fellowship training program.

What is the audience that you anticipate will sign up for the fellowship?

When we opened the Stanford clinical informatics fellowship last year, we got dozens of applications. Some of those were from physicians with strong computer science backgrounds who wanted to write code and develop apps. While they have an important place in the ecosystem, that’s not what the fellowship program is looking for.

We’re recruiting physicians who are interested in driving improved healthcare delivery outcomes. We’re looking for people who are going to keep their eye on the ball in terms of where we’re headed and using informatics and IT as a tool to improve the delivery of the care that we provide. 

We’re really excited about our first two fellows, Lance Downing and Veena Goel, who are doing some amazing work and will be future healthcare leaders. In fact, the mission of the program, we decided, was not to train physicians to become informaticists, but to train the next generation of healthcare leaders in the skill of informatics.

Once the grandfather period is over, who will offer fellowships for those people working in an applied informatics CMIO role that isn’t research based but rather feet on the ground technology adoption?

There are 140 or so medical schools in the United States and 6,000 hospitals. If the fellowship programs are only at those academic medical centers with medical schools, we’re not going to train enough people for the next generation of healthcare leaders. I anticipate, though, that we will see training programs coming up at non-academic medical centers.

In fact, I think it’s important that that happens just as with other specialties. We have internal medicine programs at over 800 hospitals. I think we’ll see opportunities for training informaticists at many, many other healthcare settings.

What’s different between this and the master’s degree programs of the past is that these fellowship programs offer experiential training. It’s the opportunity to come in, be part of the office of the CMIO or other applied clinical informatics environments, and contribute in a meaningful way to real projects. I think that this type of experiential training complements the didactics, but is a critical piece for training our next generation.

The Institute of Medicine’s recent review of medical education questioned why it’s only offered in hospital settings. Why wouldn’t a public health setting for informatics training be equally desirable given the need for population health management?

As part of our fellowship program, we offer rotations not just at the two hospitals at Stanford, but also in the clinical research informatics group at Stanford medical school. We also offer elective rotations in the industry. Our fellows have the opportunity to spend a month at a large company like HP Labs, where they do healthcare analytics research, as well as at a small startup company, Doximity. We think that there are physicians who are going to be working in all sorts of settings and having those experiences is important.

We also have our fellows rotating through the Kaiser and Sutter healthcare systems, where they have an opportunity to see a large, integrated delivery network that’s not an academic medical center.

What subjects will be covered in the two-year fellowship?

We break it down as follows. We think that it’s important that our clinical informatics fellows maintain clinical activity. They’re expected to spend 20 percent of their time seeing patients. We’ve partnered with Bill Hersh and the Oregon Health & Science University distance learning program to provide didactic support, so we anticipate they spend another 20 percent of their time with the classwork. That leaves 60 percent of their time, which is a combination of these experiential rotations and unstructured time for scholarship and longitudinal projects.

The OHSU program is rigorous and you are adding additional elements to it. It will take some work to complete the fellowship.

[Laughs] Well, we expect that the fellows will be working hard, but we also think it’s going to be a really gratifying program to complete training.

What training are medical students receiving in practicing with an EHR and then performing data analysis for research or for population health management?

At most health systems, the training for medical students is pretty limited. They may get a little introduction to the electronic health record systems, but it’s generally focused on the front-end data input and review on single patients, not on population health. Dr. Bill Hersh just co-authored a publication suggesting new competencies for undergraduate medical student training in informatics. I think that we’ll see adoption of those concepts widely moving forward.

Everybody wants to get their specific area covered in medical school education, but it’s already a busy program even though informatics is in some ways as important a stethoscope or a scalpel. Do you think the 10×10 program is meeting that need now and will that change over time?

I think the AMIA 10×10 program has played a really important role in raising the bar on informaticists. Ten years ago, any consultant with experience in clinical information systems could declare themselves an expert. But having some formal classroom understanding of what’s happened in the last 50 years in this field and where the grand challenges lie is important for coming together as a field to attack those big problems.

You’ve done work with a “patients like mine” button idea where a doctor can quickly find similar patients to the one they’re seeing. Are you doing that or is it still a concept?

We have an exciting story that was published in the New England Journal of Medicine in 2011. The story was about a 13-year-old girl with a known diagnosis of lupus who was admitted to our hospital with a flair in her lupus. One of my colleagues, Dr. Jenny Frankovich, asked a really important question, which was whether her lab findings made her at higher risk for clotting and whether we should consider prescribing anticoagulants for her.

Of course, we did what any good evidence-based clinicians would do and looked in the literature, but as in many special areas of pediatrics, there was no literature on teenagers with lupus and risk of clotting. We then asked our colleagues, and the first colleague we asked said absolutely you should anticoagulate. The next colleague we asked said absolutely not. We were left holding the bag with one of these clinical decisions that occurs every day across this nation, but has to be made in the absence of data.

My colleague Dr. Frankovich did something at this point which had not been done before. She used her IRB-approved access to a data warehouse to look at a holistic experience with teenagers with lupus at Stanford over the last five years. She found 100 similar patients, and on the day that we admitted this teenager, was able to determine that her lab findings put her at six- to seven-fold increased risk of clotting. Based on that, we made the decision to anticoagulate her. That was the experience that launched my interest in using aggregate electronic health record data for point-of-care decision making.

We just published in Health Affairs last month in the big data issue the concept of a green button. Just as a blue button is both a metaphorical and visual indication of patient’s abilities to download their own data, the idea behind the green button is that in the absence of good peer-reviewed evidence on a clinical decision, that you would be able to use the aggregate data in your electronic health record — or perhaps federated across multiple databases — to generate real-time, personalized comparative effectiveness cohorts, or “patients like mine.”

Imagine if you saw a 55-year-old woman with hypertension, asthma, and of Vietnamese heritage. Recognizing that this lady would not fit well into the American Heart Association guidelines, you could look at the experience of all 50- to 60-year-old Vietnamese women with hypertension and which medications have the most efficacious impact.

This could really change our clinical decision-making and our cost effectiveness and value of care across the United States. But there will have to be some important policy changes as well as technology developments to ensure this happens in a systematic and formalized way.

Kaiser has done interesting things given their huge database and control over all care settings for their patients. The PCORI project generates cohorts across participating health systems. Do you see the use of data going beyond the four walls to make clinical decisions as a trend?

Absolutely. I think a lot of good work on interoperability of databases is occurring. I2B2 is one example. PCORI is another and the PCORnet. Kaiser and Geisinger have been leaders in using their own data sets to make more data-driven decision about what medications they offer on formulary, for example.

But I think ultimately we need to get to a point where rather than go into a group of analysts and researchers to mine data for six to 12 months, we need to enable the clinicians with the right tools to do these queries at the front line of care. That’s really what the green button concept is about.

Do you think that’s a significant argument for virtual affiliations? The six Wisconsin hospitals jut announced plans to work together to share patient information from their Epic systems.

Unquestionably. In fact, we use the Epic electronic health record system at Stanford. One of the things that’s really exciting to us is the amount of data exchange that’s occurring in Northern California. We have such a high rate of data exchange that in the first 10 weeks on the Epic system at the children’s hospital, we connected with over 35 outside institutions for over 30,000 patients.

We know that enables continuum of care for our patients who are receiving primary care elsewhere as well as for the subspecialty care that we offer at Stanford Children’s. But the next step is using that data to provide better analytics for population health. The Wisconsin example that you describe is a great pilot and prototype for what I believe will occur increasingly as we move forward.

I should also mention that one of our clinical informatics fellows, Dr. Downing, is actively working on a project now to look at data exchange in Northern California in a 360-degree view. Most studies to date of healthcare information exchange are focused on what it means to the emergency department that they can get outside data, but in fact, the major use case that we’re seeing is that we offer tertiary care services and a lot of our patients get primary care elsewhere. 

We’re really supporting the continuum of care. Being able to look at data that’s sent and received from the perspective of multiple different health systems in Northern California is one of the benefits that this fellowship offers.

Putting on your CMIO hat, what are some other interesting projects that you’re working on?

I also have the opportunity and privilege to lead our analytics and data warehouse team. I believe, as in the green button concept, that the future of leveraging these electronic health records is going to be how we use it not just for the care of an individual patient, but for the care of populations of patients. 

We’ve got a number of innovation pilots in our analytics team. My colleague Dr. Jon Palma, who’s also the associate program director for the fellowship, is leading some exciting work in text analytics that’s already benefited our hospital in an operational way. We’re also looking at predictive analytics and forecasting. For example, our census report right now looks at historical trends. Shortly we will be adding the ability to forecast census trends for the next week.

Any final thoughts?

Stanford is accepting applications now for 2015-2017 fellows in clinical informatics. We welcome applications from candidates of any any clinical background.

I would close by saying that we’re at an exciting junction of the field. I believe in the future, as we see more and more physicians involved with health information technology, that this board certification will become a mark of somebody who’s achieved a certain set of core competencies and will be increasingly important across the spectrum of physicians working in these settings.

Morning Headlines 8/20/14

Community Health Systems data hack hits 4.5 million

Chinese hackers hit the for-profit operator of 206 hospitals for the identities of 4.5 million patients.

Apax seeks $3 billion sale of healthcare IT firm TriZetto : sources

The private equity firm is rumored to be seeking a buyer for revenue cycle vendor TriZetto in the $3 billion range after taking the company private for $1.4 billion in 2008.

White House won’t reveal documents related to ObamaCare website security

CMS and the White House refuse to turn over documents related to the security capabilities of Healthcare.gov, citing HIPAA concerns.

A Medicare scam that just kept rolling

Medicare paid $8.2 billion for power scooters, many of them for patients who had no medical need for them.

News 8/20/14

Top News

For-profit hospital operator Community Health Systems says it was the victim of a cyberattack in which the demographic information of 4.5 million patients of its 206 hospitals was stolen. The attack, which occurred in May and June, appeared to originate in China. The FBI is investigating. Community Health Systems is in the Fortune 500 with $7.2 billion in annual revenue and a pending $3.6 billion acquisition of Health Management Associates, which would make the company the largest for-profit hospital operator in the US.

Reader Comments

From Changing Wind: “Re: Orion Health. With the upcoming IPO, employee bonuses are being changed from four times a year to once, holding cash at the expense of their employees.” According to a forwarded email from Orion Health CEO Ian McCrae, “As part of the Board and Management review of the company measures and targets, a decision has also been made to move the frequency of the Company Incentive payment to annual, which aligns with the personal component of the Short Term Incentive. This change now aligns us with what is common market practice and also takes into account the recognition that the achievement of the revenue target is heavily reliant on our performance in the second half of this financial year.”

From Anonymous Tipster: “Re: Carl Dvorak’s testimony. To hear Mr. Dvorak complain about their customers bearing the cost of participating in data exchange governance mechanisms while spending many millions of dollars on Epic and then during verbal testimony claim that Epic is the underdog of the EHR industry made me laugh.“

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.  

Acquisitions, Funding, Business, and Stock

Private equity firm Apax Partners LLP is looking for a buyer for payer and revenue cycle vendor TriZetto, according to rumors. Apax took TriZetto private in 2008 for $1.4 billion and hopes to sell it for up to $3 billion. TriZetto made $190 million in profit in the most recent fiscal year.

Inc. profiles the British doctor who founded hospital workflow software vendor Medisas and the expensive, lengthy process involved in getting a visa to set up shop in this country.  

Clinician rounding app vendor Listrunner raises $500,000 in seed funding from independent physician investors. A trial version of the app is free.

Physician services group Mednax will acquire revenue cycle management vendor MedData. I’m hoping new ownership doesn’t interrupt the delicious flow of fresh-baked scones that MedData provided in the exhibit at HIMSS14 since they were a high point of the conference.

Sales

MultiCare Health System (WA) chooses Infor’s human capital management system.

People

Surgical Information Systems promotes Jonathan Lujan to EVP of North American sales for SIS and AmkaiSolutions.

Paul Sinclair (Allscripts) joins Beacon Partners as VP of business development.

Ford Phillips, who has worked in healthcare IT for 38 years, has written a short story collection about growing up in a small town in southern Illinois called “East of the Sun and West of of the Moon.”

Announcements and Implementations

KPMG will use Blue Cross Blue Shield claims information from Blue Health Intelligence, along with the CMS claims database, to enhance its service offerings.  

A Baltimore technology site profiles Maven Medical, an eight-employee startup that offers a medical procedure price transparency app that helps doctors choose cost-effective tests based on average Medicare reimbursement rates.

Self Health Network raises $5.6 million to further development its patient communications and private social network platform that supports patient-clinician communications, personal health records, home monitoring device data collection, and caregiver alerts.

Accelerator Rock Health signs three new corporate sponsors: Abbott, Blue Shield of California, and Deloitte.

Two Michigan senior living facilities implement the Visibility Resident Care call system, powered by Versus Technology’s RTLS.

Government and Politics

The White House denies a Freedom of Information Act request filed by the Associated Press that asked CMS to disclose records related to the security capabilities of Healthcare.gov. CMS refused to turn over the documents, claiming that doing so could violate HIPAA by making it easier for hackers to access consumer information. A legal expert comments, “Here you have an example of an agency resorting to a far-fetched privacy claim in an unprecedented attempt to bridge this legal gap and, in the process, making it even worse by going overboard in withholding such records in their entireties.”

Premier, responding to a call from the Senate Committee on Finance for ideas that would make healthcare data more useful while maintaining privacy, says that ONC should mandate open APIs for data access as recommended in the recent JASON report. Other suggestions: open up access to government-related claims data, allow researchers access to EHR information, and provide incentives for interoperability that includes patient matching.

A Washington Post investigation finds that Medicare has paid $8.2 billion buying power wheelchairs and scooters for patients, many of whom didn’t need them. Companies, many of them set up by immigrants who became overnight millionaires, paid recruiters to get Medicare patients to participate in the scam. One patient found it odd that the medical equipment company that claimed he couldn’t walk had second-floor exam rooms with no elevators. Medicare put out fraud alerts, but kept paying, required by law to pay most claims within 30 days and reviewing only about 3 percent of them before paying. Medicare is a bit wiser, so criminals are moving on to selling drugstore shoe inserts as $500 orthotics and prosthetic arms and legs for patients in Puerto Rico who have no record of amputations.

Other

A Brookings blog post says HIEs are “Facebook for doctors,” with three factors that encourage doctors to use them: (a) receiving referrals; (b) being located where other communications channels are limited, such as in rural areas; and (c) peer influence.

In Australia, South Australian Health argues with Allscripts over lack of functionality in its Sunrise billing module, falling short so far over exchanging lawsuits.  

Sponsor Updates

• Billian’s HealthDATA discusses five hospital hiring trends in the C-suite.
• Kareo CMIO Tom Giannulli will speak at the UBM Medica’s Practice Rx conference September 19-20 about the role technology plays in improving patient care.
• Medhost announces that Cottage Hospital (NH) has attested for Meaningful Use Stage 2.
• CoverMyMeds doubles its employee count and is expanding into a larger office space.
• Quantros will showcase its Pharmacy Safety Suite of Solutions at the NACDS Total Store Expo 2014.
• Navicure launches Navicure Payments that enables clients to estimate and secure patient financial responsibility and collect balances before service and after adjudication.
• South County Radiologists (MO) selects McKesson Business Performance Services for its 14-physician practice.
• The Advisory Board Company explains how it became a “Best Place to Work.”
• DocuSign publishes a blog entry, “Fuel the Digital Revolution in Life Sciences with SAFE-BioPharma.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 8/19/14

Community Health says data stolen in cyber attack from China

The for-profit chain of 206 hospitals says the information of 4.5 million patients was stolen, possibly by hackers with links to the Chinese government.

Microsoft cloud service Azure restored after partial outage

The hosting platform for cloud-based applications went down in multiple centers Monday evening, but the issue has since been resolved.

When Patients Read What Their Doctors Write

NPR covers the OpenNotes project with an opinion piece from an ED doctor and author.

Curbside Consult with Dr. Jayne 8/18/14

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 8/18/14

Health IT Policy Governance Subgroup

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

M*Modal Announces New Board

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

Pervasive Medicare Fraud Proves Hard to Stop

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

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

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

Monday Morning Update 8/18/14

Top News

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

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

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

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

Last Week’s Most Interesting News

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

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

Acquisitions, Funding, Business, and Stock

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

People

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

Government and Politics

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

Other

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 8/15/14

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

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

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

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

The Meaningful Use Stage 2 Finish Line

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

HHS on the hunt for HealthCare.gov emails Issa wants

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

News 8/15/14

Top News

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

Reader Comments

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

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

BOSS Award Winner – Riton Khan

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

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

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

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

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

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

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

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

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

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

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

People

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

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

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

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

Announcements and Implementations

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

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

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

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

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

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

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

Government and Politics

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

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

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

Innovation and Research

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

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

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

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

Technology

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

Other

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

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

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

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

Contacts

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

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Readers Write: Lessons on How to Survive in Healthcare

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

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

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

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

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

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