Curbside Consult with Dr. Jayne 9/22/14

A couple of weeks ago, we performed a major upgrade on our ambulatory system. Officially we’re now ready for both Meaningful Use Stage 2 and ICD-10, with all the bells and whistles installed. As upgrades go, this wasn’t my first rodeo. It went smoothly with only one minor IT concern and no significant incidents for the end users.

Since no good deed should go unpunished, management is now looking to cut our personnel resources for the next one. They can’t seem to understand why several hundred hours of work went into the upgrade because clearly it was “no big deal.” Mind you, these are not old-school IT managers, but members of our ambulatory operations team who want to avoid having super users out of the office.

We rely on the participation of super users, not only from the ambulatory practices, but also from our central business office, central scheduling department, and central referrals department. No one knows end user workflows like the super users who work with them day in and day out. We have detailed test scripts for our internal testing, but we need real-world expertise to tease out the smallest bugs. Like any organization, our users have some creative workflows that we don’t train, and if we don’t have their participation, we won’t find those issues until go-live.

We’ve been using the same upgrade methodology for half a decade, which is usually goes off without a hitch. It’s a belt-and-suspenders approach, with some duct tape and baling wire thrown in for good measure. We do a dry-run upgrade just prior to the super user testing so that we can get our timing down pat for the main event. The upgrade weekend playbook has some elements timed to the minute and there is a single upgrade commander responsible for ensuring every step is completed and communicated.

Because of the need to involve a couple of third-party vendors to handle some data migrations that we wanted to perform while we had the system down, timing for this one was even more critical. There were numerous handoffs among DBAs, access management, application analysts, build analysts, internal testers, and end-user smoke testers in addition to the third parties. Although we don’t make everyone sit on a bridge line and talk through their work and the hand-offs, we do require people to notify the team when they complete a step or if they’re running behind so that we can adjust if necessary.

The lead analyst that usually quarterbacks our upgrades had an unexpected medical issue a handful of hours before we were due to take the system down, so I ended up co-managing it with one of our analysts. This meant being on call overnight for issues, which doesn’t bother me. Once you’ve been on trauma call or managed an ICU full of patients overnight, being on upgrade call doesn’t seem very scary. Still, you never want to hear that phone ring in the middle of the night. Shortly after midnight, I decided to grab some sleep since we weren’t expecting a handoff until early morning.

When the phone rang at 3 a.m., my heart was pounding. The tone in the tech’s voice wasn’t reassuring as she apologized for calling. Apparently the upgrade was running nearly three hours ahead and she wasn’t sure if she should wake someone up to tell them or not. I have to say, seeing an upgrade run ahead, especially by that much, isn’t something you see every day. I shuffled out of bed and we walked through the checklists to make sure nothing had been missed. I cruised the error logs as well. Nothing was amiss, so we had to chalk it up to the production server being faster than our test platform.

We must have our share of either insomniacs or nervous Nellies on our team because a couple of people were showing available on our instant messenger service. They were happy to launch the next few steps early. Despite the call being a non-issue, once your adrenaline is flowing, it’s hard to get back to sleep. I curled up on the sofa with some journal articles, which thankfully did the job. By our 8 a.m. status call, I was rested up and eager for the build and testing teams to get to work.

Even though everyone has remote capabilities, we require the regression testers and analysts to be on site. We’ve learned the hard way that people are sometimes less attentive when working remote on the weekends. Sometimes it’s just better to have two sets of eyes looking at the same screen together (without a WebEx lag or dogs barking in the background) for troubleshooting. It’s a sacrifice for the team to come in, but we try to make it as fun as possible. The kind of team-building you get from an event like this is often priceless. It’s also important for the end user and analyst teams to work closely together and build mutual respect.

In response to the questions about why we spend so many hours preparing and delivering an upgrade, I’m going back through the last couple of months and highlighting some key milestones that may have been riskier with a leaner team. We have multiple people trained to do each task, which was clearly helpful when our quarterback unexpectedly sat out the game. I’m also working to quantify the intangible benefits of having disparate teams work together.

We ended up being able to re-launch the system two and a half hours early, which meant less downtime procedural re-work for the patient care sites that are open on weekends. Due to the diligent prep, we also had fewer phone calls Monday morning than we’ve ever had. That’s got to be worth something as well. The question is whether the Administralians will agree with our analysis. If they don’t, maybe we can let them run the next one and see what happens. We’ve already documented our lessons learned and updated the project plan, so it’s ready to ride.

Ever jumped in when someone said “Cowboy up?” Email me.

Email Dr. Jayne.

Morning Headlines 9/22/14

Behind the Curtain of the HealthCare.gov Rollout

A report from the US House Committee on Oversight and Government Reform portrays dissent between CMS and HHS before and after the failed rollout, with internal emails providing evidence.

Can a Computer Replace Your Doctor?

New York Times reporter (and physician) Elisabeth Rosenthal says everybody likes the potential of technology, but results haven’t been impressive and other fundamental questions should be answered first.

Building Mature Medical Software, McKesson Cardiology Achieves CMMI Level 5

The Israel-based development organization earns the highest possible rating in the Capability Maturity Model Integration framework.

CMIO Rant … with Dr. Andy

Andy Spooner, MD, CMIO of Cincinnati Children’s Hospital Medical Center, offers eight recommendations for the AMA to consider instead of complaining about EHRs.

Monday Morning Update 9/22/14

Top News

”Behind the Curtain of the Healthcare.gov Rollout,” a report from the US House Committee on Oversight and Government Reform (the committee is wildly anti-Democrat, but still interesting) contains fascinating details of the internal panic once CMS realized they were in way over their heads right after Healthcare.gov went live and failed. It concludes that infighting between CMS and HHS forced the development team to work through US CTO Todd Park, with CMS attempting to hide security exposure, keep HHS in the dark, and insist on a full site launch instead of a phased approach. Some fun snips from internal emails the committee dug up as HHS and CMS people duked it out electronically, sometimes using their private rather than government-issued email accounts:

• [Unidentified HHS employee]” “Your leadership only wanted to hear beautiful music … clearly these people are not smart enough to pull it off … you could definitely see the CYA moves coming a mile away.”
• [Unidentified HHS executive, referring to CMS Deputy Director of IT Henry Chao]: “I grow wear of the bull#### passive/aggressiveness of Henry … the other way to do this is through a complete covert ops mission to unseat the CMS FFE rules engine.”
• [HHS CTO Bryan Sivak, pictured above]: “It’s all negative. I’m going to embark on a campaign to declare victory without fully launching.”
• [HHS CTO Bryan Sivak, responding to an email in which CMS admitted that the site could not handle more than 500 concurrent users]: “Anyone who has any software experience at all would read that and immediately ask what the f## you were thinking by launching.”
• [HHS CTO Bryan Sivak, responding to US CTO Todd Park’s claim that the site’s problems were all related to user volume even though officials knew that wasn’t the case]: “This is a f###ing disaster. It’s 1am and they don’t even know what the problem is, for sure. Basic testing should have been done hours ago that hasn’t been done.”
• [HHS CTO Bryan Sivak]: “1. Bad architecture. 2. Not enough testing. Pretty simply really.”
• [HHS CTO Bryan Sivak, replying to the former HHS employee who transferred to CMS and suggested she might not be much help]: “If you don’t get access, I’m probably going to start being a little bit of a d###, which will give you ample opportunity to badmouth me and gain the trust of people at CMS.”
• [CMS employee, in urging that Healthcare.gov code be removed from open source repositories]: “This Github project has turned into a place for programmers to bash our system, submit service requests (!), and now people have started copying Marketplace source code that they can see and making edits to that.”

Reader Comments

From LL Fauntleroy: “Re: Cerner shops. The number of major ones that have pulled the plug to go with Epic (the industry term is ‘Cernover’) is the best-kept secret in health IT since neither the company nor clients announce it. Some I know from the last couple of years. Loma Linda, Dallas Children’s, Stanford Children’s, University of Utah, John Muir Health System, Connecticut, etc. There are also hospitals pulling the Cerner plug in Australia (Royal Children’s) and elsewhere around the world. There are also a number of shops that run Cerner inpatient but Epic outpatient, or Epic rev cycle, and are rumored to be considering switching, such as Northwestern. Why doesn’t HIStalk write about this?” I’ve written about those of which I’m aware, which is most of these, but I have to depend on readers to tip me off since I’m not omniscient. HIMSS Analytics could verify this trend (if it is one) or identify other Cernovers (or “Epicstinguishes” since surely a few health systems went the other direction), but they aren’t about to tell me for free.

From SoCalSurfLegend: “Re: Prime Healthcare. Three of their southern California hospitals are implementing Epic. Prime is adamant that they will not use consultants. How long before they realize it can’t be done? I’ll set the over/under at three months considering that Prime’s ownership group is the cheapest bunch around.” Unverified. Prime Healthcare’s majority owner is Prem Reddy, MD, an India-born cardiologist who has made a fortune buying and operating financially aggressive hospitals and is known as a generous philanthropist. His wife, daughter, and son-in-law are doctors.

From BJ Hunnicutt: “Re: BJC. My sources say Cerner won the demo round. Allscripts lacked functionality and the reps interrupted their own demo team to inject irrelevant information, while Epic seemed stale and self-important. BJC uses Allscripts inpatient at two academic campuses, Allscripts ambulatory for the medical school faculty clinics, the FollowMyHealth portal, NextGen for employed physicians, McKesson Horizon at the community hospitals, both Cerner and Horizon lab, and Soarian financials. They also have a homegrown clinical data repository and a massive interface support staff to keep it running. The McKesson Horizon situation is probably a key driver. I make Cerner the favorite because of their strong demo and existing relatively new Soarian backbone, plus the two other major health systems in town (SSM and Mercy) have Epic and BJC won’t want to look like they’re jumping on the bandwagon late.” Unverified. BJC’s site says the IT department has a $200 million annual combined budget and 800 employees who specialize in “clinical-based software solutions, integration of disparate systems, and expert systems intended to support caregivers in clinical practice.” Headcount assigned to that middle one seems entirely justified given the apparently lack of appetite for standardizing systems.

From The PACS Designer: “Re: Windows 9. Microsoft announces September 30 as Win 9 day, with a new Start menu, a virtual desktop feature, and a notification center.” Better get out early to camp out a spot in line. Oh, wait, that’s Apple. It’s pretty bad when the most exciting new feature of a highly touted new release is to restore functionality idiotically removed in the previous one.

HIStalk Announcements and Requests

It’s a 55-45 respondent split on whether Apple will have any influence on health and healthcare. Steven Davidson, MD added this comment to his vote: “Apple is the baby boomer tool of choice. Consumers, aka activated, engaged patients are growing in number and power and will adopt tools that enable/enhance their power. Apple wants to be that tool vendor and is the first major (well maybe Nike, but they’re giving up) consumer brand to offer a mostly complete as it is tool set. I think their presence is important and I think the hospitals still don’t get it–with a small number of notable exceptions.” New poll to your right or here: should the MU 2015 reporting period be reduced to 90 days?

Welcome to new HIStalk Gold Sponsor Phynd. The Kearney, NE-based company offers a cloud-based platform that synchronizes provider data from all of a hospital’s IT systems into a single profile, allowing hospitals to accurately answer the question, “Who are your doctors?” that includes billing address, communications preferences, licensing, internal system IDs, exclusionary lists, and contracting. It uses a patent-pending Universal Provider Profile (UPP) for all 3 million US providers, making it easy for frontline users to add a new provider on the fly, also supporting custom fields and taxonomies on any topic and from any IT system. Data quality can be easily determined by each provider’s UPP Score. Folks at Yale-New Haven Health recently did a presentation on how Phynd solved their problems involving 7,000 Epic users and 40,000 referring physicians: outdated credentialing information, endless calls to get updates, manual lookups, and lack of auditability of updates. Thanks to Phynd for supporting HIStalk.

Mr. Fraustro, the California teacher whose classroom got a 3-D printer courtesy of HIStalk readers, provided some photos of it in use. He says the students were excited when they fired it up for the first time and saw the flashing lights, heard the sounds, and smelled the printing filament and realized it exists beyond YouTube videos.

Andy Spooner, MD of Cincinnati Children’s Medical Center wrote another great “CMIO Rant” posts on HIStalk Practice, this one rebutting the AMA’s list of EHR problems with things they could be doing instead of complaining about technology.

Listening: new from Train, complete with their trademark clever lyrics despite a dangerous turn into “background music for work” territory. Extra points for the jangly “I’m Drinkin’ Tonight.” Decent for a band that’s been plugging away for 20 years and is down to just two original members.

Last Week’s Most Interesting News

• Congresswoman Renee Elmers (R-NC) introduces a bill that would allow providers to choose any three-month reporting period in 2014 for Meaningful Use reporting instead of the full-year mandate otherwise scheduled to begin October 1.
• Apple pulls HealthKit-dependent apps from the App Store after finding unannounced bugs in HealthKit that will take at least two weeks to fix.
• The American Medical Association and then its president take shots at poor EHR design and usability.
• Former Kaiser Permanente CIO Phil Fasano joins insurance company AIG in the newly created position of EVP/CIO, with KP VP named as interim CIO as the national search for Fasano’s replacement begins.
• Outsourcer Cognizant announces plans to acquire TriZetto for $2.7 billion.
• An app developer trade group asks HHS via Congressman Tom Marino (R-PA) to make it easier for them to understand and comply with HIPAA requirements, some of which predate the iPhone.
• Epic holds its UGM with over 18,000 attendees on hand in Verona, WI.
• Illinois-based systems Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system, with a stated expected benefit being the sharing of electronic medical records between their respective Cerner and Epic systems.

Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Acquisitions, Funding, Business, and Stock

Providence Health & Services launches Providence Ventures, a $150 million venture capital fund that will invest in companies focusing on online primary care access, care coordination and patient engagement, chronic disease management, clinician experience, analytics, and consumer health. It will be led by a former Amazon publishing executive. Providence will also create an internal innovation group to help it collaborate with early-stage companies, run by newly hired VP Mark Long (above), who was formerly CTO of Zynx Health.

Identity and access management technology vendor Ping Identity receives $35 million in venture funding, bringing its total to $110 million.  

Announcements and Implementations

The Tel Aviv, Israel-based McKesson Cardiology development group earns CMMI Maturity Level 5, the only FDA-regulated medical device software organization to achieve the highest software process improvement rating. I assume that’s the former Medcon that McKesson acquired for $105 million in 2005.

Other

Cerner and athenahealth say they, like Epic, are working on integrating their systems with Apple’s HealthKit. People seem excited about that for some reason.

A New York Times article calls out “drive-by doctoring,” where surgical patients receive bills from clinicians called in without the patient’s approval, often billing them at out-of-network rates. A disk repair patient was billed $117,000 by an out-of-network “assistant” neurosurgeon he had never met. Another patient complained that plastic surgeons billed him $250,000 to close an incision and a “parade of doctors” dropped by regularly post-op without mentioning that they were billing him every time they said hello. The article points out that the US has more neurosurgeons per capita than other countries and Medicare is paying them less, so they attend seminars on “innovative” coding and convince other surgeons to fraudulently declare emergencies that require their services. This is bizarre to me: the hospital sent a surgical patient’s blood tests and ECG to an out-of-network lab.

New York Times reporter Elisabeth Rosenthal, who is a Harvard-educated physician (and who also wrote the article above about drive-by doctoring), rightly calls out the silliness (and profit-seeking motivation) of entrepreneur Vivek Wadhwa proclaiming that, “I would trust an A.I. [artificial intelligence]” over a doctor any day” since AI provides “perfect knowledge.” Leave it to technologists to utter some of the stupidest imaginable statements about healthcare, exhibiting their lack of knowledge about medicine and putting unwarranted faith in the inaccurate perception that given endless amounts of unaudited data and enough computer horsepower to churn through it, better outcomes will automatically be obtained (let’s match Watson against a skilled physician instead of a “Jeopardy” contestant in treating an elderly patient with multiple chronic conditions and see who wins). Rosenthal makes great points: (a) slick technologies, including fitness trackers, haven’t affected outcomes or costs; (b) “health” can’t be easily defined with the knowledge we have today; (c) it’s easier to collect data than to know what it means, such as whether low testosterone levels in men are relevant; (d) people die even when their data points are perfect; and (e) it’s easy to find measurable abnormalities in patients who are fine, leaving the choice of treating the measurement or the patient. She concludes that some but certainly not all medical outcomes can be affected by collecting more information:

One central rule of doctoring is that you only gather data that will affect your treatment. There are now devices that track the activity of your sympathetic nervous system as a measure of stress. But what do you do with that information? Other devices continuously monitor breathing for wheezing that isn’t noticed or audible. Does that matter? Some studies have shown that continuous monitoring isn’t useful for children hospitalized with bronchial infections.

If you were dieting, would stepping on the scale 1,000 times a day help you lose weight? Or consider the treatment of an abnormal heart rhythm. It’s true that constant monitoring for a few days can be highly useful to identify the pattern and what provokes the attacks. After that, though, for many patients a wearable cardiac tracker might simply record normal beats that normal people experience all the time, increasing anxiety for many patients.

The Minneapolis paper profiles Peter Kane, founder of two failed healthcare IT businesses (ProcessEHR and Phase-1Check), who since started  a co-working space.

Weird News Andy has thoughts about this story, in which a since-fired 33-year-old female nurse is accused in a lawsuit of initiating “unsolicited sexual relations” with a 60-year-old male ICU patient waiting for a heart transplant, which the man claimed had happened with other patients. WNA’s analysis: “Was she so inept that his heart rate didn’t go up, or did alarm fatigue prevent someone from investigating?”

Sponsor Updates

• Validic will announce new clients, integration partners, and connectable fitness devices at the Health 2.0 Fall Conference this week. The company will sponsor a Codeathon and participate in panel discussions.
• Wellcentive will demo its population health management solution at the Health 2.0 Fall Conference.

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 9/19/14

Bug in Apple’s HealthKit hits iOS 8 launch

Apple discovers a bug in its HealthKit service that prompted it to pull all HealthKit-connected apps from the app store prior to the launch of iOS 8. 

Geneinsight Strategic Partnership

Sunquest and Partners (MA) create a strategic alliance to create a genomics software system that will support advanced personalized medicine initiatives.

Resurrecting Healthcare.gov Meant Dealing With Bureaucracy, Incompetence, Politics

Mickey Dickerson, the ex-Google engineer responsible for rescuing Healthcare.gov, discusses federal IT work and calls on his peers to engage with government IT projects.

Medical Records For Sale in Underground Stolen From Texas Life Insurance Firm

Medical records stolen from a Texas life insurance company have turned up for sale on a black market website, some going for as little as $6 per record.

News 9/19/14

Top News

Apple removes HealthKit-powered apps from the App Store on iOS 8’s launch day Wednesday, stating that an unspecified HealthKit bug will keep those apps offline for at least two weeks. Some app developers are reportedly scrambling to remove HealthKit dependencies from their products to avoid loss of momentum.

I upgraded my iPhone 5 to iOS 8 Thursday hoping to fix an ongoing “no SIM installed” error. While the Health app is present, it only supports basic data entry (body measurements, sleep, vital signs) until connected to source apps, so nobody’s going to get excited about that. It does offer a new Medical ID option so that users can enter emergency information (allergies, meds, contacts) that can be displayed on the iPhone’s emergency dialer screen when needed. Reader Is-It-The-Future-Yet says that feature could have “more impact than anything HealthKit or the silly watch is going to do to actually impact care,” although my observation is that you would still need a medical alert bracelet since first responders aren’t going to check your phone on the off chance you’ve entered something important there.

Reader Comments

From St. Louis Cardinal: “Re: BJC. Looks like they’ve gone out to the market for EMR replacement. Order of demonstrations: Allscripts, Cerner, Epic.” Demos were completed four weeks ago. I don’t remember what they’re using, although I know they chose several Siemens Soarian apps a few years back and I think they have some Allscripts products as well.

From MD Backle: “Re: Amazing Charts. Thought you might enjoy this email ad, in which they misspell EHR three times (twice as ERH, once as HER) plus misspell ‘it’s’ as ‘its.’ They need some proofreading!” Hopefully their programmers are better keyboarders than their salespeople.

From A Reader: “Re: KLAS report on Epic consulting, released as hordes of consultants are at Epic UGM. It would be great to hear your input on the report.” I don’t have access to KLAS reports, so I generally don’t bother mentioning them since there’s not much I can say having read only the teaser press release that intentionally discloses little of the expensive report’s contents.

HIStalk Announcements and Requests

We’re already planning for HIStalkapalooza at HIMSS15 in Chicago. We’ve booked an amazing (huge) venue, hired a band, and started planning the details that will ensure that this will be the best and biggest HIStalkapalooza ever. Contact Lorre if your company wants to participate as one of five sponsors who will get great benefits like event recognition, a private hosting area, a welcome/display space on the main floor, and a bunch of invitations to share with prospects, customers, or employees. We needed to exert more control and decided to forego the “single sponsor” approach, although we might still consider it if a company agrees to our terms in making it a great experience for attendees. I like this approach (which companies have suggested for years) because the event’s sponsors can make a big impression in front of a huge audience without having to bear the full effort and expense.

This week on HIStalk Practice: One family physician sticks up for EHRs. Dr. Gregg provides perspective on Meaningful Use. Alisha Smith shares last minute prep tips for the HIPAA Omnibus deadline. Research shows Apple won’t reach critical mass for world healthcare domination any time soon. Elation EMR CEO Kyna Fong discusses the importance of physician shadowing. New Jersey Physicians ACO goes with eClinicalWorks. Brad Boyd offers strategies for onboarding financial systems. Thanks for reading.

This week on HIStalk Connect: Keas raises a $7.4 million Series C to help expand its employee wellness platform. 6Sensor Labs announces a $4 million seed round for a portable food analyzer that can detect gluten and potentially other allergens. Researchers at the European Respiratory Society’s International Congress present study findings suggesting that lung cancer patients have measurably warmer breath, a characteristic that may lead to innovative new screening tools. 

Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Our secretive government health IT expert Dim-Sum delivered an amazing webinar Thursday on the Department of Defense’s $11 billion EHR project. We had large attendance and lots of questions in covering the EHR vendors and prime contractors that are bidding, the military health system’s structure, the opportunities for companies to do business as subcontractors, and the strengths and weaknesses of the competing teams (CSC-HP-Allscripts, IBM-CACI-Epic, Leidos-Accenture-Cerner, and PWC-GDIT-DSS.) It’s more like a conversation since we didn’t use slides, but it held my attention throughout and I highly recommend it to anyone with even a casual interest in how several billion of our taxpayer dollars will be spent or how our military members will be cared for. Thanks to the brilliant Dim-Sum for delivering a frank, funny, and highly useful presentation. 

Acquisitions, Funding, Business, and Stock

Medseek changes its name to Influence Health to reflect its mission to influence consumer choice, brand loyalty, and health behaviors before, during, and after healthcare encounters.

Larry Ellison will step down as CEO of Oracle. The 70-year-old company founder will be replaced by co-CEOs promoted from within, Mark Hurd and Safra Catz.

China-based Internet and e-commerce vendor Alibaba conducts the highest-yielding IPO in the history of American stock exchanges, raising $22 billion and valuing the company at $168 billion. The company made tentative moves into healthcare IT in the past few months with an investment into a Hong Kong-based pharma software vendor.

Perceptive Software, fresh off a move to a new headquarters building, announces layoffs and the closing of  its offices in Beverly, MA and San Francisco.

Cerner gets Federal Trade Commission approval to acquire Siemens Health Services with early termination of the waiting period, keeping the acquisition on track for Q1 2015.

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People

Kaiser Permanente names SVP of Enterprise Shared Services Dick Daniels as interim CIO, replacing Phil Fasano.

Baptist Health System (AL) promotes CMIO Chris Davis, MD to CIO/CMIO. He has served as interim CIO since June.

Announcements and Implementations

Sunquest and Partners HealthCare establish a strategic alliance to develop a next-generation genomic information system. Sunquest will make an investment in GeneInsight, a Partners-owned company that offers software for genetic testing reporting, results delivery, and collaboration.

The Denver Office of Economic Development names Aventura as a Denver Gazelle high-growth company.

Holyoke Medical Center (MA) goes live on T-System’s EV physicians documentation system.

Dallam-Hartley Counties Hospital District (TX) implements Holon’s CollaborNet HIE.

Identity and access management solutions vendor Tools4ever will use technology from Boston Software Systems to automate its solutions.

High Point Regional Health (NC) begins its implementation of Epic, which will replace Allscripts outpatient and McKesson inpatient now that the health system has merged into UNC Health Care. According to High Point’s COO, “This is one of the main reasons we sought out and merged with UNC, that is, to be able to take advantage of centralized resources, and high on that list was Epic. For us, it’s a great opportunity because it is becoming the default, go-to system in the state.”

Government and Politics

Congresswoman Renee Ellmers (R-NC) introduces the Flex-IT Act that would allow providers to choose any three-month quarter for 2015 Meaningful Use reporting, explaining,

Healthcare providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.

The Meaningful Use Program has many important provisions that seek to usher our health care providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.

The Flex-IT Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.

Mikey Dickerson, the former Google engineer brought on as administrator of the White House’s US Digital Service, says Healthcare.gov was a mess when he was called in to fix it as part of the “tech surge.” There was no system status dashboard, so “there was no place to find out whether the site was up or down except for watching CNN,” none of the project’s 55 contractors were tasked with maintaining uptime, and nobody seemed surprised or anxious that the site was down since government projects fail regularly. He explains his job change: “We have thousands of engineers working on picture-sharing apps when we already have dozens of picture-sharing apps. These are all big problems that need the attention of people like you. These problems are important, and fixable, but you have to choose to take them on. This is real life. This is your country.” I noticed that his LinkedIn profile lists his previous government-related service as “No Fancy Title, Thanks.”

Technology

The Portland, OR business paper profiles startup ReelIDX, which offers platform for creating, managing, and sharing medical video content. It emphasizes recording the patient encounter for patient education and clinician review.

Does that graph help? "@CraigJoseph: Epic makes case that they should be recognized for interoperability. #EpicUGM pic.twitter.com/USYNDqhc9c"

— Farzad Mostashari (@Farzad_MD) September 16, 2014

This tweet from Epic’s UGM seemed to polarize the Twitterverse – do the disproportionate Epic-to-Epic numbers support or dispute Epic’s interoperability claims?

AMIA joins the Commission on Accreditation for Health Informatics and Information Management Education to develop accredit master’s programs in health informatics.

Faculty of the School of Biomedical Informatics at Texas Medical Center don hats to celebrate National Health IT Week.

A clickbait Venture Beat article titled “EHR giant Epic explains how it will bring Apple HealthKit data to doctors” takes 16 paragraphs to state the obvious: user information from iOS’s HealthKit can be grabbed by Epic’s MyChart (with the patient’s permission) and then populate Epic. It misses the real challenge as to what happens on the Epic side, not only in the form of alerts or actions, but what clinicians are supposed to do as a result. The challenges aren’t technical:

• The data that an iPhone can collect is basic and not all that useful diagnostically except perhaps trended over time (such as a gradually increasing weight).
• Most app developers won’t get FDA approval to add logic that would find the one piece of potentially useful information out of thousands of data points, so that means tons of useless and unreviewed junk will get dumped into Epic.
• Providers aren’t paid to watch consumer-captured information. Even now patients could email their doctor with logs of weights, blood pressure, and blood glucose, but doctors aren’t paid to read them. It’s also not clear who should be watching the information – PCP, specialist, nurse, or someone else?
• Healthcare is designed around encounters, not monitoring. App developers don’t understand that medicine isn’t as digitally right or wrong as their world – most of us as patients want to be treated as individuals, not worksheets of measures limited by the convenient availability of sensors.
• Hospitals and practices may decline to allow patients to send them information since that accepts responsibility for doing something with it. Nobody wants to get sued for malpractice for missing one abnormal measure.

Steven Stack, MD, president-elect of the AMA, says EHRs are immature, expensive, and poorly designed. He adds that poor EHR usability is a significant driver of physician dissatisfaction. He doesn’t explain why AMA’s members greedily and voluntarily bought those systems despite their faults hoping to pocket a few dozen thousand dollars in free MU money. The market is where it should be, at the intersection of supply and demand, and perhaps the AMA should be convincing its members who are providing the demand as customers instead of scolding the companies that meet it. It’s like complaining that you hate Taco Bell while waiting in line to get your daily bean burrito. Stack has done committee work for ONC, was involved with the PCAST Report (that mostly touted Microsoft as the answer to all healthcare IT problems), and is on the board of eHealth Initiative (which includes quite a few vendor members). He’s always been a usability critic.

At least 15 children die in Syria after receiving UN-provided measles vaccine, with a preliminary WHO report speculating that medics accidentally gave the muscle relaxant atracurium instead of the vaccine since the drugs are packaged in similar vials and were stored in the same refrigerator.

A security publication finds medical records on sale in bulk on a black market Internet site, apparently stolen from a Texas life insurance company’s applicant database. The writer bought records and verified their accuracy, with prices as low as $6 for each “fullz,” slang for a complete set of records that the buyer can use to open fraudulent credit card accounts, access bank accounts, or take over someone’s identity.

UCSF surgeon Wen T. Shen says he’s embarrassed for patients to see his lack of typing skills, but doesn’t like the alternatives:

Wait until after the patient leaves to start charting (impractical given our clinic workflow); hire a medical scribe to do my documentation for me, as detailed in a recent New York Times article (not happening with recent budget cuts); use the nifty speech-to-text dictation device provided to all clinicians (feels extremely weird and off-putting to do this in front of patients); actually learn to type (old dog/new tricks, dwindling brain plasticity).

Weird News Andy says, “I <3 this password,” although he adds that it might be tough to get into your phone to dial 911 during a heart attack. Researchers develop an authentication method that uses wristband-detected ECG patterns as “the perfect password,” although people with fibrillation might not be ideal users.

• Nordic announces that it has earned the top ranking among Epic implementation support and staffing consulting firms in a new KLAS report. Also named in the report is Orchestrate Healthcare, the highest ranked vendor-agnostic consulting firm in the implementation support and staffing category.
• ADP AdvancedMD’s EHR earns ONC-ACB certification as a Complete EHR.
• Huntzinger Management Group recognizes its clients and IT professionals for National Health IT Week.
• Access provides Normal Regional Hospital (OK) with giveaways to help celebrate National Health IT Week.
• EClinicalWorks names several ACO clients that are generating savings after deploying its CCMR.
• ESD’s Phil Sierra discusses the value of healthcare IT in a recent blog.
• Etransmedia shares a video about its success and growth.
• SRSsoft is participating in the American Society for Surgery of the Hand conference in Boston this weekend.
• Truven Health Analytics and National Business Group on Health partner to facilitate an improved Employer Measures of Productivity, Absence and Quality program.
• AirWatch by VMware offers instant support for devices running on iOS 8.
• An Imprivata survey finds that 65 percent of hospitals will use Virtual Desktop Infrastructure within two years and 84 percent of those will add single sign-on.

EPtalk by Dr. Jayne

The physician lounge was buzzing this morning with the news of HR-5481, the “Flexibility in Health IT Reporting Act.” If passed and signed into law, it would allow providers to report 90 days rather than a full year in 2015.

I have to say my pulse quickened when I saw it. Congress set precedent with their ICD-10 push. This one might have less of a chance, however, since it’s not being tacked onto another high-profile bill. Maybe we can hook it to a bill everyone can get behind, such as the “We Love Mom, Apple Pie, and America Act.” If this passes, it just might defibrillate Meaningful Use, moving it from “mostly dead” to “slightly alive.”

In other bandwagon-jumping news, the American Medical Association releases a paper on setting “Priorities to Improve Electronic Health Record Usability.” I’m not a big fan of the “blame the EHR” game since there are so many more factors that influence usability, user behaviors, and generally how the health system runs. Rather than putting all of our eggs in the proverbial basket and assuming that if we just “fix” the EHR everything will be awesome, let’s look at the other issues that cause slowness and waste in health care.

My laundry list includes E&M Coding, obnoxious precertification requirements placed on physicians without good reason, The Joint Commission requirements, RAC audits, payer audits, Meaningful Use, other certification body requirements, and numerous non-value-added steps throughout the day. I could go on, but it would be aggravating. Although some of these have been shown to improve outcomes, many are just nuisances. Let’s take a multi-pronged approach and stamp out ALL poor usability, not just that of the software variety.

Back to the AMA, they again sent Medicare reimbursement codes for end-of-life care discussions to CMS for consideration. I’m in favor of efforts that would actually help physicians be paid for non-procedural work. We don’t die well in the United States. TV and media paint a picture of heroic lifesaving measures where everyone recovers fully, but don’t ever show patients with poor outcomes. The last time this came up, the scare tactics around “death panels” crushed any hope of approval.

As a primary care physician, one of the best things I can do as part of our partnership is talk to you about end-of-life care, getting your wishes out in the open and ensuring you have a support system that can carry them out when the time comes. Unfortunately, this isn’t for just Medicare patients. We need a national dialogue (heck, our EHRs all have prompts for it anyway) for patients of all ages. Young women die in childbirth, people are in horrific accidents, and overall stuff just happens.

I had some nurses make fun of me when I rolled into an outpatient surgical procedure with my healthcare power of attorney and living will at the tender age of 31. As a physician, I don’t want “everything” done and am firmly convinced there are things worse than passing on. Unfortunately, there’s no way commercial payers will cover this service until Medicare takes the lead or until patients pay out of pocket.

Until then it’s just one more thing we have to do without compensation, like keeping your diagnosis list maintained in both SNOMED and ICD-9 and explaining ethnicity to elderly people who have no idea why we would need to gather that type of information. I’m expected to share all data, but patients can pick and choose what I see, potentially placing them at risk. Proponents of MU argue that the potential of up to $44K worth of incentive payments effectively compensates us for all the extra work, but it doesn’t even scratch the surface.

I’m interested to hear what else we should ask Congress to fix for us while they’re at it. Got an idea? Email me.

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 9/18/14

Bill Would Cut 2015 Meaningful Use Reporting Period To 90 Days

A bipartisan bill introduced by representative Renee Elmers (R- NC) will reduce the 2015 attestation period from 365 days to 90 days if passed. Elmers explains the intent behind the bill, saying “By adjusting the timeline, providers would have the option to choose any three-month quarter for the EHR reporting period in 2015 to qualify for Meaningful Use. The additional time and flexibility afforded by these modifications will help hundreds of thousands of providers meet Stage 2 requirements in an effective and safe manner.”

EHR giant Epic explains how it will bring Apple HealthKit data to doctors

An Epic spokesman comments on Apple HealthKit integration points, saying “If the patient has given permission for the MyChart app on their phone to know about that data, HealthKit “wakes up” the MyChart app and tells it there’s new data.”

 What the new uninsured numbers don’t tell us about Obamacare

Several new polls indicate that the US uninsured rate is dropping, presumably due to the introduction of the Affordable Care Act.

2014 Survey of America’s Physicians Practice Patterns and Perspectives

The Physician Foundation publishes survey results representing 20,000 physician respondents. The report finds that 46 percent of physicians feel that EHRs have detracted from their efficiency, 47 percent feel that EHRs have detracted from patient interaction, and 24 percent report that EHRs have detracted from quality of care.

Readers Write: The Elephant in the Waiting Room: Healthcare Organizations Can No Longer Afford to Look the Other Way on Patient Pay

The Elephant in the Waiting Room: Healthcare Organizations Can No Longer Afford to Look the Other Way on Patient Pay
By Sean Biehle

In the past five years, patient payment responsibility has risen dramatically and continues to increase with the implementation of the Affordable Care Act. More people insured means more people who don’t understand their health insurance and many of the plans on the healthcare exchanges are high-deductible plans. At the beginning of the year, Aetna CEO Mark Bertolini projected patient pay responsibility to climb to 50 percent of the healthcare dollar by the end of the decade.

The New Normal: High-Deductible Plans

Once considered a last-resort alternative for those with limited income, high deductible (HDP) or “catastrophic” plans have gone Fortune 500. As a result, self-pay now includes a lot of the people who have insurance with HDPs.

• A 2012 Rand research brief estimated that half of all workers on employer-sponsored health plans could be on high-deductible insurance within a decade.
• The average deductible in employee sponsored health plans was $1,100 in 2013, but deductibles in the healthcare exchanges average between $3,000-$5,000.
• A report released by S&P Capital IQ estimates that 90 percent of S&P 500 companies will shift their workers from employer-sponsored insurance plans to health exchange plans by 2020.

As more Americans are paying a greater proportion of their healthcare costs out of pocket, getting reimbursed for the patient pay segment could now be the most important number to a healthcare organization’s bottom line. Collecting from patients is estimated to cost up to three times more than collecting from payers. 

Focus on Education

Healthcare organizations should make it their mission to help patients understand their bills, educate them on payment options, and help them navigate any insurance issues. Seventy-five percent of patients say that understanding their out-of-pocket costs improves their ability to pay for healthcare.

Plus, the Hospital Value-Based Purchasing (VBP) portion of the Affordable Care Act returns higher Medicare reimbursements based on patient experience scores. The payment process is integral to the patient experience. Patients who don’t understand their bills, what they owe, and why they owe it tend to give lower scores on patient satisfaction surveys. Last year, 2013, more hospitals were penalized than bonused, leaving millions on the table.

Create a Consumer-Focused Culture

Because patients are paying more, they are using social media and other online tools to shop around for physicians and hospitals that not only provide the best care, but also the best service. Service is more than having a good bedside manner. Service means providing frequent and transparent patient communications, especially as it relates to billing.

• Emphasize patient satisfaction over collections.
• Create a consumer-focused culture – align staff incentives with patient satisfaction.
• Perform patient satisfaction surveys to help identify potential problems before they escalate and determine reimbursement rates.

Be There When and Where It’s Convenient for the Patient

Many patients work and they have to take off work to visit their office or facility. Don’t make them take more time off when it comes to having to figure out their bills.

• Offer extended call center hours, including open evenings and weekends, to optimize patient access.
• Offer online payment platforms to provide 24/7 access for making payments, arranging payment plans, and viewing and updating demographic and insurance information.
• Offer services in multiple languages so no patient gets left behind.

Make It Convenient and Easy for Patients to Pay

Connecting with patients in a meaningful way helps them understand the how and the why eliminates any confusion when it comes to their bills. Show patients how easy paying their bills can be.

When possible, consolidate payments and balances across the entire patient care continuum. This makes it easy for the patient to pay everything in one place and drastically simplifies the patient pay process.

Provide multi-channel patient communications and payment options:

• Point-of-service (POS) payment portals make it easy to collect balances at the time of service.
• Automated phone/IVRS options enable payment over the phone.
• Online payment processing for debit and credit cards and electronic checks provides 24/7 access for patient payments.

Additionally, a number of provider organizations have developed pricing transparency tools for consumers to access clear and easy-to-understand billing information.

Offer Payment Plans Upfront

Medical bills can be daunting and patients are far less inclined to pay on larger balances, especially over $400. However, informing patients of their payment options at the time of billing greatly increases the odds of getting paid.

Offer Incentives for Self Pay

Unlike insurance companies, patients don’t get to negotiate adjustments to what they are charged for a procedure. Sweetening the pot by offering payment incentives can greatly increase reimbursement and patient satisfaction.

Treat Patients with Dignity and Respect During the Billing Process

Patients aren’t just numbers. In fact, we’re all patients, so it’s easy to see how frustrating it can be in the absence of clear, reliable, and efficient patient billing communications. Healthcare is one of the very last vestiges of American culture in which the consumer doesn’t have access to complete transparency to what they will owe before they incur the costs

Until the continuum of patient communications can be fixed from the inside out, it’s imperative to treat each individual with the respect and dignity they deserve throughout the entire billing process. Help them avoid collections at all costs using the strategies above and show them that the care provided continues beyond the bedside.

Expected Results

When focused on patient education and satisfaction, physician groups and hospitals can expect stronger reimbursement on patient balances. Educated patients pay their bills. Satisfied patients translate to higher Medicare reimbursements. Many organizations have seen their reimbursement rates increase by more than 30 percent after adopting patient education and satisfaction programs.

Emphasizing customer service can also help verify insurance and uncover secondary or additional insurance. This can dramatically streamline the revenue cycle process. Many organizations find after talking to their patients they discover additional insurance on accounts originally categorized as patient pay.

Lastly and perhaps most importantly, providing clarity of communications builds patient loyalty and increases trust over time. Patients who are highly satisfied with an organization’s billing process are twice as likely to return. Plus, over 80 percent of patients who are satisfied with their billing experience are likely to recommend an organization to their friends.

Sean Biehle is marketing manager for MedData of Brecksville, OH.

Readers Write: Protecting the Network with Endpoint Security

Protecting the Network with Endpoint Security
By Jeff Multz

CIOs are forever struggling to ensure that technology helps their businesses run efficiently and effectively and that their networks are protected. That’s a heavy undertaking for any business, but especially for healthcare organizations, as medical professionals rely on a bevy of computer devices (including their own.) These devices have become high targets for threat actors who are increasingly attacking endpoints (laptops, workstations, and mobile devices) to break into networks of healthcare and financial institutions.

The FBI recently issued an alert following a highly publicized attack on a US hospital group that warned healthcare companies they are being targeted by hackers.

"We are seeing an increase in attacks within healthcare," said Ann Patterson, senior vice president and program director of the Medical Identity Fraud Alliance. "The healthcare sector’s security and privacy controls differ from more secure industries, such as financial services, and [healthcare organizations] may be easier targets."

Why is healthcare so attractive to threat actors? A few reasons.

• Nation states are after the intellectual property of medical equipment and pharmaceutical companies so they can copy their products and sell them more cheaply.
• Threat actors are also after personal identifiable information (PII) of healthcare providers, which attackers use to open up new credit card accounts under the names of patients. That PII includes a patient’s name, address, phone number, Social Security number, date of birth, and billing information.

Because it is often difficult to evade network detection devices such as firewalls and intrusion detection/prevention systems (IDS/IPS), attackers are going directly to the end user via phishing or watering hole attacks to break into networks. The trusting souls who click on the links or attachments inside these emails have no idea that when they do, that malware is automatically downloaded.

While there have been new innovations in protecting the network from outsiders, there’s been a dearth of innovation in endpoint security technology. Since antivirus (AV) software is not very effective, it has become quite easy for attackers to infect endpoints. Defenses for endpoints are still mostly malware-signature based, so threat actors run pre-attack tests to see which signatures are being detected and which ones aren’t.

This ploy has worked so well that attackers sell their testing services to other attackers, running a service similar to that of VirusTotal, which scans malware for detection rates. However, unlike VirusTotal, the threat actors don’t share the results with AV vendors.

With about 200,000 new pieces of malware being created each day, according to Kaspersky Labs, and much of the malware being polymorphic, signature-based threat detection methods can’t keep up with the pace of new malware creation.

It’s hard to keep endpoints, especially personally owned endpoints, up to date with the latest patches. There are more applications than ever that people download onto their devices and all these applications have flaws, making them easy targets for attackers. Additionally, Web-based technologies are being designed so users can do anything over the Web using HTTP or HTTPS, which subverts perimeter-based controls and makes the Web an easy way to deliver malware.

With the Internet of Things (IoT) growing daily, the front line of attack has moved from servers to the endpoint. This year alone, IDC expects shipments of smart-connected devices (PCs, tablets, and smartphones) to surpass 1.7 billion units worldwide. Organizations are being attacked via their endpoints, yet have no idea they’ve been compromised.

The average time it takes for organizations to discover they have been compromised is 229 days and 69 percent of the discoveries are made from outside sources, such as federal authorities, the FBI, or private security companies.

An organization must be able to see all activity taking place on the endpoints so they can remove attackers as soon as they enter the network. The only way an organization can know whether it has been compromised is to continuously monitor the network and the endpoints. It needs to see what’s going on at the endpoint and tie that to what is going on across the network. Anomalous activity must be spotted as soon as it occurs.

An organization should be able to determine what happened when the affected system ran, who the system communicated to, what changed on that system, what the lateral movement was, and what tools were used. Endpoint activities should continuously be collected and logged. The information should be fed into a system that takes an end-to-endpoint view of all that has occurred, providing full visibility into a network. Organizations can then take that information and adapt their infrastructure, user training, and applications accordingly to defend the network.

As soon as anomalous activity is spotted, an investigation should be initiated. If the investigation reveals that an endpoint was compromised, the system can provide a blueprint of all activity that has occurred, and all activity as it is occurring, so the threat can be contained as quickly as possible.

The 2014 SANS Health Care Cyberthreat Report found that endpoint devices not only provide challenges for securing them and the network they are connected to, but also for recovering from an incident. Continuously scanning endpoint devices that are connected to a network can tell an organization exactly where the infection is hiding in the endpoint and how to remediate it. Breaches can often be remediated without being wiped or re-imaged, alleviating the possibility of inadvertent data loss during a wipe.

Work stations are critical attack vectors, and organizations that have a multitude of high target endpoint devices must always be on high alert for attacks. For now, there is only one way to do that. Gartner calls the solution Endpoint Threat Detection & Response, also known as Advanced Endpoint Threat Detection. It should be mandatory for any organization that needs to protect its business.

Jeff Multz is director of North America Midmarket for Dell SecureWorks of Atlanta, GA.

Health IT from the Investor’s Chair 9/17/14

Some Musings from the Chair

With summer winding down and Labor Day in the rear view mirror, it felt like a good time to write a quick Investor’s Chair post and share one or two of the more interesting things I’ve noted in the market of late.

The biggest news of the summer was clearly Cerner’s announced acquisition of Siemens’ healthcare information technology unit (or, as we old timers would say, Shared Medical Systems.) When I got a call from a reporter related to the transaction, my first reaction was a sense (as perhaps the Siemens folks would say) of schadenfreude, as this is yet another example of yet another European technology company foundering on the shores of the US healthcare IT market (think Misys).

Recall that Siemens bought SMS 15 years ago for $2.1 billion, only to sell it now for $1.3 billion. Why the decrease in value? Perhaps because in the greatest boom times our sector has ever seen (thanks in no small part to ARRA), revenues over these 15 years were astoundingly FLAT!

With this purchase, Cerner is now the clear sector leader and will enjoy mammoth cross-selling opportunities given the product fit. Cerner is a clinical leader, where Siemens (née SMS) always lagged there and was more focused on financial systems. (In fact, I recall the former CEO of SMS explaining to me that Cerner’s clinical focus was off base!)

From an investor perspective, this was a good use of both the cash hoard Cerner had built up on its balance sheet and its high-multiple stock, allowing the deal to be almost instantly accretive – especially with the $175 million in pre-tax synergies the company guided to in its press release. While the stock traded fairly flat around the release (likely because rumors had circulated for several weeks prior to the deal, causing the deal to already be priced into the stock), Cerner’s shares are up almost 10 percent as I’m writing this post, more than twice the S&P — Ms. Market seems to be more excited.

The vast majority of analyst commentary has been positive and we here at the Chair are fans of the purchase as well. The only thing that gives me pause as a long time Cerner watcher (and fan) is that the company has zero history of large-scale M&A and the sector has not been kind to such large-scale bets in the past.  What’s especially noteworthy here though is that the cultures of the two companies are literally more than an ocean apart, and in the words of famed management guru, Peter Drucker, “Culture eats strategy over breakfast”.

That said, the price Cerner paid clearly de-risks the acquisition, and Cerner is known for its strong culture (and full parking lots).

Another aspect of autumn I’m eagerly anticipating is attending the Health 2.0 Fall Conference in a few weeks. My impressions of the 2010 event can be found here. I missed it last year, so I’m really looking forward to the opportunity to see some of the new thinking and more cutting edge tech that this event usually attracts. With “digital health” so beloved of the venture world these days, I’m expecting both a fair number of cheap but cheerful innovators with apps and dreams, but also know there will be more than a few companies straight out of HBO’s show “Silicon Valley” strutting their stuff and spending their VCs’ money on booths and travel like there’s no tomorrow (and if they’re not careful, there won’t be).

Part of what I like most about this event is the great dichotomy in participants, sponsors, and attendees. I’m also particularly excited to be mentoring the HealthTraction component, Health 2.0’s Startup Championship – CEO mentoring for companies of all sizes is one of my favorite aspects of ST Advisors’ work.

As for the actual sessions, in the past they’ve varied from truly fascinating to really annoying, but that’s the beauty of industry conferences. My big complaint is that the conference moved from San Francisco to “the Valley,” but I’m keeping an open mind and will be writing a debrief post afterwards. Drop me a note if you’d like to drink some sponsor’s wine or coffee during the event.

Ben Rooks spent a decade as an equity analyst and six years as an investment banker. Five years ago he formed ST Advisors to work with companies on issues of strategy, growth, and exit planning (among other fun topics). He lives in San Francisco with his wife and the cutest dog ever!

Morning Headlines 9/17/14

HIMSS, CHIME, AHA, AMA, and others urge HHS to reduce 2015 attestation period to 90 days.

Several industry advocacy groups write a co-signed letter to HHS secretary Sylvia Burwell calling for the 2015 Meaningful Use attestation period to be reduced from 365 days to just 90 days.

Outsourcing Firm Cognizant to Buy TriZetto for $2.7 Billion

IT outsourcing firm Cognizant Technology Solutions will buy health IT vendor TriZetto for $2.7 billion in an effort to bolster its health IT portfolio.

Federal Health Care Website Faces Security Risks, Watchdog Finds

The GAO publishes a report on the security of Healthcare.gov, concluding that despite increased security efforts "weaknesses remained in the security and privacy protections applied to HealthCare.gov and its supporting systems."

AMA Calls for Design Overhaul of Electronic Health Records to Improve Usability

The American Medical Association publishes a framework with eight recommended changes for improving EHR usability.

News 9/17/14

Top News

Several member organizations — including HIMSS, CHIME, AHA, and AMA — urge HHS Secretary Sylvia Burwell to shorten the 365-day 2015 Meaningful Use reporting period to 90 days. The groups say they are “incredibly concerned” that the full-year reporting period will kill the Meaningful Use momentum, pointing out that only single-digit percentages of providers are ready for Stage 2 with only 15 days remaining. Meanwhile, Burwell focuses on more important issues – writing her first HHS blog post, in which quite a bit of Presidential butt is kissed.

Reader Comments

From Hospital IT’er: “Re: GE Centricity HIS. We have been getting calls from GE asking us when we’ll get off their platform. It is clear to me that they are going to abandon the product line sooner rather than later.” Unverified.

From Teddy Lemur: “Re: Tuesday’s CMS/ONC Meaningful Use webinar. One of the most confusing I’ve attended. If you were to try and create a decision tree based on whether the site is an EH/EP/CAH, their Stage, their Year, site’s first year of attestation, date of attestations, site’s mix of certified EHRs, EHR’s level of certification,  etc., etc., it would rival the family tree of European royalty for the last 700 years. How would you like to be a MU auditor and try to judge a site’s 2014 attestation a year or two from now? It’s time to figure out how to best achieve the MU program’s future goals. Better patient care, anyone?”  

Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Acquisitions, Funding, Business, and Stock

Outsourcer Cognizant will acquire TriZetto for $2.7 billion in cash from its majority owner, London-based private equity firm Apax Partners. I reported on August 19 that Apax was hoping to flip its 2008 investment of $1.4 billion in TriZetto, which earns $190 million in annual profits, for $3 billion.

Craneware announces FY2014 results: revenue up 3 percent, EPS $0.34 vs. $0.33.

Readmission software vendor RightCare Solutions raises $4 million in funding.

QPID Health will move to a larger Boston headquarters building and open a West Coast office in Carlsbad, CA.

Sales

Flagler Hospital (FL) chooses Allscripts dbMotion to connect community EHRs.

Oncology device and software vendor Varian Medical Systems will deploy the Infor Cloverleaf Integration and Information Exchange Suite.

In England, Wrightington, Wigan and Leigh NHS Foundation Trust names Allscripts as its preferred EHR vendor. Allscripts acquired Oasis Medical Solutions in July 2014 to improve its position as a single-source vendor to NHS Trusts in pairing that company’s patient administration system with Allscripts Sunrise.

Willis-Knighton Health System (LA) selects Merge’s enterprise cardiology and interoperability solutions.

People

Phil Fasano (Kaiser Permanente) joins insurance company AIG in the newly created position of EVP/CIO. His pre-Kaiser background was in the financial sector.

Joining Phil Fasano in leaving Kaiser Permanente for AIG is Madhu Nutakki, KP’s VP of digital health, who has taken the role of CTO of data, innovation, and advanced technology at AIG.

Brad Allen (Lumeris) joins ESD as regional VP, as does Aaron Johnson (The Morel Company).  

Patientco names Jared Lisenby (Greenway Health) as VP of sales.

John Volanto, VP/CIO of Nyack Hospital (NY), is named interim CEO after the resignation of David Freed.

Announcements and Implementations

Surescripts adds four pharmacy benefit management companies and six EHRs to its electronic prior authorization service.

Registration for HIMSS15 is open along with hotel booking. Early bird registration (through the end of January) is $745. A new (and somewhat odd) option is the free Conference Plus Pass, which allows Sunday pre-conference attendees to move from one session to another during breaks, which would be a benefit primarily if the one you paid $325 for is a dud and you’re willing to roll the dice.

Billian’s HealthDATA makes its searchable Vitals hospital news and RFP feed available at no charge.  

Siemens will offer its customers patient financing programs from CarePayment.

InstaMed and Coalfire release a white paper covering the security of payment cards in healthcare.

Infor announces CloudSite Healthcare, providing its solutions via Amazon Web Services as a subscription service.

Government and Politics

A trade group for healthcare app developers asks Congressman Tom Marino (R-PA) to influence HHS to change HIPAA regulations, saying they are “mired in a Washington, DC mindset that revolves around reading the Federal Register” or “hiring consultants to explain what should be clear in the regulation itself.” It adds that small-scale app developers have few resources to help them understand their HIPAA responsibilities. The letter asks HHS to (a) publish a HIPAA FAQ for app developers; (b) update HHS’s HIPAA technical documentation, which in some cases pre-dates the iPhone; and (c) participate in developer-focused events.

A GAO report will call out security vulnerabilities in Healthcare.gov, warning that they will persist until fixed. GAO says CMS didn’t finish security plans, didn’t perform adequate security testing, failed to enforce password strength requirements, didn’t secure some of its infrastructure from Internet access, and failed to create a failover site.

Technology

Stanford University Hospital and Duke University Health System will pilot the use of Apple’s HealthKit for tracking patient information. Stanford will send two pediatric diabetic patients home with an iPod Touch to record blood glucose levels, while Duke will track basic vital signs for some unannounced number of cancer and cardiac patients. Both health systems use Epic, with Stanford saying it hopes to be able to trigger alerts from the patient-provided blood glucose levels that will be sent back to the patient via Epic’s MyChart. It’s not much of a commitment by either organization and little detail was provided, so I assume it’s just a couple of university people playing around with Apple’s technology just because they can, possibly (or not) to eventual patient advantage.

IBM is desperately seeking new nails for its Watson hammer that has failed to hit its sales numbers, now packaging it as Watson Analytics.

In Canada, volunteers at Bruyere’s Saint Vincent Hospital develop a headband-powered computer navigation system for quadriplegics using open source tools and consumer-grade parts. A quadriplegic resident of seven years says, “It makes life interesting. When you are in bed, it’s boring. If you can go online, you can go anywhere. With Google Maps, I can go on virtual tours.” She also uses the technology to connect with family via Skype.

Other

The American Medical Association lists eight recommendations to make EHRs better:

1. Design systems to enable physician-patient engagement, with fewer pop-up reminders and complicated menus.
2. Allow physicians to delegate tasks.
3. Track referrals, consults, orders, and lab results automatically.
4. Modularize system design for easier configuration.
5. Create tools that provide more context-sensitive, real-time information beyond overly structured data capture.
6. Open up systems for interoperability.
7. Link EHRs to patient apps and telehealth to support digital patient engagement.
8. Build in capabilities for users to send product feedback and problem reports to vendors.

HL7 tweeted out this photo of the brilliant and always-entertaining “Father of HL7,” Ed Hammond of Duke University.

Eastern Maine Healthcare Systems (ME) will eliminate 43 IT jobs, about 12 percent of the department’s headcount, hoping to avoid a $100 million shortfall by 2019.  

Kaiser Permanente Hawaii launches an internal medicine residency, touting in the announcement its HealthConnect system.

A Wisconsin newspaper is amused in its coverage of Epic UGM, reporting that Judy Faulkner joked that health IT acquisitions will accelerate and Epic will buy GE and rename it General Epic. She said, “The greatest users of electronic health records are the patients.” The photo above was tweeted out by David K. Butler, MD.

Weird News Andy says this is one of his “pet” peeves among vets of the animal kind. A Colorado veterinarian pleads guilty to charges of unauthorized practice for using creams on humans.

Sponsor Updates

• PerfectServe will exhibit at MGMA and the ACPE Fall Institute.
• Impact Advisors is included in Modern Healthcare’s “Largest Revenue Cycle Management Firms.”
• MedAptus announces that approximately 4,000 charge capture and management suite end-users have rolled out its ICD-10 software upgrade.
• Allscripts offers a short list of dos and don’ts of clinical IT deployment based on a new Alberta Health Services case study.
• Consulting Magazine names Aspen Advisors, Deloitte Consulting, and Impact Advisors to its “2014 Best Firms to Work For” list.
• The Massachusetts eHealth Collaborative receives ONC HIT 2014 Edition Modular EHR certification from ICSA Labs.

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 9/16/14

 Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy

A new RAND report conducted with the American Medical Association finds that EHR use is a direct contributor to physician burnout. Physician survey respondents  cite poor clinical notes, interruption of face-to-face time with patients, time consuming data entry, and less fulfilling work as EHR-related drivers of their dissatisfaction.

Apple HealthKit Trials Spearheaded By Duke And Stanford University Hospitals: Report

Stanford University and Duke Medicine announce plans to use Apple’s HealthKit to streamline data capture in support of their population health initiatives. Stanford Children’s Hospital will track blood sugar levels in its type 1 diabetes population, while Duke will capture weight, blood pressure, and other values to monitor heart disease and cancer patients.

Glitch in health care law allows employers to offer substandard insurance

A known bug in the validation tool that Healthcare.gov uses to ensure each plan listed on the market meets the minimum requirements outlined in the Affordable Care Act has resulted in employers flooding the site with cheap substandard insurance plans that do not offer basic protections, like hospitalization coverage.

AIG Raises Profile for Technology With Creation of CIO Job

Former Kaiser Permanente CIO Philip Fasano has been hired to a newly created CIO position with insurance giant American International Group.

Curbside Consult with Dr. Jayne 9/15/14

I was having a pretty pleasant week until one of my group’s more challenging physicians walked into my office with a copy (printed, of course) of an article entitled, “Physicians report losing 48 minutes a day to EHR processing.” Once again, Medical Economics uses an eye-catching headline to remind us why EHRs are evil.

When looking at patient care, my colleagues will sit in Journal Club and rip scholarly articles to shreds, dissecting them and discussing why they do or do not apply to our patient population and care paradigm. They’ll argue about the composition of the study population as well as the methodology. Only when they’re fully convinced as to the integrity of the data and the statistical analyses performed will they agree to add the paper’s recommendations to their clinical protocols.

When there’s disparagement of EHRs to be had, however, they take the article as gospel without a single moment of review and pass it all around the physician lounge. This is the same physician who barged into a meeting last year with a survey of EHR satisfaction, demanding we replace our system. He didn’t both to notice that fewer than 20 respondents use the same EHR as us and are likely not in the same situation.

He took the same approach with this article and wouldn’t listen to anything I had to say, ultimately storming out when I wouldn’t feed into his negative energy. For anyone who does want to listen, however, here is my critical review of the article.

First, the article cites a survey by the American College of Physicians as the source of the data. Key points cited in the Medical Economics article included:

• 89.9 percent reported at least one data management function was slower with EHR
• 63.9 percent reported that note writing took longer
• 33.9 percent said data review took longer
• 32.2 percent said it took longer to read electronic notes

In digging deeper, the survey results were published in a letter in the Journal of the American Medical Association’s Internal Medicine. They weren’t published as part of a peer-reviewed study, which is an important distinction.

In looking at the letter itself, I’m not following the math. They said they sent the survey to 900 ACP members and 102 non-members. That’s 1,002 people by my math. In the next paragraph, they talk about “845 invitees.” Since 485 opened the email, that gives them a contact rate of 62.5 percent. But if you divide by the original 1,002 people to whom the survey was sent, I get 48 percent. Either way, only 411 of the responses were valid.

The survey also found differences in the time “lost” by residents vs. attending physicians differed – 48 minutes vs. 18 minutes, respectively. They suggest “better computing skills and shorter (half-day) clinic assignments” as possible contributing factors. I found the last sentence of the results section particularly interesting: “For the 59.4 percent of all respondents who did lose time, the mean loss was 78 minutes per clinic day.” Pulling out my handy math skills again, that would seem to indicate that 40 percent of respondents did not lose time.

The fact that this data was self-reported makes it less reliable than observer data. Their methodology relies on physicians remembering what their days were like a year ago (or two, or three, depending on when they went live on EHR) and comparing it to the present. I don’t know about you, but my clinical time is significantly harder for a lot of other reasons other than the fact that I’m on an EHR.

I’ve used EHRs for more than a decade and have to say that the Meaningful Use program (with its many required data elements) alone increased the time I spend charting. It wasn’t due to the EHR per se, but due to the required data. It’s kind of like when E&M coding was introduced – notes took longer because the volume of required data increased.

They authors seem to acknowledge this with their statement: “The loss of free time that our respondents reported was large and pervasive and could decrease access or increase costs of care. Policy makers should consider these costs in future EMR mandates.”

I also find it interesting that they didn’t mention results of any questions asking about how many data functions were faster with EHR. From my own experiences (across eight or nine different platforms) there are always areas that work faster and better in EHR and others that were faster on paper. But faster doesn’t equal safer, more reportable, or higher quality – it simply means faster. You can’t look at speed alone as a marker of EHR value, but I’ll take my EHR’s telephone message system over chart pulls and little pink pieces of paper any day.

When our medical group initially went live on ambulatory EHR, we actually did the time and motion studies pre-EHR and at multiple points post-EHR. We had data that showed that the EHR was neutral for time as well as for revenue. It didn’t matter that we had good data, however, because physicians naturally assumed that we “cooked the books” on it to show the EHR in a favorable light. That kind of bias is hard to overcome.

Looking at some of the raw data from our observations, we found the presence of a computer during documentation to be a confounder. Physicians were more likely to access other resources, such as UpToDate,  formulary information, or our system’s clinical repository, while reviewing data and documenting. Those resources were simply not available to them in the paper world. It’s hard to separate that kind of computer use from the actual use of the EHR product when you’re considering how long it takes to complete your notes.

I would much rather take a little longer because I spent a few minutes validating something in UpToDate than to simply finish faster. I also spend time in the EHR making sure patients get appropriate personalized education handouts, which I couldn’t do in the paper world. A survey cannot control for these other types of computer usage within the context of the EHR. Because of single sign-on and CCOW, half of my physicians would be unable to tell you where the EHR proper ends and the rest of our data universe begins.

What’s the bottom line? Although this survey has scholarly trappings, if other research was conducted this way, it would have holes like a block of Lorraine Swiss. The fact that review and documentation takes longer may not necessarily be a bad thing.

I’m interested to see what readers thing about the publication of this letter. Have thoughts about it? Or a favorite Swiss of your own? Email me.

Email Dr. Jayne.

HIStalk Interviews Marc Grossman, Principal, WeiserMazars

Marc Grossman is principal with WeiserMazars of New York, NY.

Tell me about yourself and the company.

I’ve been in the healthcare IT industry for 30 years. I’ve worked on the provider side as a hospital administrator and have been doing healthcare IT consulting for about 25 years.

I work for WeiserMazars. It’s an international consulting and accounting firm. I head up the healthcare national practice within the United States. Our clients are all provider-side clients in healthcare IT.

How are hospitals selecting and implementing systems differently now than they were five or 10 years ago?

There’s really not been that much change in how they’re selecting core systems. Hospitals typically keep systems for 10 to 20 years, which is a lot longer than most people would expect. I think it’s due to financial reasons.

We’ve gone through a lot of clinical selections recently. Our emphasis was on clinical systems due to Meaningful Use. There’s a cycle that I see the industry going through in the type of system, whether it’s financial, patient accounting, clinical lab, radiology, and so forth. But the process is basically still the same. That hasn’t changed.

The pendulum always swings back. People are paying more attention to revenue cycle and even talking about customer relationship management systems. What systems do you think are poised to make a comeback?

Patient accounting is going to see a big shift. That also has a lot to do with the fact that Siemens is being purchased by Cerner. Lab systems are starting to go through a cycle again.

People have in the past three or four years started looking at systems that haven’t taken off significantly yet. Systems related to population health management, data analytics, data warehousing, business intelligence. Those types of systems will cause a shift in purchases.

What are you seeing with lab systems? 

We’re seeing a push for an integrated approach, getting away from best of breed. You see it with Epic. You see it with Cerner. Those are probably the two biggest right now that I see people moving to. If they already have Epic, they’re moving to Epic’s lab. If they have Cerner, they’re moving to Cerner’s lab. 

We have seen that in lab systems, there seems to be a cycle about every seven years. I’d say about half of organizations are replacing. They keep it for about 14 years, typically, and about every seven years, we seem to be doing a lot more lab system selections than we have in the past. I’m talking about replacement of whatever they have — best of breed or some kind of niche vendor system.

How do you see Cerner’s acquisition of Siemens unfolding?

A lot of it’s going to depend on where the Siemens client is. Are they live on Soarian or in the process of implementing Soarian? Cerner has been much more successful with their patient accounting system recently. They’ve changed the name because it had such a bad reputation – they no longer call it ProFit. 

I believe Cerner is buying Siemens for intellectual property. On the patient accounting side, I think they’re also looking at the RCO base that Siemens has, which is a great revenue stream for them. 

Given Cerner’s history and the industry’s history over the last 20-30 years, Siemens Soarian and Invision product support is going to go downhill. I think they probably won’t sunset it officially for at least 10 years, just because I know Siemens does have numerous contracts which are going out 10 years. I also hear Siemens’ sales guys are really pushing to provide great deals right now, to get people to sign up or extend their contracts for 10 years. 

Like we’ve seen with many other vendors that purchased other systems, Cerner is clearly not going to put R&D money into two patient accounting systems and two clinical systems if they have an integrated system now. I just don’t see any indication that Cerner is going to continue the development of any of the Soarian or Invision products.

What are you seeing with population health management and analytics?

We’re seeing a lot of disappointment because the systems are so early in their life cycles. People are hearing a lot of promises from various vendors, both the major players like Cerner, Epic, and Allscripts and down the line. They have products in their infancy.

Then you have the niche players, which definitely have more mature systems, but there’s still a lot of disappointment even with those. Difficulty with interfacing issues and difficulty with the depth and breadth part of the applications.

Is there a mature enough process in place in hospitals that even if the systems could give them what they want, that they could follow through on the promise of either population health management or analytics?

I’ll say eventually we’ll get there. I don’t think we’re there yet.

Some of the larger academic medical centers that have large IT shops, are more sophisticated, and have a lot more money to spend have gotten their feet wet, some of them 10 years ago. But a lesson we have to learn is that vendors and consultants set false expectations. It’s a multifaceted challenge that we’re dealing with in our industry.

The biggest problem we have is that our industry is the only industry that I know of where the revenue side of the financial equation is heavily regulated, but the cost side is totally unregulated. We have a ton of regulations, a ton of incentive programs, but the money isn’t there to pay for all the wants and the needs.

We also as an industry need to accept responsibility for the fact in that we don’t have real standards when it comes to interoperability. Each hospital thinks that it’s unique. I’m not suggesting that they’re not different in some ways and some have certain specialties that others don’t. But the reality is that they’re in competition with each other, so they’re not willing to share things where they should be sharing.

The other issue is that each individual hospital’s incentives are not in sync with the government’s incentives and drive. The government can save money by having hospitals operate in a certain way. Each hospital doesn’t necessarily benefit from it. The desire of where we’re going to put our money at each hospital is not consistent.

Is the era of hospitals running applications from their own data centers fading as they move to the cloud?

We’re at least five to 10 years away from that. I’m hearing from a lot of our clients – they want to get out of the data center business. I don’t know if it’s going to necessarily be the cloud. There’s definitely a push to move more to RCO-RHO kind of approach like Siemens and Cerner have been doing for many years.

When hospitals negotiate agreements with companies to host their applications in whatever form, what’s important for them to look at contractually to protect their interest?

Service levels, to make sure that response time and downtime is going to be sufficient. Address areas related to growth and the impact on fees. Also, the whole issue of who really owns the data and how do you access that data if and when the arrangement ends. It sounds like a simple thing, but the reality is that it’s often very difficult for hospitals when they’re trying to pull out of an RCO arrangement to easily get their data.

Those are probably the biggest issues in my mind — cost, access, and availability.

What are the top issues that are challenging health system IT departments?

What I’m hearing from most of our clients are four or five big issues. CIOs expressing concern that they have too much on their plates, not just individually, but as an organization. They have too many high priorities and don’t have the necessary resources in most instances. ICD-10, Meaningful Use, the related offshoots from all of that, population health, changes in reimbursement, growth in terms of hospitals buying up physician practices or buying other hospitals or merging.

A second category is lack of strong IT governance. A lot of what relates to that unfortunately at many hospitals, especially at smaller hospitals, CIOs still do not have a full seat at the table. They’re often viewed as not being strategic. A lot of the hospital executives still view IT as a necessary evil rather than a strategic enabler. It becomes an uphill battle for CIOs.

There’s a lot of frustration and lack of trust among a lot of the executive leadership at many healthcare providers due to the history of false promises and expectations that were not met in the industry over the many years. Look at how many failures we’ve had with just EMRs alone and how organizations have had to replace systems.

Even in this day and age, I find a lot of executives don’t understand what systems are going to really give them and that systems are not going to solve all their problems. It’s just an enabler as opposed to the solution itself.

Do you have any concluding thoughts?

We’ve actually grown a lot as an industry. I think we still have a lot of growing to do.

Morning Headlines 9/15/2014

Advocate, NorthShore merger means 16 hospitals, 3 million patients

In Illinois, Advocate Health Care and NorthShore University Health System announce merger plans that will result in a 16 hospital, 45,000 employee organization with a $6.5 billion combined revenue.

State abandons search for new health exchange company

Nevada abandons its search for a new health insurance exchange contractor, after firing Xerox in May, and announces that it will join Healthcare.gov instead.

Docs frustrated with transition to electronic medical records

A local paper covers the frustrations that clinicians at Community Health of Central Washington are experiencing as they transition to a new EHR that has fallen short of their expectations. CMO Michael Schaffrinna is quoted saying “It reads like a translated Russian novel. It doesn’t flow, and that means it takes a lot longer for people to find the information they’re looking for to care for the patient.”

Monday Morning Update 9/15/14

Top News

Illinois-based Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system with 16 hospitals, 45,000 employees, and $6.5 billion in annual revenue. The CEOs of both systems say more mergers or acquisitions are likely as hospital consolidation continues. They also touted the benefit of shared electronic medical records and future plans to roll out more patient-facing technologies. I would bet that NorthShore’s Epic will eventually become the new standard, replacing Advocate’s Cerner system.

Reader Comments

From Core Consumer: “Re: Apple and Epic. Apple used Epic screen shots in their HealthKit presentation. There’s no doubt that the companies signed a partnership agreement. Just because details weren’t announced doesn’t mean it didn’t happen.”

From The PACS Designer: “Re: Office 365 Garage Series. With the focus these days on security, Microsoft in their Garage Series wants everyone to know where the Office 365 improvements will be to enhance user performance, collaboration, and connectivity.” I’m surprised Microsoft hasn’t crowed more loudly about Apple’s iCloud breach.

From Smooth Operator: “Re: Kaiser CIO Phil Fasano. Kaiser confirms that Phil has resigned. There’s all sorts of internal discussion on who will be named interim CIO.”

HIStalk Announcements and Requests

HIMSS and CHIME are the organizations most often joined by poll respondents. New poll to your right or here: what influence will Apple have on health and healthcare? Vote and then click the Comments link on the poll to elaborate further.

Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

We ran a couple of great, well-attended webinars in the last few days. Here’s “Meaningful Use Stage 2 Veterans Speak Out: Implementing Direct Secure Messaging for Success.”

This is last week’s “Electronic Health Record Divorce Rates on the Rise- The Four Factors that Predict Long-term Success.”

Sales

The Amerigroup Texas Medicaid health plan will use analytics from Treo Solutions, which was recently acquired by 3M Health Information Systems.

Announcements and Implementations

Australia’s leading interactive patient care vendor, Hills Health Solutions, will distribute patient engagement technology from Lincor Solutions. The agreement was signed during a trade mission visit to Australia by officials from Ireland, where Lincor is based. The company’s touch-screen offerings for both wall-mounted and mobile devices include clinician EMR access, audio and video patient calling, entertainment, patient education, surveys, and meal ordering.

Visage Imaging is sponsoring the full-day New York Medical Imaging Informatics Symposium this Thursday, September 18 at New York City’s Marriott Marquis. The $70 registration fee includes a sushi lunch and up to 6 AMA PRA Category 1 credits.

National Decision Support Company releases an Epic version of its ACR Select evidence-based imaging appropriateness module that includes not only the decision support rules, but also recording utilization data that can be reported from Clarity and Reporting Workbench.

Government and Politics

Nevada votes to shut down its Nevada Health Link health insurance exchange and move to Healthcare.gov after a problematic rollout and the firing of contractor Xerox, who had a $75 million contract to build the site. The state announced plans in May to use Healthcare.gov for at least a year, but decided last week to make the switch permanent.

Other

The weather this week in Verona, WI for Epic UGM attendees: highs in the mid-60s, lows in the low 40s, sunny all week other than a chance of rain Monday morning.  The local paper and TV stations are warning commuters of significant traffic delays through Thursday. The folks at Madison-based Nordic wrote up “10 ways to make the most of your 2014 Epic UGM experience.”

The Yakima, WA paper covers EMR use by doctors who aren’t thrilled by it. One is the chief medical officer of Community Health of Central Washington, who says doctors are using up to half of the already-brief patient encounter to work on the computer and complains that EHRs weren’t designed by doctors. Another doctor says EHRs can improve care and patient relationships if doctors stop their foot-dragging and give patients the benefit of real-time lab results and e-prescribing. 

Bonds of SoutheastHEALTH (MO) are downgraded with a negative outlook after the hospital loses $39 million in 2013 because of revenue cycle problems caused by its Siemens Soarian implementation.

”The Onion” covers telehealth.

The Permanente Medical Group CEO Robert Pearl, MD lists five reasons healthcare IT isn’t widely embraced:

1. Developers focus on doing something with a technology they like rather than trying to solve user problems, such as jumping on the wearables bandwagon despite a lack of evidence that they affect outcomes.
2. Doctors, hospitals, insurance companies, and patients all feel that someone else should pay for technology they use.
3. Poorly designed or implemented technology gets in the way of the physician-patient encounter.
4. EHRs provide clinical value, but slow physicians down.
5. Doctors don’t understand the healthcare consumerism movement and see technology as impersonal rather than empowering.

My list might instead be:

1. People embrace technology that helps them do what they want to do. Most healthcare technology helps users do things they hate doing, like recording pointless documentation and providing information that someone else thinks is important.
2. Technologists assume every activity can be improved by the use of technology. Medicine is part science, part art, and technology doesn’t always have a positive influence on the “art” part.
3. Healthcare IT people are not good at user interface design and vendors don’t challenge each other to make the user experience better. Insensitive vendors can be as patronizing to their physician users as insensitive physicians can be to their patients.
4. Technology decisions are often made by non-clinicians who are more interested in system architecture (reliability, supportability, affordability, robustness, interoperability) than the user experience, especially when those users don’t really have a choice anyway.
5. Hospital technology is built to enforce rules and impose authority rather than to allow exploration and individual choice. Every IT implementation is chartered with the intention of increasing corporate control and enforcing rules created by non-clinicians. That’s not exactly a formula for delighting users.

California HealthCare Foundation covers the Cerner implementation of Los Angeles County’s Department of Health Services, which will replace several siloed systems that require photocopying paper charts to transfer a patient from one of the county’s hospitals to another. Harbor-UCLA Medical Center goes live first on November 1.

Tampa General Hospital (FL) fires an employee who it identified from audit logs as having printed the facesheets of several hundred surgery patients without authorization.

An oral surgeon in Pennsylvania creates a public outcry when he lays off an employee of 12 years because he says her cancer (ovaries, liver, and pancreas) will leave her unable “to function in my office at the level required while battling for your life.” The doctor claims his intentions were noble: he laid her off so she could collect unemployment during treatment, he says, after which time she’s welcome to come back to work.

A hospital in England bans use of the term “computer on wheels” or “CoW,” fearing that patients might be insulted in hearing a nurse ask a colleague to “bring that CoW over here.” They like “workstation on wheels” better. A cynical employee said patients weren’t the problem, but rather hospital executives tired of hearing employees complain that the computer system is a “right cow” to use.

Here’s another example, along with bathroom scales in the homes of obese people, that having health data is not the same as using it: McDonald’s admirably posts calorie counts for every menu item and offers low-calorie choices like salads, apple slices, yogurt parfaits, and bottled water, but nobody buys the healthy items – they’re lining up for 600-calorie milkshakes masquerading as coffee and the 1,200-calorie feed trough known as the Big Breakfast. It would be interesting to calculate the annual death toll from both kinds of malnutrition – over and under.

Weird News Andy declares this story to be “efficient drug operation.” Federal agents arrest two employees of the Bronx VA hospital for using its mailroom to receive packages of cocaine mailed from Puerto Rico.

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.

Readers Write: The Engaged Patient – Are They Really?

The Engaged Patient – Are They Really?
By Helen Figge

Sorry to be the bearer of mediocre news, but despite the growing conversations around the value of engaging patients in their own healthcare, the term “patient engagement” is a really cute flavor of the month healthcare buzz phrase.

Many seem to be confused by what “patient engagement” means. It lacks a standardized approach to its interventional aspects or for a better sense rules of engagement.

The major thrust for patient engagement legitimacy comes in most part to the expansion of health insurers rewarding providers based on services that support the improvement of a patient’s health and wellbeing. Likewise, the anticipation that engaging the patient will reduce the utilization of healthcare resources plays into this concept. Finally, healthcare providers were vocal concerning the 10 percent patient engagement threshold originally mandated in Stage 2 of Meaningful Use and these “squeaky wheels” enabled a pushback to 5 percent.

The legitimacy behind engaging the patient appears evident because investing in the healthcare consumer who utilizes our healthcare resources (you and me) and turn creating healthier assets is the overarching goal of better health. This in turn fundamentally assumes we lower costs of healthcare. So, from this point of view, “investing” in consumers of healthcare and helping them to be more effective partners in our own care makes good sense practical sense, right? 

One would think and hope so. Based on several research sources, it is indeed possible to meet the requirements to support these patient initiatives through various technologies on the market today, like the patient portal, yet only a small percentage of providers are currently supporting these efforts.

The basic question is how do we engage patients to want to stay in control of their own health’s trajectory? What motivates and stimulates and excites someone to want to get and keep control of his or her own health destiny?

This is the one question gone awry, because the majority of consumers consistently participating in their health is quite low, with the majority of less than 5 percent consistently engaged if at all in their healthcare. Many practitioners are finding out that each and every one of us is motivated by something different when it comes to our own healthcare.

My dad was a great example of a non-compliant chronic disease sufferer who, when he felt better stopped taking his meds. Only when his blood glucose reading recordings were hooked up to his senior citizen daily calendar for dating (he was 87) did he remember to record his blood sugar readings for his care coordinator. One could say my dad’s health was directly stimulated by his desire to see which eligible senior citizen lady friend was going to the senior center that night for bingo.

In order for any patient engagement opportunity to be successful, each and every engagement might have to be customizable with each step in the care process to create a meaningful role for patients and their families and specifically tailored in such a way that helps patients acquire the knowledge and skills they need to effectively manage their health and do so in a consistent manner.

We also need to realize that some patients are not prepared to take on any type of role in their healthcare and might not be able to cope with their various illnesses regardless of the enticement. This is oftentimes a concern with those suffering from chronic diseases, where they will need to engage for the duration of their lives to keep and maintain their health.

I equate this type of patient engagement to eating your favorite food every day until after a while, boredom sets in. Your favorite food loses its luster. You just stop eating it and substitute another. When patients are unable to manage these types of often complex tasks, the result is less control over a person’s health and well being and ultimately higher health care and human costs.

If patient engagement has a chance to really hit the numbers we hope it will, it is important to tailor the care and instructions a patient has to support that care. In healthcare, we tend to provide the same amount of support regardless of the patient population or skill set at hand. We always try to standardize approaches, which 99 percent of the time is great, but patient engagement is that 1 percent where it just can’t be done. This is the reason for the low numbers in patient engagement we are seeing firsthand today. Each patient needs to be motivated in his or her own way to accomplish the empowerment needed for successful personal intervention.

Finally, another point to consider in all of this when trying to motivate a patient to “engage” in their own care is that it cannot be monetarily based. Patients are not motivated by financial incentives direct or otherwise for long-term behavior change. It is documented that highly engaged patients with the skills and knowledge respond better to the monetary gains of engaging in their healthcare, while some less than enthusiastic patients accept defeat much easier and accept their disease states and the sequelae of them regardless of intervention and assume it is what it is and thus accept any increased cost incurred by the disease state to be inevitable.

So when considering patient engagement, consider the patient first and foremost because patient engagement is based on the patient’s active and sustained participation in managing their health. It is a marathon race, not a sprint. Only through this mechanism will this lead to better health outcomes.

Proactive action to change and maintain our health into productive health behaviors is the mainstay of the effort. At its center is the concept of taking an active role in our own health and healthcare. We know objectively it can be measured using various tools like the Patient Activation Measure (PAM). This testing helps to identify a patient’s engagement level and used as a tool for improving activation for health and wellness, although I’m not sure how helpful it is right now given the lower-than-expected statistics of patient engagement overall.

The evidence suggests that increasing a patient’s engagement in their own health trajectory can have an impact on controlling costs and helping patients to become healthier – to live longer with fewer complications. The problem is that no one has come up with a standardized approach as to how to engage a patient for long-term success to any disease resolution. 

Maybe we need to interview each patient and see what drives him or her to wake up each morning. For my 87-year-old dad, it was trying to find a date for bingo night at the senior citizen center. Only after he answered his blood glucose reading did the senior citizen screen pop up. Maybe we need to do something like this for each and every patient. 

Helen Figge, PharmD, MBA is VP of clinical integrations of Alere Accountable Care Solutions.